COVID-19: System leadership in a crisis

We tend to think about system leadership in the context of integrated place-based care and as part of collaborative multi-agency efforts to improve population outcomes, rather than as a leadership approach in a crisis. Yet during the global response to the Covid-19 pandemic I’ve witnessed many of the system leadership behaviours described in Welbourne and Fathers model that lead me to think that, in a situation of this complexity and scale, crisis and system leadership can operate hand-in-hand.

Welbourne and Fathers describe three key behaviours related to system leadership:

Courage: Most senior leaders have some training in emergency preparedness, but training and simulations of pandemic responses may not adequately equip leaders to face the true system challenge of  Covid-19. Its fast moving, poorly understood and its repercussions simultaneously affected human and structural elements of society (banking, transport, supply chains, procurement etc). During the crisis period, there was only so much that could be directly controlled, and we relied on the willingness to embrace uncertainty and trust people to respond to the Government’s call to ‘Stay at Home, Protect the NHS, Save Lives’.

Leaders have demonstrated trust and a willingness to distribute leadership and find alternative solutions. For example, asking communities to convene and support one another, particularly vulnerable and shielded people; in foregoing normal procurement methods by sourcing ventilators from suppliers such as Dyson and BAE Systems; and in reliance upon charities and volunteers to self-organise and provide PPE such as Salford’s visor production collaboration between the hospital and local volunteers.

Curiosity: Leading a system when many elements were unknown required a questioning and enquiring mindset. Having recognised the earliest cases of Covid-19, China quickly shared the gene sequencing data which led to collaborations across the international scientific community to better understand the virus, and to experiments in testing and vaccine production. In hospitals, clinicians demonstrated deep curiosity in seeking alternatives to mechanical ventilation for Covid-19 patients. They scanned the international literature, connected with colleagues in countries further ahead in pandemic than the UK, and generated ideas for alternative treatment. With the courage to test and implement something new far faster than in normal times, innovations such as Warrington and Halton’s Hospitals ‘black box’ CPAP model were introduced.

Clarity: A key public act of system leaders is the messaging, communication and, in the case of Covid-19, the clear instructions for citizens and institutions. Jacinda Ardern, Prime Minster of New Zealand, has been lauded for her leadership of the country in both the 2019 terrorist shootings and in her clear and compassionate announcement of a Covid-19 alert system and a request ‘Please be strong, be kind, and unite against Covid-19’.

This uniting voice is a common feature of system leaders, whilst they might not have the answer – and as discussed above, they may rely on others to find solutions – they catalyse people to act on a common problem, and inspire confidence that together people have the ability to achieve a common goal.  

Now, pause for a few minutes and reflect on the leadership examples around you.

• What do you see?
• How is system leadership evident in your local leaders, what’s working well?
• If you find yourself leading a system in a crisis in future, what learning will you take from COVID-19?

Elizabeth Bradbury
Director, AQuA