This Pandemic Will Not Be the Last
We must accept that the current pandemic will not be the last. The epidemic crisis is an obvious threat, but it is also an opportunity and a valuable lesson we must all carefully study. This lesson shows that underestimating the functions and true managerial competencies, whether in normal or crisis situations, can have dramatic consequences.
Pandemics have been rare occurrences so far. This is why the behavior of not only ordinary people but also specialists and experts during the current pandemic crisis is so ambiguous, sometimes even contrary to common sense, and occasionally harmful.
Asian countries seem to be managing the current pandemic best. The Southeast Asian region has experienced more frequent epidemics in this century, such as SARS I and more dangerous strains of influenza. As a result, decision-makers in this region have already gained experience in managing epidemic threats. Now, it’s our turn.
One of the key goals of management during an epidemic crisis is to ensure the continuity of the state, the economy, businesses, and healthcare. Healthcare is part of the so-called critical infrastructure, which includes interconnected systems and industries on which the security of the state and its citizens depends. The collapse of one element of critical infrastructure causes a crisis in the entire system.
During the current crisis, we have been and still are witnessing efforts to save healthcare to ensure citizens’ health security. However, this has come at the cost of the economy and social life of citizens, and, as it turns out, at the cost of citizens’ health. A report by the Polish Economic Institute from November 12 shows that between August 6 and October 28, 2020, Poland observed excess mortality not attributable to the official number of COVID-19 deaths, indicating neglect in the treatment of other diseases.
The answer to why this is happening is complex and multifaceted. One controllable – and therefore improvable – aspect is the management of the state’s infrastructure, including the healthcare system. While funding for healthcare can be debated, as it is everywhere globally, it is also an open secret that public healthcare is one of the most neglected areas of state management.
The COVID-19 Crisis and the Healthcare Crisis
Management and medicine are separate fields of science for a reason. Both fields are highly specialized, and their practice requires combining solid, scientifically developed knowledge with experience and the intuition derived from it. The long-standing neglect of good management practices in many non-commercial state functions, including healthcare, has led to the situation we currently observe, which cannot be explained solely by the pandemic crisis and underfunding of the healthcare sector.
It is high time to draw conclusions from the nomination processes for managerial positions in healthcare. A long clinical and academic track record in medicine does not make one a manager. One cannot be a manager on a “half-time” basis. In such cases, a doctor-manager is forced to allocate very limited time to operational management and strategic thinking. Often, the priority – and rightly so – is given to patients requiring care. Combining the perspectives of a doctor and a manager in one person is also very demanding and highly stressful.
An important and often underestimated benefit of separating managerial functions from medical functions and entrusting the former to non-practicing doctors is the humility presented by a non-specialist manager. This manager is compelled to seek information supporting their decisions and, due to their limited medical knowledge, typically looks for many diverse sources, leading to better systemic decisions that meet the needs of all stakeholders, including patients and their families, healthcare staff, the state budget, and society as a whole.
In this context, entrusting the Ministry of Health to an economist, a specialist in financial management, and strategic management rather than a doctor seems like a good decision. Observing his actions and decisions, we can see the behavior of a seasoned manager, making decisions efficiently in a crisis. The emphasis he places on the flow of information between hospitals and the pandemic management center, the coordination of available medical resources, and the establishment of a medical advisory body consisting of various specialists with often different and critical views on the government’s actions is appropriate managerial action fitting within the canon of crisis management.
Managing the Pandemic
Leadership during a pandemic requires political and organizational decision-makers to make firm and swift decisions, even at the risk of making mistakes. However, there must be absolute consistency in decision-making and communication throughout the crisis team.
In a crisis, especially one caused by a previously unknown threat, making mistakes is inevitable. More important than the mistakes themselves is how quickly they are corrected. Decision-makers make decisions based on the data available to them. The quality of these decisions will depend on the adequacy, timeliness, and completeness of the data. Their interpretation will depend on the uniqueness of the crisis situation. Therefore, it is crucial to have very good information support for decisions, diversity of sources, and interpretative approaches. Simultaneously, the ability to connect facts, reconcile conflicting interests, handle limited resources, and courage in decision-making are key.
A leader does not expect everyone to see and understand the crisis in the same way. The crisis must be continuously redefined in light of new knowledge and consistently communicated to all stakeholders. It should not be assumed a priori that lower-level decision-makers have the same level of understanding of the crisis situation, knowledge, and skills to take necessary actions. Not only may their experience, skills, and crisis management capabilities be insufficient, but psychological paralysis may also play a role.
