A framework for inclusive crisis leadership in health care
Javeed Sukhera, MD, Lisa Richardson, MD, Jerry M. Maniate, MD, Ming-Ka Chan, MD
In a crisis, leadership is often driven by a sense of urgency. Leaders find themselves looking inward with a narrow focus and surrounding themselves with those who share similar values and ideas. We propose an empirically informed framework for maintaining inclusive leadership and creating an environment that fosters inclusion throughout a crisis situation. Its three components are rooted in constructive tensions that inclusive leaders can leverage to bring balance, predictability, and moderation to their teams and organization.
CITATION: Sukera J, Richardson L, Maniate JM, Chan MK. A framework for inclusive leadership in health care. Can J Physician Leadersh 2020;7(1):24-26.
Most leadership theory is built on predictability and moderation.1 Crisis leadership, on the other hand, is often driven by a sense of urgency and the need for a narrow focus. Times of crisis can unintentionally precipitate and perpetuate an exclusive approach to leadership. Policies are developed quickly. Timelines are tight. Urgency drives decisions. In these situations, we tend to look inward to our “known allies” and surround ourselves with those who share similar values and ideas. Crises pose a unique challenge to the formation of diverse teams, as problems with communication and shared understanding may result from differences in status and training, as well as professional norms.2Top
Consider the example of health care leaders who have always strived to be inclusive by avoiding tokenism and seeking meaningful input from patient/family partners while developing policy. Despite their best efforts, policy decisions made quickly during a crisis have alienated their patient/family partners and eroded trust. How can such leaders adapt their inclusive leadership to times of crisis? As a group of scholars who have been involved in equity, diversity, and inclusion in both principle and practice, we propose an empirically informed framework for inclusive leadership.
A framework for inclusive leadership
Our framework is designed to guide health care leaders in maintaining inclusiveness and creating an environment that fosters inclusion throughout a crisis situation. Each component of the framework is rooted in a constructive tension that inclusive leaders can leverage to bring balance, predictability, and moderation to their teams and organization. We identified three such tensions: fix versus feel, whole versus parts, and self versus other (Figure 1). Top
Constructive tension 1: fix versus feel
When encountering a crisis, many leaders are hard wired with an implicit impulse to fix things. This response is often accentuated or even sought out during a crisis. However, inclusive leadership requires stepping back from the urge to fix and being prepared to sit with complex emotions. Moments of crisis highlight that there are many problems outside a leader’s control that cannot be solved by simple fixes. Therefore, inclusive leaders can be role models by explicitly describing these moments for their team, encouraging others to share, and creating psychologically safe environments for others to experience and process heavy emotions. Top
Inclusive leaders should also recognize that others may cope with crises in diverse ways. There may be challenges that a leader has overcome, but with which their team members are still struggling. In these contexts, leaders are at risk of falling into the trap of toxic positivity. It can be profoundly invalidating for others to be told to have gratitude or be kind when they might be struggling to meet basic needs, in survival mode, or facing grief and loss. Sometimes, the greatest challenge for a leader is to step back and simply emphasize that they are present and truly listening and offer unconditional support. Crisis leadership is about having compassion and being able to take another’s perspective.
Constructive tension 2: whole versus parts
During a crisis, our threat response becomes activated and we tend to narrow in on specific details. It can be challenging to prevent our amygdala from overriding our brain and hindering our ability to step back to distinguish “the forest from the trees.” Narrow thinking can prevent diverse ideas from being considered. Inclusive leaders can engage in active reframing for their teams. For example, a crisis can be reframed from threat to opportunity, diversity from dangerous to driving excellence, and engagement from time to presence. Top
Leaders can create mechanisms to ensure dialogue around complex problems while considering a wide range of possible solutions and being mindful of unintended consequences. The use of online tools to solicit engagement with teams can be useful for rapid feedback. Inclusive leaders should ask themselves if they feel the need for such activities to be anonymized or not. If a team prefers anonymity, leaders might ponder whether they are truly creating the kind of psychological safety where diverse ideas can thrive. The actions of a leader directly influence whether people on their team are willing to speak up.3
Team leaders are often in a unique position of being able to see a crisis situation as a whole rather than in parts.4 Sometimes leaders have more access than other members of their team to information from those with more power and status in the organization. Inclusive leaders must find ways to bridge this divide of power and hierarchy by distributing power within their team, while not diminishing the agency and control of others. In doing so, these leaders often break down historical or organizational silos by drawing on expertise, resources, and perspectives not usually accessed to create innovative solutions. Top
Constructive tension 3: self versus other
Times of crisis may make it difficult for leaders to introspect and reflect on their own performance. Leaders may also amplify self-blame and self-doubt. During a crisis, inclusive leaders should model humility and empathy for others, as well as for themselves. During any crisis, all members of the team (including the leader) are sharing the experiences of suffering and distress because of the shared nature of the crisis situation.
Another challenge in the context of a crisis is that our ability to engage in empathic listening is constrained. To maintain a sense that leadership should be collaborative and distributed, listening is simply not enough. Some listening involves confirming what we already know, some requires presence and empathy;5 however, deep listening requires listening to what is not being said. It requires listening to the emerging story that has not yet been written.6
Although leadership theories emphasize the concepts of mentorship and followership, inclusive leadership requires allyship. Inclusive leaders recognize their own privilege and start their journey toward inclusion by looking in the mirror at themselves. Top
Leadership in crisis can feel like both a burden and a gift. Health care leaders are asked on a daily basis to demonstrate character and engage in critically, contextually aware judgements.7 By understanding the challenges that arise during times of crisis, we can also identify leadership strategies that build on inclusive principles. Inclusive leadership may provide us with some guidance on what steps we need to take individually and collectively with our teams, organizations, and community at large.
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2. Edmondson AC. Speaking up in the operating room: how team leaders promote learning in interdisciplinary action teams. J Manage Stud 2003 Sep;40(6):1419-52. https://doi.org/10.1111/1467-6486.00386
3. Edmondson AC. Learning from mistakes is easier said than done: group and organizational influences on the detection and correction of human error. J Appl Behav Sci 1996;32(1):5-32. https://doi.org/10.1177/0021886396321001
4. Wheelwright SC, Clark KB. Leading product development: the senior manager’s guide to creating and shaping the enterprise. New York: Free Press; 1995.
5. Scharmer CO. Theory U: learning from the future as it emerges. San Francisco: Berrett-Koehler; 2009.
Javeed Sukhera, MD, PhD, FRCPC, is an associate professor in the Departments of Psychiatry and Paediatrics, and scientist at the Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry.
Jerry Maniate, MD, Med, FRCPC, is vice president of education at the Ottawa Hospital and associate professor in the Department of Medicine, University of Ottawa.
Lisa Richardson, MD, MA, FRCPC, is vice-chair, Culture and Inclusion, and associate professor in the Department of Medicine. She is also strategic lead in indigenous health, Faculty of Medicine, University of Toronto.
Ming-Ka Chan, MD, MHPE, FRCPC, is co-director of the Office of Leadership Education, Rady Faculty of Health Services, and an associate professor in the Department of Pediatrics and Child Health, University of Manitoba.
Author attestation: Each author has been involved in both research and manuscript preparation, meeting the international criteria for authorship. All authors have approved the final article.