Physician Leadership During COVID: 3 Things You Need To Know

by | Apr 2, 2020 | Physician Leadership

In coaching physician leaders over the past week, I heard about a variety of challenges on the front lines. A New York CMO deciding which department would get limited PPE supplies. A cardiac surgery director’s staff angry about being deployed to the ED. A palliative care department chief home sick with COVID herself. Difficult decisions, lack of resources, and the need to maintain already depleted morale.

And whether you’re the physician leader of a healthcare organization, your team, or your family, there are things you need to know. Prior to the pandemic, you may have been overwhelmed by your responsibilities and the challenges of your role. Now, with this crisis, your leadership is being tested daily. So many difficulties and so much uncertainty, with fires of every sort to be put out on a daily basis. But this is also a time where you can shine, and truly flourish in your role.

From Warren Bemis to Atul Gawande to the Harvard Business Review, all expert sources understand that the key to strong and effective leadership is self-management. After all, you can’t effectively manage others if you don’t manage yourself. But did your training provide the guideposts that are required in this difficult time? Most physicians would answer “no.” Unfortunately, there is little in medical or surgical training that does.

At the heart of self-management is self-awareness, another aspect of mindfulness. We first have to build awareness of ourselves and our patterns, before we can intervene with effectiveness. This is how new habits are not only formed but also how they are sustained. Here’s an article from the American Association for Physician Leadership that featured my work in this area. Here are three strategies you can utilize this week to build your confidence, steadiness, and calm.

Physician Leadership: Subdue your stress

During a crisis like this, there is plenty of stress to go around. Just like all other aspects of effective physician leadership, however, the key is managing your response to stress so your decisions are not coming from a place of fear, stress, worry, or physician burnout. By being mindful of stress and how you typically react to it, you can ensure that your choices derive from a balanced mental state resting firmly in your priorities. This is important for your function and it’s also important for those you lead. If you can maintain calm, you’ll help others do so. Yet, we’ve all had leaders who react to stress in ways that are counter-productive. If you think about leaders you’ve had who inspired you, it’s likely that they are the ones who remained calm under pressure. Reviewing the neuroscience of our stress response will help you build this ability.

The Neuroscience Of Stress

When our sensory organs bring information about danger to the CNS, the fight/flight/freeze pathway is activated via the amygdala, that part of the brain that is busy scanning the environment for threat and danger. Within seconds, our sympathetic system is in gear, pumping adrenaline into the bloodstream, shunting blood away from our digestive tract and off to our muscles. We’re primed to fight or take flight, or to roll over dead—the lesser known freeze element.

Where effective leadership comes in, though, is in the next phase, where executive function comes into action. Our prefrontal cortex (PFC) activates, helping us make decisions based on more than alarm and fright, and making sure that our actions are in the interest of long- and not just short-term goals. When the PFC engages, we can take a step back, see that we’re safe from harm, and move into resourceful action.

Infrequent activation of the sympathetic system doesn’t negatively impact us—adrenaline leaves the body 20-60 minutes after the reaction, and cortisol flows out of the blood stream in the following 4-6 hours. But being in a constant state of stress wreaks havoc with our mental and physical well-being. We’re all familiar with the symptoms of stress—from anxiety, depression, insomnia, lack of energy, to difficulty concentrating, to name just a few.

Over-activation of the sympathetic response is dangerous for a variety of reasons. First, it can prevent us from acting rationally in the face of stress. Second, as non-essential body systems are shut down, we lose the systems that regulate our mood and, especially in a crisis, our mood needs to be regulated! Third, chronic sympathetic activation weakens immune function, and we need our immune system to be as strong as possible during this time.

What’s key for effective leadership is engaging the PFC as early as possible to mitigate the stress response. There are two important strategies to do so:

  1. Get to know your early warning signs of stress (EWS.) Just as we tell at-risk patients to pay attention to early warning signs of stroke, we need to get to know our EWS for amygdala activation. Racing heart, shallow respiration, clenched jaw, tightness in the body. And just like with stroke prevention, the more we can get to know our EWS, the more we can intervene before things escalate.
  1. Allow these physical sensations to cue you to take the second step: taking a purposeful pause.

Take A Purposeful Pause

Stop what you’re doing, physically and mentally. Take a time out.

Take three slow breaths. Doing so activates your parasympathetic system, rapidly dampening overdrive and bringing almost immediate calm.

The purposeful pause takes less than a minute and provides moments of calm that are an invaluable asset for you as a leader. Be sure to try this out today.

Don’t Run On Empty

Especially in times of crisis, it’s all too easy to put ourselves on the back burner. We can be so busy with all the additional tasks and responsibilities that we get home and collapse into bed, only to get up 4-5 hours later and do it all over again. If we do this day after day, we run in sympathetic overdrive, our hearts pounding, body tight, ready and in action all our waking hours.

Unfortunately, running on empty only wears us down. All the stress worsens our ability to make good decisions and maintain calm. It erodes our ability to lead effectively. And right now, you simply can’t afford to put yourself at risk. Not for yourself, not for those you lead, and not for your family. The oxygen mask analogy is an apt one: if you don’t invest in your own care, your efforts to support others will fail. It’s that simple.

