Leading a healthcare organization through accountability in crisis

The recent COVID-19 pandemic has caused significant disruption across the globe instituting major lockdowns and worldwide fear, prompting one of the worst unemployment and economic impacts in decades. With over 10 million positive global cases, causing several hundred thousand deaths through the pandemic has resulted in one of the worst distress of the century. Healthcare institutions around the world and in the United States suffered major disruptions throughout the crisis.

As the pandemic is ongoing at different rates across the globe, the leadership to counter this insurgency has been anything but analogous. It has probed the leadership and preparedness of most countries globally, including the most developed nations. In particular, the healthcare industry is challenged with the planning and preparation of an unknown crisis. Not only are they tasked to operate through the uncertainties, but also take care of the COVID 19 patients. Leading healthcare organizations during this pandemic are further challenged by the shortage of several essential supplies and managing through the unpredictable surge of the COVID 19 patients.

Accountability ladder is a Leadership tool often used in an organization to foster culture change and promote accountability across the organization. Several leadership gurus, including Senn-Delaney, have used this tool to develop leadership and promote responsibility. However, the primary purpose of this tool is to assess the state of accountability in an organization. It can be easily extended to the leadership of a city, county, state, or even a country.

Accountability is a reflection of the leadership and actions of its members. The Accountability Ladder steps define the behavior from "unaccountable-reactive" to "accountable – proactive." The steps climb from

1. unaware,

2. blame others,

3. excuses,

4. wait and hope,

5. acknowledge,

6. own it,

7. find solutions, and lastly,

8. get on with it.

Leaders from small to large organizations, local to the national level, have reacted differently while fighting against the pandemic. The actions of the leader are key to successful prevention and containment of the virus and often fall between the rungs of the accountability ladder.

The stage of Unaware: Though the initial cases of COVID 19 were detected in China around December of 2019, most of the other countries were unaware of the magnitude of the situation and mostly remained in denial.

The stage of Blame others: Once the virus started to spread, people and leaders from different countries started blaming others for the spread. President Trump accused China of not telling the world sooner about the pandemic. The Chinese officials blamed the U.S. Army for allegedly introducing the disease to China. Many blamed the World Health Organization for assisting China to hide the necessary information.

The stage of Excuses: "Nobody knew there'd be a pandemic or an epidemic of this proportion"- famously said by the President of the U.S. to justify the pandemic's limited preparedness. Still, his views were echoed by various leaders across the world with similar statements or actions. Excuses are often ways of not accepting the blame. It does not matter if there is any validity to the information within the excuse. "Not my job" and, "No one told me" are some of the most common reasons in the corporate industry, which is evident during the pandemic and continues to be one of the hindrances to working together as a team.

The stage of Wait and hope: In this stage, the leaders typically hope for miracles and expect results without putting in the effort to go out and get it done. This was very much visible for leaders across the world. Many believed that it would not affect their region and expected the virus to disappear like a 'miracle.' As the coronavirus cases rose in Brazil on March 17th, the news of the country's first death from COVID-19 made headlines. President Bolsonaro described it as just a "little flu" and said COVID-19 would not affect Brazilians because they possess superior immunity. Little to no measure was taken, and within weeks, the pandemic caused thousands of deaths.

The stage of Acknowledge: The leaders at this level have a distinct perspective of the situation, and they realize some tasks need to be taken care of as well as the fact that they have a responsibility to play their part. Once leaders acknowledged the virulence of the virus, they made subsequent plans to prevent it's spread. Different phases of lockdown were planned, and healthcare measures were also implemented.

The stage of Own it: Once a leader acknowledges the reality of the situation, they are empowered to climb up the ladder and take ownership of the problem, which is the key, and then choose to move forward by creating meaningful solutions.

The stage of Find solutions: During COVID-19, the leaders designed meticulous strategies to find solutions for timely testing and design plans to reduce the spread. Different phases of lockdowns were planned for prevention, and focus was given on future vaccinations and possible medications. Now that the leaders own the problem and are motivated to find solutions, they have put their solution in action across the continents. We are currently awaiting the goal of defeating the virus.

The stage of Get on with it: Once the solutions are found, the next steps are to operationalize it and make it happen. In this stage, there are often possibilities of slipping down the ladder and finding alternate solutions. As the leaders are looking for solutions to curb COVID-19, there could be multiple solutions. Some solutions may work, some may fail, and others will require tweaking. The goal needs to be to remain focused on the problem until it is resolved.

The lower levels of accountability ladder are often manifested by feelings of frustration, helplessness, and lack of power while the higher levels of the ladder demonstrate owning and finding solutions. During this global pandemic, leaders across the world display their maturity or the lack thereof while dealing with the solutions. They climbed up the ladder and slipped but still carried on. A true leader will understand the situation, own, and lead towards a long-term solution.

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