Back to the Future: Long-Term Leadership Lessons From the COVID-19 Pandemic.

Introduction: The loss of 50,000,000 people during the 1918 influenza pandemic was blamed on war, unsanitary conditions, and lack of vaccines and preparation. Nine decades later, a similar virus (H1N1) killed 285,000 people, and again, the response was that preparation was ineffective, inefficient, and inequitable. Less than a decade later, preparedness for the coronavirus disease 2019 (COVID-19) outbreak revealed the United States was not prepared. This study's objectives were: 1) to develop a deeper understanding of leadership practices that led to successful responses to the COVID-19 pandemic, and 2) to learn about the underlying principles and practices that may help in preparing for the next pandemic.

Methods: Senior leaders (14/23 or 61%) from across a multisite, multicountry integrated health system were recruited using maximum variation sampling. Individual recorded interviews (averaging 20 minutes) were based on principles of Appreciative Inquiry and critical incident reporting. Iterative consensus coding produced 6 major themes: self- and situation awareness, teamwork, readiness, inspirational leadership, internal communication, and external communication.

Results: Beyond individual leadership decisions, organizational culture, shared cognition, and history may play a major role in shaping system-wide responses to catastrophic events like the COVID-19 pandemic.

Discussion: Lack of preparation for dealing with novel events and one-way communication may be risk factors for chaotic and ineffective responses.

Conclusion: Senior leaders must balance clinical necessity with humanistic values and purpose. Situation awareness and attention to organizational culture may improve the quality, timeliness, and effectiveness of responses to the next pandemic threat.