Think Tank

Leadership in Crisis: A View from the Trenches

Gautam Khanna, CEO, PD Hinduja Hospital and Medical Research Centre

A crumbling economy, lengthy lockdowns, social distancing, a scramble to develop a vaccine, and varying perspectives on how to manage the crisis: there is much in common between today’s situation and the Spanish Flu of 1918, which killed millions. It remains to be seen if mankind has learnt the lessons of history, and whether it can stave off a second wave of the pandemic. For their part, business leaders have so far been focusing mainly on employee safety and business continuity. However, structural changes are becoming visible in terms of workforce management, customer interface, service delivery and supply chains. These present extraordinary challenges for leaders, all while keeping themselves positive and energetic. How can we adapt our leadership styles to respond to the crisis? At recent joint discussions of IMA India’s CXO Forums, Gautam Khanna, CEO of PD Hinduja Hospital and Medical Research Centre, shared his experience of dealing with the crisis from the front lines of battle.

The first case is discovered

The unfolding of a crisis
In early March, PD Hinduja Hospital had its first confirmed Covid-19 case: a patient in its ICU ward. The hospital quickly moved to quarantine other ICU patients and 96 of its staff, began contact-tracing and sanitised the entire hospital. Little could be done, however, to control rumour mongering on social media. From exaggerated numbers to fake news, all added to a sense of crisis. The hospital leadership soon had to grapple with difficult questions: Should it treat Covid patients at all? Should it shut down elective services? How should it bring in outside expertise – both clinical and non-clinical? How should it manage the financial risks, and the conflicting views of different stakeholders?

Tactical measures are put in place

Learning from best practices elsewhere, PD Hinduja initiated several new safety measures. These included separating out the chain of service; having a dedicated building, doctors and staff for Covid patients; enforcing social distancing for patients entering the hospital, in waiting areas as well as other common areas; new tele-consulting and tele-triage services to minimise hospital visits; building larger triage areas; and procuring enough protective equipment for its staff.

Continuing challenges in operations…

Myriad challenges…
These measures helped, but hospitals today face multiple other operational, staff and patient management challenges. With infrastructure requirements intensifying and no options to construct new facilities during the lockdown, existing areas had to be converted into isolation wards. Frequently changing government advisories are also affecting operations. For example, the norms around discharging patients – how many times they must test negative, or what to do with asymptomatic patients – have shifted many times. Elective procedures have been put on hold and the number of road trauma cases has declined steeply but there is no let-up in terms of other emergency cases. Further, there is no clarity on how to ‘return to normal’.

…people management…

Being at the frontline of the crisis, hospital workers are at greater personal risk than other people. Constant communication and motivation are key to ensuring that they overcome their fears, societal pressure and other hardships. A constant reminder of the good coming out of their work and the lives they save, helps keep up morale. While there will always be some detractors, the leadership must ensure that decisions are made quickly and followed diligently. Finally, patient management takes on a whole different hue when so many procedures are being cancelled and technology being used to manage patient care.

…and sustainability

A recent FICCI/E&Y study found that hospitals are on average operating at 25-30% occupancy rates and losing Rs 7,500 crores a month. Additionally, the government has imposed price controls that cap private hospital rates at par with state-run hospitals. In the extreme, non-compliance with these rules can, under the Epidemic Diseases Act, lead to the government seizing control of hospital facilities. Industry associations are currently in discussions with the government to rationalise some of these directives but several hospitals face imminent closure. For now, they are managing their liquidity and sustainability issues by seeking extra credit from suppliers, closely monitoring weekly cash flows, and reducing expenses.

Situational leadership

Lessons in leadership
In a short span of time, the crisis has nuanced the definition of leadership. Decisions today need to be more directive and authoritative; adaptability is more important than ever; there is greater reliance on external expertise; planning around cash flows focuses mainly on shorter time frames; and communication has become more frequent and intense. In such times, there are a number of leadership traits that can keep the organisation ‘winning’:

Maintain uncompromising ethics

  • Integrity and ethics: Every leader faces conflicting demands from different stakeholders, more so in times of crisis. Be it other department heads, Board members or customers – everyone has an agenda to push, and often, these agendas conflict. Leaders must be able to determine the right path, establish an order of priority, and ensure that the organisation follows suit.

Adapt to change

  • Adaptability: In navigating unchartered waters and experiencing new learnings and challenges each day, the ability to adapt quickly to a constantly changing environment is key.

Develop expertise inorganically

  • The ability to seek help and expertise: Leaders must grapple with unknown issues and uncertainties. What we deal with today may be completely out of our realm of knowledge and experience. Instead of surrendering to this ‘lack of expertise’, leaders must be able to bring in expertise by engaging with external consultants from different fields.

Communicate frequently

  • Effective communication: Given the intensity of the crisis, there is no such thing as over-communication. Communication should be repeated and transparent, and must come in different forms, including notices, emails and in-person meetings. Employees come from all walks of life and have varying levels of exposure to risk. Leaders must be able to communicate with them individually, and demonstrate their commitment to employee safety at all times.

Delegate judiciously

  • Strong execution: Delegation is important and leaders cannot shoulder the burden of managing the entire organisation. However, in such times, leaders must delegate judiciously. In the pre-Covid days, one had the ‘luxury’ of waiting for sufficient data and information to drive decisions. Now, one must learn to make quick decisions on the basis of minimal information, and continuously evolve with changing circumstances.

Understand technology

  • Tech-savviness: Technology adoption is relatively straightforward in most organisations. However, leaders must be able to understand various options and identify the right solutions, often in a relatively short span of time.

Manage the stakeholder ecosystem

  • Stakeholder management is never easy, given that everyone comes with their own point of view. Some may regard financial viability as the most important issue, while others may focus on the customer experience, and still others on employee safety. In times of crisis, leaders must be able to establish the priorities, and drive them all the way through the organisation.

Practice self-care

  • Internal motivation and discipline: Leaders are looked upon to ‘take care’ of others, but their own needs are often overlooked. Truly, it is lonely at the top but faced with daily difficulties, leaders must be able to care for themselves, both physically and emotionally. Regular exercise, meditation and mindfulness are some practices that can help in de-stressing and re-energising oneself.

Continued precautions as the situation improves

What tomorrow brings
In the near term, India – and the healthcare sector specifically – will have to contend with an economic crisis, heavy government regulation, and rising stress on the healthcare system. The present quarter will be a wash-out for many industries, especially healthcare. A recovery is likely to start only in the September quarter, and some sort of normalcy will return by December. As hospitals and healthcare workers continue to fight on the frontlines, other businesses can do their bit by contributing through their CSR funds. With or without a vaccine, the world will have to learn to live with Covid for a while.