Looking Forward – July 2020

David B. Hoyt, MD, FACS

Times of crisis call for leadership. During the coronavirus disease 2019 (COVID-19) pandemic, surgeons and other health care professionals have demonstrated their extraordinary dedication to maintaining quality care. More recently, we have witnessed and responded to turmoil in the nation after the tragic death of an unarmed black man, George Floyd, while in the custody of Minneapolis, MN, police officers.

The American College of Surgeons (ACS) has provided resources and guidance to its members who have been battling COVID-19 on the frontlines. Much of this information was reported through a twice-weekly e-newsletter, Bulletin: ACS COVID-19 Updates. As the curve flattened in many areas of the nation in the middle of May, we moved to weekly publication of Bulletin Brief, an e-newsletter that highlights not only the College’s leadership in caring for patients who have been affected in some way by the pandemic, but also patients who had to reschedule a nonemergent operation.

The College also issued comments condemning racism and police brutality after the deaths of Mr. Floyd and Breonna Taylor, a 26-year-old African-American emergency medical technician in Louisville, KY. We stated:

The ACS stands in solidarity against racism, violence, and intolerance. Our mission is to serve all with skill and fidelity, and that extends beyond the operating room.

Racism, brutal attacks, and subsequent violence must end. We will help any injured, and we will use our voice in support of the health and safety of every person.

Furthermore, the ACS Committee on Ethics and the Board of Regents issued a call to action June 9, stating that racism is a public health crisis, resulting in health care inequities and asking all members of the organization to treat all patients, regardless of race, ethnicity, religion, or sexual preference with compassion, skill, and fidelity.

How to lead during a crisis

Sensing the direct involvement of the leader is reassuring. Being visible is possibly the most important thing a leader can do in a time of crisis.

Early on in the COVID-19 crisis in the U.S., I was in contact with Carlos A. Pellegrini, MD, FACS, FRCSEd(Hon), FRCS(Hon), FRCSI(Hon), Past-President of the ACS. He noted, “This is not leadership as usual—this is leadership on the edge,” and offered the following tenets for leaders in the difficult days ahead:

  • Be present. Crises engender anxiety and fear among all those affected. Sensing the direct involvement of the leader (by written communications, personal outreach to the members of the organization known to be more vulnerable, visibility through social networks, and so on) is reassuring. Being visible is possibly the most important thing a leader can do in a time of crisis.
  • Communicate frequently. The best way to avoid panic among those who are fearful and anxious is to hear from the leader frequently with updates on what is happening and what actions are being taken/considered to ameliorate the crisis.
  • Communicate thoroughly. Share with the group more rather than less. This situation calls for more talk, for storytelling, rather than “cold instructions.” Connecting with the constituency is more important than issuing dictates. Communications should explain clearly and concisely what is expected. The challenge for the leader is to strike the right balance, bearing in mind that constituents will remember when they heard their leader speak from the heart. This type of connection is how people build relationships.
  • Communicate truthfully. Most members of a team will have collected information from a range of sources and will have a pretty good idea of where the situation stands. Being truthful, even if that means providing information that may not be desired, is important. In as much as the leader remains credible, followers will respect him/her as a leader and do what they are asked to do. Err on the side of overinforming, recognizing that sometimes truly confidential information may need to be kept private. Because most people are terrible at keeping a secret, a leader should be the first one to provide the news. By being the first to communicate good and bad news, a leader ensures that accurate information is shared and is seen as the trusted source.
  • Exercise pragmatic optimism. Remain true to the facts and anchor the message in reality, but sound a note of optimism. Remind people that there is Leaders and their constituents feel comfortable following strategies that they have crafted. Crisis management, particularly in severe crisis, may require that we ignore elements of a strategic plan that up to that time have been guiding our actions.a “way out of the crisis,” and describe a future worth pursuing.

Leaders and their constituents feel comfortable following strategies that they have crafted. Crisis management, particularly in severe crisis, may require that we ignore elements of a strategic plan that up to that time have been guiding our actions.

  • Delegate and empower. Exercising authority at a time of crisis may help ensure that decisions contribute to solving problems, but it also can become obstructive, creating a bottleneck when all decisions and responsibilities go through one person. A good leader has chosen his or her associates well and must empower them. Trusted allies will support their leader and enable that individual to achieve much more than one can achieve alone.

    Of course, delegation and empowerment of other team members can have a downside. If other members of the team develop solutions and move ahead with a plan that is not aligned with the leader’s vision, the rest of the workforce will have unclear direction and receive mixed messages about their responsibilities and roles. Thus, constant communication with allies and the team is necessary and should emphasize gratitude for what they are doing and the need, while in crisis mode, to communicate their actions and intentions to the leader. In moments of crisis, most leaders want to be completely informed and to have a chance either to be the official conduit for communication or to have the opportunity to modulate the discussion, so the message matches their vision.

  • Generate support from the constituency. Buy-in from all individuals affected will hasten achievement of the goal. Consultation and engagement to the extent possible will contribute to feelings of ownership. A key element will be appealing to constituents’ shared values, the sense that they are involved in a worthy and just cause, and that the cause is aligned with the mission/vision of the organization. Crisis management requires identifying the “north star” and following it.
  • Manage the relationship with superiors and constituents. In times of crisis, a leader must show support for the decisions of the leadership of the entire organization and simultaneously listen to constituents and decide when and how to communicate upward their feelings. The more intense the crisis, the more difficult it will be to question the top officials’ decisions, and the leader may have to “sell” them to his or her constituency.
  • Define the magnitude of the crisis. Leaders and their constituents feel comfortable following strategies that they have helped to craft. Crisis management, particularly in severe crisis, may require that we ignore elements of a strategic plan that until that time have been guiding our actions (key performance indicators, finances, volume of patients seen, and so on). One should be very careful about declaring a “crisis” as such, but COVID-19 is unprecedented and will require that we concentrate on “navigating through these difficult storms” rather than following the path decided upon. During the management of a crisis, leaders must strike the balance between two different activities: those related to the management of the crisis and those associated with more routine business. It must be clear to the followers whether the leader’s actions are related to management of the crisis or conduct of business. The former will be associated with a more authoritarian style, whereas the latter lends itself to a more democratic style. Clarity regarding management mode will allow everyone to function effectively.
  • Be resilient (and patient). The anxiety and the fears that followers feel as a result of the crisis will frequently manifest as criticism of the actions the leader takes. The leader’s authority, judgment, and style may be questioned. Leaders must muster all the resilience possible to maintain inner calm, confidence, and the ability to take the high road. This is not a time to feel hurt, victimized, or to seek justice. This is a time to stand tall, acknowledge the criticism, and move forward without thoughts of retaliation. Taking the high road will inspire followers and provide support and an example to all.

I want to commend the College’s officials, members, and staff for taking the high road throughout the COVID-19 outbreak and the mostly peaceful protests this summer. You have repeatedly shown a commitment to doing what is best for the surgical patient. The long-term effects of these crises may linger for some time. I have every confidence that we will get through this period together because of your leadership.


If you have comments or suggestions about this or other issues, please send them to Dr. Hoyt at lookingforward@facs.org.

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