Many innate survival behaviours that served us well as cavemen work against us during the uncertainty created by the current crisis. Evolution wired us to be cautious about new situations and potential threats. However, that neurological wiring increases our distractibility, as continuing changes and the daily onslaught of COVID19-related information shift our attention frequently. Other evolutionary tendencies include both self-preservation and the need for social connectivity and empathy. Finally, our brains prefer the safety of the known and the certainty and predictability of ordered systems.
Unfortunately, the analytical mind set of experts and perfectionists, who thrive in the ordered world, is a liability in complex and chaotic systems and can jeopardize decision-making in the disordered world of a crisis. Three leadership styles can help to counteract our innate behavioural tendencies: agile, compassionate, and servant leadership.
Leadership agility is the ability to zoom out from a focus on the details of the expert into wide-angle mode to increase our awareness of context (Figure 1). Although attention to the detail in front of us that requires immediate action is important, zooming out allows us to see the bigger picture, the connections between the details. As physicians, we move quickly from one problem to the next, driven by the large number of patients and their needs. Or, as part of a group of physicians, we are involved in one aspect of a patient’s care, often without seeing the entire patient or the connections with the patient’s living conditions.
Our tendency toward perfectionism, so important in medical school, isn’t that useful in a time of crisis. Perfectionism keeps our surveillance in close up mode, and we jerk shakily from one detail to the next without seeing the big picture. While we focus the danger in front of us, we don’t see things in the periphery that might be threatening or might provide a solution to what is in front of us. This can happen easily during a crisis, with the deluge of real and false information and the excessive number of emails and meetings.
Shifting our focus from decisive action to the meta-view counteracts the chances of being constantly distracted while trying to handle everything with the mindset of a perfectionist. Attenuating distractibility and separating noise from the signal that is trying to emerge can be helped by inserting small pauses for reflection into the day. Asking ourselves what else is going on and re-imagining the future will deepen our ability to practise agility by shifting the focus of our zoom lens.
Before the pandemic, people might have viewed us as experts with knowledge in a certain domain and with successes to prove it. However, in a chaotic and fast-changing environment, past successes are irrelevant and previous approaches might be unusable. Yet, our personal insecurity and our fear of the unknown will make us cling to the world we knew, even if it no longer exists. We are tempted to hold onto our ego, to the image people have of us (looking to “the doctor” for answers and guidance).
In conditions of uncertainty and chaos, selflessness helps us serve the common good and the community by making us part of the cause and by turning passion into compassion. We need to see beyond ourselves, place the good of others first, and embrace health as a common good. The difference between ego-centric and servant leadership could not be more strikingly illustrated than the case of US president, Donald Trump, versus New Zealand’s prime minister, Jacinda Ardern, as well as some of our Canadian public health officers.
Letting go of the ego also means showing vulnerability by having the courage to acknowledge what we don’t know and to ask for collective wisdom. When those around us, team or community, see a balance between our selflessness and honesty, on one hand, and competence and confidence in what needs to be executed, on the other, psychological safety and trust will increase.
The traits of a compassionate leader and a servant leader overlap. The four elements of compassion are awareness, emotion, cognition, and action (Figure 2). We must become aware of a person’s pain or suffering, before understanding and an emotive response can follow. These three elements constitute empathy, which is the inner feeling and understanding we have of others’ suffering.
However, empathy without action doesn’t help anyone. We may express our feelings, but only by adding action and willingness to help and relieve the suffering of others do we turn compassion outward. In times of crisis, empathy alone might actually paralyze our decision-making. Imagine how little Mother Theresa would have accomplished if she had shown empathy for all the suffering without living up to her actionable vow of wholehearted free service to the poorest of the poor.
Compassion extends beyond empathy. Because compassion is empathy turned outward by action, it is motivating and energizing. Evidence also shows that compassionate leadership is an antidote to burnout. Pausing briefly and asking ourselves how we can be of benefit to this person or to that cause will help us move from empathy to compassion.
In summary, evolution has wired us to be distracted, to preserve our ego, and to engage in social interaction and empathy. This might work in the ordered, predictable world of experts and perfectionists, but it will disadvantage us in the uncertainty and volatility of a crisis. Leadership agility, compassionate and servant leadership will serve the common purpose during the current pandemic.
1.Joiner B & Josephs S. Leadership Agility. Jossey-Bass; San Francisco, CA. 2007.
2.Greenleaf R. Servant leadership. Paulist Press; New York/Mahwah, NJ. 2002.
3.West M, Eckert R, Collins B, Chowla R. Caring to change: How compassionate leadership can stimulate innovation in health care. King’s Fund, 2017. https://bit.ly/2YeegJx
Johny Van Aerde, MD, PhD, FRCPC, is editor-in-chief of the Canadian Journal of Physician Leadership and executive medical director of the Canadian Society of Physician Leaders.