Leadership lessons from the pandemic of 2020
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“You never let a serious crisis go to waste. What I mean by that it’s an opportunity to do things you think you could not do before.”
– Rahm Emanuel
“There cannot be a crisis next week. My schedule is already full.”
– Henry Kissinger
As this goes to press, we are now approaching the first anniversary of the COVID-19 pandemic, which turned out to be the biggest mid-term leadership exam for every physician and lay leader working in ophthalmology.
The pass-fail rate on the “COVID-19 Leadership Test” has been depressingly low — but then, the exam was exceedingly tough, and it was sprung on all of us with little advance notice. Plus, not many eye care leaders are crisis management specialists. Given the relative business stability of eye care (with high patient demand in good times and bad), most leaders in this profession were never hardened by the kind of crises found in abundance outside of the comparatively genteel business of medicine.
Those doctors and administrators who have directed their practices well over the last year have done so by grasping (at least intuitively) the following 10 critical leadership dimensions. As a result, their people and patients are still confident and ready to take on whatever else COVID-19 is likely to impose on our profession. Meanwhile, their balance sheets are largely restored. Visit and surgical volumes are at or above 2019 baseline levels. And the entire staff cohort is better prepared for whatever challenges come around the corner next.
1. Doctor-administrator collaboration is key. Great leadership, as it turns out, has been the essential pandemic game-winning resource, not just capital access or working in a less affected rural market. But this has not, in our observation, been the result of a strong unitary leader — just the administrator acting on their own or the managing partner. In the least damaged, best recovered practices today, we have seen that the classic dyadic leadership model, long present in health care, has held the line against the pandemic. Like two parents, docs and managers have led their practices as a united front.
The most impressive practices we have seen are those in which there was a preexisting strong bond between administrator and managing partner. Together, they have secured all of the other resources needed to return to former patient volumes and cash flows. Together, they have rallied the staff to push through their fears and adapt to new patient care standards.
2. Think of others first. By the end of March 2020, we were fielding scores of calls a day. About half of the callers asked, “How can we keep our staff and patients safe?” The other half asked, “How can we make sure we get through the pandemic financially intact?” Fast forward 1 year later. Which practices are doing best today? You can probably guess — the practices led by doctors and managers whose first thoughts were to keep their staff and patients safe, which was, of course, the best way to keep the company safe, which in turn resulted in better financial performance. It is difficult, but in a crisis, it is not only important to rise about self-interest as a business owner, but it is more effective, in the end, to do so.
3. A crisis demands faster learning. If you are paying attention, the individual leadership lessons to be gained in a crisis are the same as in normal times — they just move faster, like an advanced placement course in college. Instead of one important insight a week (often gained by making a mistake), you get one or two new lessons a day. The cycle time from gathering facts to implementing policy speeds up. Decisions demand faster deliberation. The inevitable errors need to be revised (and gotten over) quicker.
4. Self-effacement and humility, not overconfidence, win the day. Only a few ophthalmologist clients, those with a prior background in epidemiology and public health, had a sense of what might be coming around the corner in March 2020. Everyone else, except the good guessers, got it wrong in one direction or another. And this was not just at the outset of the pandemic. It has been true all along the way. From the beginning, honest ophthalmologists and their administrators have said, “We are all new at this. Every day, we are going to get up and do the best we can based on our understanding of guidance from national and international health experts. I promise we will make mistakes. I promise we will keep changing protocols. I promise I will do my very best for you, for our patients and for our practice.” (Good words to tuck away for the next practice crisis.)
5. Keep tabs on what your people are feeling. The year 2020 was an emotional roller coaster. In some practices, it was mostly a thrilling, energizing, only somewhat scary ride. In other practices, less well-led ones, it was terrifying. How can you get a read on how the troops are doing? Ask them. Ask their department heads. Don’t just say, “How’s everyone doing this week?” Try to help people objectify a subjective feeling. Ask a question like, “On a 0 to 10 scale, how stressed are the staff this week in keeping up with the new protocols?” When they say back to you, “We’re at an 8 right now, pretty darned stressed,” ask them, “What could we do to take that stress level back down to a 5 or lower?”
6. Overcommunicate. With everything else on your plate in the last crisis (or the next crisis), it is easy to not get around to communicating where things stand. In the best practices, the administrator or managing partner, or both together, put out a daily or at least weekly email to all hands describing current events, praising continued efforts, and defining goals and expectations.
7. Harness diversity. Some practice owners interact with just their administrator and a few senior managers, who they select for their similarity to themselves. Smarter owners do not do this. They hire a wider diversity of management staff (age, gender, ethnicity and educationally diverse) and interact with a wide cross-section of staff when making important decisions. The value of this was obvious during the pandemic. With new directives coming from every angle, it was critically important to have the entire team sifting through the data and coming to a group consensus on the best policies of the week.
8. Persevere, even if you think you may be failing. As they say, “It’s lonely at the top.” Even if you are doing an astounding job in the midst of crisis, it is unlikely your people or your board are giving you much positive feedback. In the absence of overt praise, it is easy to assume that you are doing a poor job. Instead, if you are an administrator, ask your lead doctor and board directly for their feedback on how you are doing and what more you could accomplish.
9. Normal ophthalmic times are like a marathon. One foot in front of the other. A crisis like COVID-19 means we switch to playing dodgeball. Nimbleness and speed win the game. In the absence of a crisis, you might dawdle months making a small decision involving a $5,000 expenditure. When the pandemic hit, you made much larger decisions in a few hours. And, mostly, it worked. When they sound the “all-clear” bell and the pandemic is over, try to remember how decisive you were in the midst of crisis, and try to harness the same speedy reflexes even when you return to the daily, dull marathon.
10. See the large and small picture at the right times. Ophthalmologists are famously poor long-range planners, which is understandable. Forty or fifty times a day, they walk into a darkened room, gather facts, make a plan — and then erase their mind and tend to the next patient one room over. Fewer than 5% of private practices have a written long-range plan. And those that did had their plans blown to smithereens by the pandemic, at least temporarily. But as COVID-19 recedes, the season has returned to think about the big picture. Where do you want your practice to be in 5 or 10 years? What will be your service area? Scope of services? Provider mix? Growth rate? How will succession work when it is time for you to retire?
Did you pass your pandemic leadership test? Leadership lessons from COVID-19 will be remembered for the next generation by doctors and managers. Comparatively small urgencies (“Oh no! My favorite technician is quitting!”) will no longer seem so important or distressing. Big decisions will be easier to make. We will not sweat the small stuff so much anymore. And guess what? If COVID-19 has taught us anything, it is that by comparison almost everything is mostly small stuff.
Editor’s note: This month’s column is abstracted from Ophthalmic Leadership: A Practical Guide for Physicians, Administrators, and Teams, Second Edition, available now for purchase at healio.com/books.
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- John B. Pinto is the author of several books on ophthalmic practice management, including John Pinto’s Little Green Book of Ophthalmology: Strategies, Tips, and Pearls to Help You Grow and Manage a Practice of Distinction, UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance, and Career Satisfaction (with Corinne Wohl), Simple: The Inner Game of Ophthalmic Practice Success, and Ophthalmic Leadership: A Practical Guide for Physicians, Administrators, and Teams. Available now for purchase at slackbooks.com. Receive 20% off with promo code PINTO20.