Crisis leadership requires resilience, adaptability

Priya Singh and Catherine Krna on crisis leadership, resilience and adaptability

The COVID-19 pandemic has presented challenges of unprecedented magnitude for institutions around the country. Stanford Medicine met many defining moments of this pandemic with resilience and adaptability, fulfilling its critically important role as a care provider, research center and medical school.

“The complex nature of the disease and our response required us to pivot quickly and frequently,” said Priya Singh, chief strategy officer and senior associate dean of Stanford Medicine.

Throughout the pandemic, Stanford Medicine leaders have created processes to allow swift decision-making while reinforcing the importance of accountability and transparency. These collective efforts, combined with clear and continuous communication, engendered trust among the Stanford Medicine community and the many people who rely on its expertise.

“I have marveled at the organization’s ability to maintain its steadiness, purpose and focus during this period,” said Catherine Krna, associate dean and president and CEO of University HealthCare Alliance.

Below, Singh and Krna discuss the pandemic’s impact on crisis leadership and the long-lasting effects it will have on Stanford Medicine.

Before the pandemic, what strategies and infrastructure did Stanford Medicine have in place to lead during the unique circumstances of a crisis?

Krna: Stanford Medicine had a largely decentralized crisis infrastructure. While the Office of Emergency Management housed at Stanford Health Care had made progress in recent years to include Stanford Children’s Health and University HealthCare Alliance, the entities within Stanford Medicine have functioned more separately than synergistically.

One of the silver linings of COVID is that in the creation of the Clinical Oversight Resource Team and other governance committees, we gained alignment among the clinical enterprises of Stanford School of Medicine, Stanford Health Care, Stanford Health Care – ValleyCare, University HealthCare Alliance, Stanford Children’s Health and Packard Children’s Health Alliance. We were collectively able to respond more nimbly and work together effectively in this way.

Singh: As an academic medical center, Stanford Medicine is accustomed to mobilizing people and resources to respond to urgent situations. Yet, our efforts to achieve greater alignment through the integrated strategic planning process provided a strong foundation on which we built our pandemic response.  

In 2017, Stanford Medicine’s three entities came together for the first time to identify a shared strategic vision and to develop a concrete road map to get us there. Through our conversations, we identified opportunities for shared functions and supports, including in my area of communications and strategy, as well as others, such as marketing and IT services.

Just as important as aligning our resources were the newly formed connections made across Stanford Medicine. We forged stronger relationships with counterparts and colleagues. These close relationships allowed us to step up and meet the challenges we faced. The culmination of our efforts to transform how we work and to be more collaborative and streamlined made us better able to respond when COVID-19 hit. That said, the pandemic certainly stretched us, but we are now even better prepared to address crises.

What particular aspects of the COVID-19 pandemic required the biggest adjustments to strategic leadership during a crisis?

Krna: The aspects requiring the largest adjustments were the necessary pace of decision-making and fatigue. While the Clinical Oversight Resources Team provided a structure for decision-making, the ability to make decisions quickly (e.g., personal protective equipment for our physicians, staff and patients; testing rollout; pausing elective cases; vaccination rollout) has required an almost 24/7 ecosystem to keep our collective head above water. This crisis has now lasted for almost a year, and while there have certainly been many acute periods of intensity, there have been few periods of stability.

The team has tried to catch its collective breath during periods with more stable inpatient COVID numbers, but even during these brief breaks, the system was not able to fully recover. In addition, the other environmental and societal challenges we have faced — wildfires, civic and racial unrest, a contentious election season — contributed to anxiety and threatened mental well-being.

I have just marveled at the organization’s ability to maintain its steadiness, purpose and focus during this period. It speaks to the grit and perseverance of the Stanford Medicine community.

Singh: The pandemic has pushed society into a chronic state of crisis. We find ourselves having to manage constant change. These endless adjustments and inability to forecast the future have required frequent pivoting, sometimes to comply with rapidly evolving state and county guidelines around vaccination rollout, at other times involving operational adjustments during different phases of the pandemic. Developing a strategic response in an environment with many tiers of crisis was particularly challenging.

I echo what Catherine said in that I am also thankful for the Stanford Medicine community’s ability to weather these storms while providing reliable and trusted counsel to officials and serving our neighboring communities. The responses we have seen to this cluster of crises exemplifies why our people are the heart of Stanford Medicine. Their expertise and scholarship proved invaluable as we and policymakers around the Bay Area and the nation developed actionable insights and perspectives to guide us through the pandemic.

What have been Stanford Medicine leaders’ greatest challenges and achievements in responding to the pandemic?

Singh: The pandemic has been an ultramarathon. The prolonged nature of this crisis required us to come together quickly across our entire organization and add oversight and control, while still ensuring that diverse expertise and perspectives were heard. The complex nature of the disease and our response required us to pivot quickly and frequently. It was crucial to ensure everyone was moving in the same direction.

And, of course, the pandemic wasn’t the only issue on the table. Stanford Medicine leaders also addressed challenges related to racial and social justice, uncertainty on the national political scene, and the California wildfires that affected our community and those we serve.

Throughout, Stanford Medicine’s leaders shared their vision and gave our community a common direction to follow. They didn’t just speak to the immediate crisis; they addressed underlying issues and strengthened us for the future.

Krna: Stanford Medicine’s greatest challenge during this pandemic has been the dynamic nature of it. Health care service is a variable business — it is hard to predict what patient ailments we will be treating on a normal day. Insert a global pandemic into an already variable equation, and the ability to be both agile and effective is more challenging. That said, I think our response has been remarkable. We have stayed focused and resolute to our mission and purpose in the care of our patients. We have taken care of our people, and we have, most of the time, displayed grace with one another, leveraging one another’s strengths.

I worked in New York during Hurricane Sandy, and this has been infinitely harder and more complex for a number of reasons. Stanford Medicine should view its COVID response as an achievement, and I feel privileged and honored to have served with the leadership team during this period.

How will experiences from this pandemic inform Stanford Medicine’s approach to leadership?

Krna: Stanford Medicine is so much stronger as a system than an assemblage of stakeholders. The alignment between the dean and the two system CEOs was critical in establishing the foundation and expectation that we work together and in harmony. This will, hopefully, inform our collective approach to leadership. There is a way to honor the separate entities across the system but also to harness the collective power of the system. One Stanford for now and for always.

Singh: These experiences will have a profound impact on our approach to leadership. The pandemic gave us a glimpse of Stanford Medicine’s full potential and how much more we can accomplish when we work together. Catherine is right. We are much stronger as one than as a collection of stakeholders.

The pandemic highlighted the depth and breadth of talent and leadership we have throughout the organization

Stanford Medicine’s relationship with local communities and policyholders is in such a different place now than it was a year ago. We can build on that. What we can offer — with testing, through consistent patient care and as a reliable source of accurate information — is also what benefits the community the most at times like these.

Finally, we have tremendous people and resources. The pandemic highlighted the depth and breadth of talent and leadership we have throughout the organization. The display of courage and determination was staggering. It also showed we can have the greatest impact when we partner with others, and listen to the many diverse voices in our community.