Finding Resilience In The Throes Of Crisis: The Physician Leaders’ Response

The presence of COVID-19 has thrust physician leaders into a new and uncertain environment. While their mission — the noble cause of maximal patient care — has not changed, the context within which they operate may now appear as a mesh of statistical probabilities and mixed messages. Each day brings new evidence and complicating twists and turns.

Against this backdrop, the centrality of physician leadership has never been more prominent; nor has it been more critical. Physician leaders carry the mantle of our most pressing need: the educated confluence of research, science, and point-of-contact practice. Understandably, their insights and their voices must help guide the emerging strategies of their respective organizations.

Behaviorally, physician leaders understand what patients, staff, and our broader communities are experiencing. Uncertainty leads to fear and disillusionment. And as fear extends its angry tentacles, nearly everyone is struggling to gain a sense of control, a sense that must be drawn from a logical application of the best available evidence.

That being said, what do physician leaders do? How do they become stronger leaders, navigators, and influencers? How do they help offer a sense of what’s going on and what’s needed? How do they offer a path of resiliency?

During this period of foundational searching, let’s consider some key perspectives on understanding and leading through periods of crisis. Here, the seminal work of organizational and social psychologist Karl Weick is appropriate, and we draw liberally from his conceptual framework.(1)

With liberties, Weick and his colleagues would describe our current experience as a “cosmology episode.”(2) During these episodes, people experience confusion as their sense of rationality, structure, and accepted practice collapses and no longer makes sense. Expressively, Weick notes that we feel vu jade (as opposed to déjà vu). “We have never been here before” and are uncertain of where or to whom to turn. The situation is further clouded and compounded by dissonant rhetoric and mixed messages. Our situations can appear to be both ambiguous and insurmountable.

Amid the throes of impending disaster, physician leaders are being asked to become our best “sensemakers” — somehow drawing logic and direction. Such sensemaking emerges dynamically and incrementally. But, how?

A Model of Response

On all sides — patients, staff, fellow physicians, and healthcare administrators — there exists a need for physician leaders to be sources of accuracy, armed with research and evidence from which strategies of progress can be proposed. These constituencies seek and expect decisiveness over equivocation. Empathy is important. Inspirational surges of hope offer brief emotional relief. But physician leaders represent our “collective best hope” for creating a meaningful path of resiliency, decisiveness, and action.

Weick offers insight and help by outlining four sources of movement — four sources of resiliency: (1) bricolage; (2) virtual role systems; (3) the attitude of wisdom; and (4) respectful interaction. Let’s examine each of these.

Bricolage

The first source of resiliency is through “bricolage,” a word of French origin that refers to the capacity to “create order out of whatever materials (are) at hand.”(3) This image smacks of creativity and, importantly, the capacity to provide creativity against the demons of persisting uncertainty and damning pressure.

Bricolage does not come easily. The reality of crisis and its ensuing panic ensures that we resort to past behaviors — what has always worked. Of course, when faced with a cosmology episode, normal behaviors are decidedly insufficient. Past practices and strategies no longer work, or at least not as desired or as expected. Here, adaptation is paramount. Ideal approaches, with an accompanying full array of resources, will not occur.

Applied in many contexts, the concept of bricolage pushes us to improvise and ply the best resources available to find a way to secure a positive new reality where time is our most essential and our most fleeting resource.

We see clear examples of bricolage during the current pandemic. Social distancing initiatives have ushered in a surge in telehealth. Limited PPEs, such as masks, have led to innovative thoughts about alternative methods of production and use. Examples of bricolage permeate our landscape. Instead of allowing our resource limitations to impede our progress, we use the resources we have (no matter how limited) in new and alternative ways to execute progress-focused action.

Virtual Role Systems

The second source comes from “virtual role systems.” Each of us has a virtual role system — our mental picture of what roles need to be fulfilled in order for us to succeed in our mission. During crises, elements of that system may collapse while others need to be reconstituted.

