During a crisis, healthcare leaders need to find ways to carve out time to think through complex problems and model that behavior for colleagues.
Editor's note: This article appears in the September/October 2022 edition of HealthLeaders magazine.
Healthcare leaders need to have honed skills and abilities to guide their organizations during a crisis, an expert at Mayo Clinic says.
Richard Winters, MD, MBA, is director of leadership development at Mayo Clinic Care Network and a practicing emergency physician. He is an executive coach and the author of a new book, You're the Leader. Now What? Leadership Lessons from Mayo Clinic.
HealthLeaders talked with Winters recently in a conversation that included how healthcare leaders should work with colleagues during a crisis, delegating decision-making during a crisis, and being realistic during a crisis. The following transcript of the conversation has been edited for brevity and clarity.
HealthLeaders: How can a leader liberate colleagues' time for deliberate focus so that they can adapt to a crisis and triage what is most important to address?
Richard Winters: First of all, it means that there is an understanding that it takes time to process and think through complex problems. As you are meeting with groups of colleagues, it starts out with whether people are just making decisions or are they thinking about the decisions that they are making. Even as we are structuring meetings and group decision-making, are we allotting time for individuals to process what is occurring, to understand different perspectives, then to make decisions? Generally, that tends not to be the case. Generally in a crisis, a few people who are opinionated speak up and a decision is made, with those who did not speak up not being able to reflect or not feeling safe to evolve their thinking.
Leaders need to role model taking the time to consider complex, thorny issues.
Leaders can also block out time. They need to understand that they are there to act but also to gain perspective. I use the metaphor of the balcony and the dance floor. Leaders need to get off the dance floor and get up to the balcony, then gain perspectives on what they might do about a situation before they react, so they can act with deliberate intent. That means as leaders are scheduling meetings and putting things on their schedule, they are leaving some space to take time for deep thinking. That can be role modeled by senior leaders so others can feel free to move deliberately.
HL: How can you use your leadership team to clarify perspectives as well as align thinking and actions?
Winters: The thing that is great about Mayo Clinic is triad leadership. You have a physician leader, a nursing leader, and an administrative leader who work together to run the departments and divisions. With triad leadership, each individual has a perspective that the others may not have. The nurse has a different perspective than the administrator and the physician. If you just have a physician alone looking at a difficult issue, they proceed forward with their own perspective, which includes their blind spots.
With triad leadership, you have multiple perspectives that help address blind spots. You can see different ways to move forward and different possibilities. You can benefit from multiple perspectives.
HL: What about aligning thinking and actions?
Winters: Aligning thinking and actions means understanding the thinking at play. You are not aligning individuals with your thinking and blind spots. You are aligning thinking by understanding the perspectives that are within the environment in which you are making decisions. To align thinking, we must first understand the perspectives of others and bring them together. Within those perspectives, you will find disagreements, but those thoughts represent a range of understanding. By understanding the disagreements and agreements and what individuals see as the opportunities and the threats, then you can start to think about the options.
First, you develop a shared reality and shared perspectives, then you develop options for what you might do given the shared reality and perspectives. From there, you can move forward. So, first you are understanding perspectives and aligning perspectives, then you are choosing the options for how you can move forward.
HL: How can a leader delegate decision-making to experts in a crisis?
Winters: As leaders step up—as a cardiologist becomes a leader or an emergency physician becomes a leader—we have our expertise but there are things that we do not know. Leadership requires other individuals who have a broader knowledge or understanding to make sense of specific areas. So, it makes sense to delegate decisions to individuals who have the necessary areas of expertise.
For example, when the coronavirus pandemic started, we did not know anything about the virus. We did not know what was going to happen. We did not know the morbidity and mortality associated with the virus. But the CEOs needed to make decisions, and they did not have the benefit of bringing together task forces and having committees over several months. They had to make difficult decisions. So, some decisions were delegated to the infectious disease specialists, who certainly knew more about virus transmission.
HL: Why is it important for a leader to be open, humble, and realistic during a crisis?
Winters: During a crisis, there are many unknowns. You are in a world of unknowns. If a leader is operating without an openness to the unknown, they are at a disadvantage.
During a crisis, there may be a sense that we make decisions and if a decision works out, then it was a good decision. If it doesn't work out, then it was a bad decision. However, that is not the correct way to make decisions in times of crisis. The best way to make decisions in times of crisis is to acknowledge that the leader has some expertise, the leader sees the situation, the leader senses what is occurring, then the leader simulates in their mind what might happen if different options are pursued. The leader makes decisions to poke at the crisis and see how the situation responds. It is not about failing in a decision. The leader makes decisions of discovery.
So, being open and humble about what might occur is essential. You need to be open to how the situation responds and the new data that arises. You need to be open about what information the leadership team can come together around to make better decisions as we move forward and continue to understand the situation. A leader needs to be humble because they may make a decision that does not generate the desired effect.
HL: Why is being realistic important?
Winters: There are constraints that we all face. There are limitations. We do not have infinite budgets. We have groups of individuals who have different perspectives. There are politics. There are regulations. Within these sorts of constraints, we need to be understanding and realistic about them. We need to face them head-on. We need to make decisions based on realistic constraints about where we do have efficacy and where we can affect change.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Mayo Clinic uses triad leadership—running departments with a physician leader, a nursing leader, and an administrative leader—to limit leadership blind spots.
In a crisis, it is often necessary to delegate decision-making to individuals who have expertise that a healthcare leader does not possess.
In a crisis there are many unknowns, and a healthcare leader who functions without openness is at a disadvantage.