Jan. 26, 2022

A radical new work model for physicians during the COVID crisis built on a network of relationships

Lessons in peer-professional leadership for rapid change
A radical new work model for physicians during the COVID crisis built on a network of relationships

As COVID-19 upended ‘business as usual’ across the world, leaders were forced to reassess conventional wisdom in every sector. Nowhere has the impact been felt more keenly than in healthcare. Urgent ICU and emergency services, as well as tertiary and quaternary care, have carried an unprecedented burden of decision-making that is novel, dynamic and complex.

A team led by Professor Jaana Woiceshyn of University of Calgary Haskayne Business School of Business has been examining how peer-professional leadership achieved a rapid change in the ways of working required in a healthcare crisis.

Qualitative research by Professor Woiceshyn, Jo-Louise Huq, Sunand Kannappan, Gabriel Fabreau, Evan Minty, Sachin Pendharkar, and Aleem Bharwani examines how existing, informal peer-professional networks were leveraged to create a flexible physician work model that could be modified as quickly as the virus mutates.

Woiceshyn’s team was invited to analyze the processes and role of peer-professional leadership at four tertiary care hospitals in the Calgary Zone of Alberta’s Public Health Authority (PHA), as well as the Cumming School of Medicine at University of Calgary.

The research found that a core group of just four physician colleagues drew on informal relationships to create a leadership structure of 30 peers between March and May 2020, known as the Calgary Zone Medical Emergency Operations Command (MEOC).

This small, self-organized entity “designed, implemented and handed over (to the Calgary Zone and the PHA) a new, scalable acute-care pandemic workforce model to organize, staff, train and deploy physicians across four tertiary/quaternary care hospitals.”

Typically, physicians value autonomy and consensus-based decision-making; they set their own schedules, arrange their own training, and maintain boundaries between specialisms. The pandemic threatened the integrity of this peer-professional model with an imposed administrative hierarchy. The MEOC’s distributed leadership approach allayed these concerns by inviting ‘peer-review’ from frontline colleagues.

Physicians embraced the changes to their work. As the new work model was deployed, physicians volunteered in high numbers for emergency shifts, collaborated with colleagues across specialisms, and underwent training outside their areas of expertise.

The four core leaders and the extended leadership group of 30 created a distributed leadership structure based on trusted relationships to achieve rapid development and acceptance of the new work model.

Professor Woiceshyn and her team identified the work model development process as based on relationships. At the outset, the threat was recognized and a commitment to action was made within a close group of friends and colleagues who talked about ‘mutually inducing’ each other to help out in a crisis. Next, they formed and organized a wider cohort through a weekend ‘sprint’ of invited colleagues with a diversity of backgrounds; this sprint process spawned the larger leadership group organically.

At that stage, the extended MEOC group through its networks was able to review diverse sources of information about the spread and treatment of COVID from the frontlines in Canada and overseas. At the same time, the group asked for and received assistance and input from the formal organizational leaders within the healthcare system, including a full-time project manager.

MEOC created two-way digital tools to track data from physicians in Calgary COVID wards, updating the prospective model to address issues in real time. The issue-tracking system was complemented by more sprints and virtual meetings, a purpose-built website and webinars. A virtuous feedback loop was created building trust with peers who were not used to having decisions about their work habits taken by others.

Professor Woiceshyn and her colleagues suggest that other peer-led organizations could learn three lessons to inform leadership beyond crisis healthcare scenarios:

First, peer-professionals can be agents of rapid change, provided the leaders are recognized as legitimate authorities in their field.  Structurally, a distributed leadership model is efficient since professionals can directly participate in decision-making and thus accelerate it.

Second, decisions cannot be imposed arbitrarily on professionals accustomed to autonomy and independence. Instead, two-way communication is crucial for the decisions to be widely accepted. Peer-professional leaders need to obtain and incorporate real-time evidence from other professionals (particularly those in the frontlines) and then use it to justify decisions.

Last, and crucial, is leveraging existing peer and informal relationships — and creating new ones — to unify actors behind a mutually accepted goal, particularly when formal authority is absent.

Read the original research paper here in full, first published in the BMJ Leader in August 2021.

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