The behavior of decision-makers and experts, even experienced ones, seems to reflect to some extent the classic trauma response pattern described by the well-known American psychologist Elizabeth Kübler-Ross. Chaotic reactions or complete inaction resembling decision paralysis were observed in both the entire healthcare system and political decision-making circles. These reactions to the evolving pandemic seemed to express disbelief and denial that the pandemic was actually happening and affecting us directly.
In such situations, we see people looking to others, waiting for someone else to take responsibility, or engaging in magical thinking, believing that the crisis might somehow bypass them. In this context, crisis management principles resemble a medical procedure for saving a critically ill patient who has lost the will to live.
Every doctor who has survived several tough shifts in the emergency room understands the crisis and can act effectively within their trained specialty. However, managing a patient’s health is different from managing complex organizations and distributed structures, considering various areas of responsibility and power, extremely complex logistical problems, and many often contradictory information sources – which are the only available decision support. This situation requires making firm but implementable strategic and systemic decisions, fully aware of limited resources and time pressure. This is precisely our world – the world of management specialists and professional managers.
What Next?
Managing a pandemic requires centralizing the decision-making center in a military-like manner, trusting the leader. A leader-manager, equipped with all necessary powers and authorizations to enforce decisions, can act effectively and efficiently. This action does not leave lower-level decision-makers and managers alone with decisions beyond their competencies and often beyond their effective influence. Precise guidelines and orders are necessary, along with binding information on how to allocate scarce financial, human, and technical resources and when and to what extent they can expect support.
In a crisis, time and information are precious. Ensuring a quick data flow necessary for making accurate decisions determines whether a decision will be effective. A decision made too late may no longer matter and may even cause harm. Additionally, communication is crucial. Consistent, coherent, and credible communication will be an effective tool for gaining public support for actions.
The effectiveness of crisis actions is attributed not only to the proper use of schemes and tools appropriate to the situation. The fundamental role in crisis management is played by the leader, who, besides knowing the action schemes, possesses the ability to implement them effectively. Such leaders understand the role of the human factor in crisis situations, are authentic and credible, and can build social trust and authority. Crisis management is also an opportunity to go beyond the scheme of limiting the crisis’s effects. A proactive leader will use the shock associated with the crisis to return to the roots and values from which their organization has strayed or boldly break from the “old” policy and make a fresh start, restoring hope and faith in the sense of the struggle.
A leader does not fear “better than themselves,” surrounds themselves with specialists, ensures access to various viewpoints and opinions, seeking the most effective path in a given situation. They centralize decision-making competencies within a tight decision-making team, consisting of representatives of the most critical functional areas for managing the crisis situation, such as social communication, data science, human resources, procurement and logistics, and in the case of an epidemic crisis, epidemiology, diagnostics, and treatment. A crisis leader should also have enough authority to subject the entire organization, enterprise, or in the case of a state, government and administrative structures at central and local levels, to crisis management while simultaneously implementing systems that prevent prolonged decision-making centralization after achieving clearly defined milestones.
Communication in crisis management requires strictly adhering to the principle of one source – one message. Therefore, during a crisis, the crisis management leader controls the information flow in all communication channels, deciding within the tight steering team about their scope and content, considering the benefits and potential risks of disseminating or withholding specific information. In most cases, informational openness brings the best results.
It is good that the government crisis center includes ministers representing key areas of state functioning most affected by the pandemic, including ministers responsible for health, education, internal affairs and administration, and development. Synchronizing these areas is essential for anticipating the consequences of decisions. It’s a pity that the heads of the aforementioned areas so rarely participate together in press conferences to strengthen public belief in the close cooperation of critical state functions.
The Achilles’ heel of many crisis management efforts, especially
in administration and public services, is the lack of sufficient awareness of the differences between two key roles played by specific individuals – the role responsible for the outcome (accountable) and the role responsible for the task leading to the outcome (responsible). However, this weakness can be quickly overcome using the well-known crisis and agile management mechanism of short reporting periods (e.g., daily) concerning precisely defined tasks and performance monitoring indicators. Thanks to the development and dissemination of IT technologies, this approach is no longer a significant burden for implementers, can be quickly implemented, and largely functions automatically.
COVID-19 will pass, but whether the problems in the healthcare system will end depends not on how effectively we combat it but on bold and strategic decisions that, building on the opportunity the pandemic has given us, will allow for a civilizational leap in healthcare.
Observing the efforts to fight the epidemic crisis in Poland, we can see a clear light at the end of the tunnel, but remember that there is still a long way to go to exit the tunnel.
Photo:
Technology photo created by master1305 – www.freepik.com