You’re probably thinking: how can I possibly take time to care for myself with everything going on? With all the demands of this crisis, there isn’t a spare moment in the day. Here are two important strategies:

First, getting enough sleep is critically important. I’ve coached many physician leaders who boastfully talk about catching up on email or doing meeting planning at 4 AM. Unfortunately, though, inadequate sleep has many adverse short-and long-term effects, from lost productivity to poor temper to cognitive impairment. A few things you can do to get the rest you need are putting your devices in another room, setting and sticking to a bedtime, and avoiding late-day caffeine.

Second, think about what typically fills your tank. This could be exercising, listening to your favorite music, reading a book, being outside in nature, working in your garden, watching TV, spending time with friends or family. Even if you can’t spend as much time as you’d like on these, you can still give yourself a small dose of the activities that fill your tank. Doing so will help ensure that you have what you need to meet all the demands.

Maintain Morale To Decrease Physician Burnout

During a time of crisis, it’s critical to build and maintain morale. Whether it’s at work or at home, people are working hard to manage, and their efforts need to be validated. Pre-COVID-19 we had high levels of physician burnout. And now, things aren’t exactly easier, are they? Building your people ensures that they’re at their best to stay out of burnout and carry out the difficult frontline work.

Be sure to thank others for all they’re doing. Everyone is working hard, so let people know that you see this. Thank them for a job well done, for going the extra mile, for taking such good care of patients.

Celebrate strengths and wins. Go out of your way to recognize every success your team is having.

Encourage your people to pace themselves and take time for self-care.

In difficult times, it’s easy to fall into command and control. But this physician leadership style will leave your people drained and, ultimately, less willing to follow your lead. These simple measures will bring you a lot in team morale and goodwill.

Next Steps

Your role as a leader is powerful. When you manage your stress you role model calm, helping others do the same. When you avoid running on empty, you have what you need to be at your best. When you build the morale of your people, you help them rise to meet the challenges COVID-19 has brought and stay out of physician burnout.

Now, more than ever, you can step into your full leadership potential. Follow these steps and reap the benefits you’ll find in confidence, steadiness, and calm.

  1. Embrace uncertainty

When you stop and think about it, uncertainty and change are the only things that are certain. Impermanence is one of the basic laws of our world.

After all, everything changes. Our relationships change. Our kids grow up and change. Our bodies age and change. Our environments change. Our planet changes.

All too often, however, we forget this basic truth. We somehow expect things to be predictable and stable.

The problem is that this expectation sets us up for difficulty. It leaves us struggling unnecessarily when something shifts. It adds a layer of suffering above and beyond that caused by all the VUCA around us.

What I’m getting at is that we have a choice. We can meet uncertainty with reactivity or we can meet it with mindful understanding.

More than meditating on a remote mountainside, mindfulness helps us have the calm, steadiness, and clarity we need to work constructively with all the change and uncertainty.

At the same time, while we can find ourselves resisting change, we can remind ourselves that it does not have to mean something bad! Just take a moment right now to think of all the difficulties you have faced in your life and work that are now resolved and far behind you. This can help you see how change has actually been quite the positive.

  1. Respond to complexity with compassion

Even knowing that change is the only thing that is certain, it can still be difficult to weather. Living in such a VUCA time is difficult. You deserve compassion for managing all the challenges.

With mindful awareness, we can bring ourselves compassion for what we’re going through. There is increasing evidence that self-compassion is a powerful antidote to stress and even burnout. From where I sit, I think that it is actually one of the most powerful medicinals available to us.

  1. Take purposeful pauses

With mindfulness, we are aware of what is going on within and around us. We tune in and pay attention to our experience. We learn to utilize our breath to take us out of the fears, worries, stories, and preoccupations our minds are so good at generating about what might come next, and bring us back to the present moment. Here in the present, we leave that overly activated limbic state and can experience a sense of calm.

A pause also serves to allow our prefrontal cortex to come online. It creates a critically important space between our emotional response and conscious, intentional action.

Once we have paused, we can then see more clearly that fear had taken hold. 

With a pause, we become the witness of our experience as opposed to the one trapped by it.

  1. View VUCA as opportunity

I don’t know about you, but I can find myself reacting to the VUCA environment with something of a fixed mindset. With a fixed mindset, I am telling myself things like ‘it shouldn’t be this way’ and ‘why is this happening?’

When I can utilize mindful awareness, I can see that I’ve boxed myself in with a fixed mindset. I can challenge myself to grow. By grow, I mean challenging myself to see whatever difficulty I’m experiencing as an opportunity to learn.

Here again, mindfulness again throws us a lifeline. Mindful awareness involves leaning into curiosity.

I can flip the script and ask myself:

What can I learn from this experience?

How can I use this to be a better version of myself?

How can I help others cope in this VUCA environment?

What do I want to look back and see about how I acted?

In summary, while VUCA is definitely the order of the day in healthcare and beyond, you don’t have to succumb. You don’t have to live in fear. There are constructive actions you can take to help you cope with uncertainty, build calm in chaos, and even thrive in chaos and VUCA. While we can’t control much that is contributing to the VUCA time, with mindfulness we can control how we respond to it.

I hope you’ll try out these 4 mindfulness strategies as I have seen them help countless people. I’d love to hear how it goes.

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To learn more about how mindfulness coaching can help you cope with this VUCA time, please reach out for a complimentary consult.

6 Free Resources To Help You During COVID19 And Beyond.

  1. 14-day meditation series 
  2. Imposter No More PDF
  3. Resilience Book Chapter
  4. Leading In Crisis PDF
  5. Balance To Burnout PDF
  6. 30-minute consult

Take advantage of one or more of these valuable resources created for clinicians and non-clinicians.