Not only are established and ingrained roles shifting and changing, but also the importance and centrality of new roles are also in flux. Epidemiologists, community health experts, and those with backgrounds and demonstrated experience in telehealth are now thrust into positions of enhanced significance. Scheduling, an important but at times underappreciated role, becomes increasingly critical. Avenues and roles that provide an approach for virtual triage gain significance. And critically, essential roles for establishing and carrying out meaningful testing protocols are suddenly of primary concern.

Leaders are being asked to determine what roles need to be filled and who is best to fill them right now. And, with a nod to bricolage, some of the “fits” may not be ideal. Physician leaders must help build and inculcate this new role system to enable their organizations to operate. Within such a virtual role system, leaders help others conceptualize not only the presence of key roles, but also how they interconnect to move us ahead in the best manner available.

Having a virtual role system — an understanding of the various roles that must be performed and having a mental picture or understanding of who is playing each of those roles — is part of the path to resilience. To be resilient in times of crisis — when others are unable to fill their roles for various reasons — resilient leaders recognize that all roles must be filled. Even if someone vacates their role, someone must step up and perform that role. Our flexibility to step out of assigned roles and to step into roles that need assistance becomes paramount to surviving chaotic situations.

Attitude of Wisdom

The third structure may be one of the most critical for our current situation: the “attitude of wisdom.” In simplest terms, the attitude of wisdom asks physician leaders to consider how they will proactively adapt if the situation changes again, as it inevitably will. As we learn more, new and expanded avenues are opened. Weick reminds us that as we learn more about the current situation and its dynamics, the number of uncertainties, complexities, and confusions are likely to increase. His words are dramatic: “In a fluid world, wise people know that they don’t fully understand what is happening now because they have never seen precisely this event before.”(4) Our patterned assurances need to be tempered. We must remain receptive learners — open and adaptive.

In addition, we must remain agile in our planning, for it is impossible to plan for the unknown. Resilient leaders accept that unknown changes and even periods of chaos will occur again in the future. It is a key dilemma. Leaders must think proactively about how to overcome future changes in the landscape, while accepting that one can never truly plan for what exactly will happen.

Respectful Interaction

The fourth structure is one of “respectful interaction.” Here, leaders are called upon to be open to the perceptions and responses of others, even as they veer from our re-established sensemaking. Trust and honesty are paramount. One must be receptive to other experts — our allies in action — and the credibility that they convey.

Here, physician leaders must confront the restrictive parameters of their own biases and raise the banner of collective wisdom while eschewing the easy dismissal of others’ divergent views. In short, they must be open to influence. And of course, these influential capacities may come from varied and even unexpected sources.

At least two factors seem important within this context.

First, we must allow our colleagues to risk sharing their perceptions of reality and their strategies for action. We must accept a willingness to be vulnerable. And those expressions of vulnerability must never be held against those bold enough to risk novel perspectives.

Second, we must look beyond ourselves for other towers of wisdom. The mantra of “not invented here” should be shunned. This is a time for competing hospitals and even competitive healthcare systems to combine their knowledge and resources in respectful interaction, geared to expand our realm of collective wisdom.

A Summary Context

Today’s crisis demands risk-taking and an attitude of resilience. Indeed, one of our more pressing challenges is to refrain from an understandable desire to return to normal. Lessons have been learned; critical needs have surfaced; systems have been realigned and restructured; new and important roles have emerged; and existing roles have assumed greater significance and mission centrality.

Physician leaders, using the elements noted in this brief article and armed with a strong attitude of wisdom, must be the creative levers of coping, resilience, and forward-leaning advancements. This period of challenge will reveal those physicians who are truly creative and resilient leaders, embracing change and helping patients, staffs, and organizations embrace a more enlightened future.

References

1. Weick KE. The Collapse of Sensemaking in Organizations: The Mann
   Gulch Disaster. Administrative Science Quarterly. 1993;38:628–52
   (0001-8392/93/3804-0628).

2. Ibid., p. 633.

3. Ibid., p. 637.

4. Ibid., p. 639.

Jason S. Stoner and Charles R. Stoner are the authors of Inspired Physician Leadership, published by the American Association for Physician Leadership. https://shop.physicianleaders.org/collections/all/products/inspired-physician-leadership-creating-influence-and-impact