Frontline Leadership

Lessons from the Frontline

COVID 19 has shone a much-needed light on the importance of excellent frontline leadership to navigate organisations through the challenges posed during a pandemic. Many leadership teams that would have survived in the good times have fragmented in the COVID 19 battleground. 

Over the last 20 years at Haig Barrett, we’ve helped leadership teams drive cohesion and positive results in turbulent times. We recognise that at times like these, support from long drawn-out consultancy projects simply won’t cut the mustard as they don’t respond to the immediacy and urgency of action required. Leadership teams need a framework and supporting tool kit to get the right structure and strategy in place to enable results quickly.  

Haig Barrett has curated 3 of the best action-ready tool kits for executives available and will be running a frontline leadership series in support of their invaluable wisdom. The first in the series on frontline leadership comes from IncusER. IncusER is orchestrated by the collaboration of one of the most topical and current examples of frontline leadership, the Senior Emergency Consultant for the NHS, Pete Jaye and the client director for RADA Business, Liz Barber. 

Together they have pioneered an emergency response tool kit, taking frontline NHS experience and applying it to leadership through turbulent operating environments. Haig was invited to take part in one of the IncusER training sessions which was centred on a critically ill patient in ER and the response of all the team dealing with the situation.This involved quick decisions, constant communication and working together as a team. This high pressure simulated situation caused anxiety, stress and fatigue in a very short period of time. Following the training session, Liz and Peter give us a preview below of a few fundamental lessons learned from the core of the UK’s operating system for pandemic relief in a chat with Haig.

 

Haig: ‘Hi Liz and Peter, great to have you on the show. IncusER talks a lot about frontline leadership in a VUCA world. Could you give us insight into VUCA from a leadership perspective?’

Liz: Leading in the VUCA world is no more real than today.  And the lessons learned from our healthcare professionals, no more important than now.  Already in crisis management mode, what they face over the coming weeks is even more challenging: Volatile, Uncertain and Complex.  Ambiguous too, as the race is on to develop a vaccine. As the scientific advisors suggest, we are in the UK following a plan to flatten the curve of recorded positive cases – or as our PM, Boris Johnson describes “flattening the sombrero” –   in a bid not to overwhelm the ‘capacity limit’ of the NHS. The implications of this plan is we will see more positive cases over a longer period of time.  For the healthcare professionals this means even more gruelling times ahead, with long hours, over stretched resources and some really tough life and death decisions to make.

 

Haig: What should be the number 1 priority of frontline leaders?

Liz: Resourcing oneself is critical to safeguard against fatigue and burn out.  Not just at the prospect of this spreading out over months, but daily too. In every moment the heightening stress of the ever-increasing influx of cases and complex planning of resources means that managing stress is of chief importance.

Peter:  I work at one of the busiest A&E Departments in London and there seems to be a 

general feeling of anxiety. For me and my team, some of this is about gaining control.  There is so much about this situation that we have no control over, so understanding which bits I can control is helpful.  I can take care of myself physically and mentally. 

Taking physical exercise, eating and sleeping properly and preparing myself for the job at hand allows me endurance. Practising breathing techniques, both in the Emergency Room and when recouping at home are so important at managing my state and countering the stress”

“Naturally there are numerous worries about the situation for me and all of the team.  This could be about lack of equipment and resources, as well as anxiety about our own friends and family, and the fact we are exposed to the virus ourselves.  Allowing time to recognise our own state and taking steps to control our response in the moment ensures we can perform at our best.  

Haig: I completely agree with the importance of managing oneself. How does your personal response impact your team?

Peter: The fact is that this virus doesn’t discriminate. We are all affected.  Just observing the behaviour around stockpiling, it is clear that the panic is as infectious as the virus itself.  So recognising the challenges and emotional needs of his own team is critical for me. I can control my personal response, and I can have direct influence over the wellbeing of my colleagues. Leading by example and listening to their needs.”

Many of us are concerned about the ambiguity and lack of clarity of the departmental advice we are getting. People in my own team feel that in our position at the frontline in critical care we are perfect guinea pigs for new plans.  We are used to working long hours and managing uncertainty.  But no-one has ever experienced a situation like this.  I try to create some clarity and certainty, and as best I can,  model the behaviours for effective team work.  

Liz: to build on this, just recognition of the difficulty of this situation in a clinical setting can help.  Nothing compares to this emergency, so listening to people’s challenges, and talking about it, helps build trust and collaboration in Peter’s team.

Peter: To a great extent the dealing with this rests on the coming together.  We will all be pushed further than we would choose.

 

Haig: How important is strategic thinking in this scenario?

Liz: The pace of this pandemic is extraordinary.  It has made planning difficult and bigger picture thinking complex.  As the government reacts to the unfolding crisis, the healthcare workers are constantly having to adapt their strategies, and from centre to centre.  Operationally the strategic planning must be agile and flexible, and rely on gaining a real understanding of the situation, skills and resources of those that must deliver to the plan. For each hospital department, this will have a different implication.

Peter: To give some context to this, my time and I are treating the usual flow of A&E patients, as well as meeting the new challenges posed by the virus. Last Sunday, I was looking after a number of different patients  – some with Covid19 and otherwise, such as somatic disorders.  They need treatment without prejudice, whether or not they repeatedly appear in one evening with alcohol-related problems.  One patient who was being restrained by 5 people needed a plan to manage her pseudoseizures.  A group of specialists were called together to decide on treatment, and create a plan in consideration of a variety of factors.  Under pressure, the risk is jumping to a solution that manages just one of those factors,  but which may create wider issues. I always challenge myself with the question ‘are you looking after the patient?’ 

Liz: In such situations Peter must consider the risk benefit.  Every decision has a consequence – and it is key to consider the positive sum and negative sum of the plan. Weigh up the risk.  And in Peter’s world this must be done within minutes.  This is the typical challenge faced in A&E – and now with the added pressure of ‘cohorting’ coronavirus patients, the system by which they isolate suspected coronavirus cases.  

Peter: I have had a number of difficult conversations this week. Decisions made by other departments such as cohorting impacts hugely on our own systems and planning.  Especially when we are pressured to act immediately.  Each medic needs to put on personal protective equipment when treating suspected cases, and this takes time.  This has a knock-on effect to all the care we can provide to a whole department of patients over a shift.

To devolve plans successfully, you need to involve people, or devolve responsibility.  Recognise that when you are asking people to do things, there will be inherent challenges.  One of the key things I have learnt is that in any crisis, the plan never quite replicates the process.  We make plans in abstract – but then they completely change when rolled out on the shop floor.”

Liz: We need to recognise the skills of the people in the team that will activate the plan.  This moves the message from ‘this is what needs to be done’; to the question ‘and how are we going to make it happen?’ Without engaging your team, you run the risk of leading a workforce that is completely devoid of what you think or say.  Of course in crisis, there is no time to create that trust and relationship with your colleague, so any investment up front and in the longer term will pay dividends.  

Peter: “Right now, as a leader, I need to provide direction. But in this context, direction is about ‘how’.  Being visible, listening to staff and their needs, and showing vulnerability have been hugely valuable skills to draw on. “

Liz: In summary, this approach has provided a vital and durable framework for Pete and his team in coping with the pandemic and this VUCA environment we are in.  His leadership comes back to the three competencies: Managing self, Managing others and then being able to Manage the situation.