Priorities and challenges for healthcare leadership

Few organisations have been under such pressure to change and adopt as hospitals world-wide during the Covid crisis.

What general leadership lessons can be made from their challenging situation? Alumni talks to Carolina Samuelsson, CEO of Region Halland’s Network of Hospitals, about the challenge of leadership in a time of crisis and the positives that have emerged as a result.

Baptism of fire

Just five short months after being appointed CEO of Region Halland’s Network of Hospitals, Covid-19 reached pandemic status presenting the world and Region Halland’s hospitals with an extraordinary situation. For Carolina and her staff this was a start of an 18-month intense period of trying to predict the future in a rapidly changing situation, asking employees to take on tasks they were not trained for under an unprecedented avalanche of patient numbers in order to provide the citizens with the best possible care. Although the challenges are far from over, Carolina and her colleagues can now look back and conclude that without some key principles for conducting their mission, this would have been an even harder journey.

Purpose is key – Change without purpose risks creating fatigue in an organisation. With clarity regarding the goal and why changes need to be made, people can handle so much more than you would think possible and really rise to the occasion.
Empower staff – Decisions should be made as close as possible to the scene of action to enable rapid action, short feedback loops and higher engagement from staff. This is especially true in a time of crisis.
Information and transparency – Cascading and disseminating information is key to enabling decentralised decision-making. Transparency regarding the facts upon which decisions are being made ensures credibility and kill rumours.
Celebrate big and small – don’t forget to celebrate the successes you have achieved within your organisation and give credit to the people and methods that helped you achieve it.

Carolina came to the role as CEO of Region Halland’s Network of Hospitals, on the west coast of Sweden in October of 2019 from a background of specialisms in anaesthesia and intensive care, and later leadership roles where she had practiced both in Sweden and as far away as Australia. “Prior to my current position I managed the merger between two large Departments at Skåne University Hospital in Malmö and Lund, with the intended result of creating one of the biggest clinical departments in Sweden for Anaesthesia and Intensive Care.” states Carolina. “It was a major and challenging task which fitted my leadership style and clinical background – I got to work with extremely skilled professionals within the very core of the University Hospital where sound relationships are pivotal for progress and good service to the other departments who rely on us for the benefit of their patients.”

Carolina Samuelsson, CEO of Region Halland’s Network of Hospitals, Sweden. — *Carolina Samuelsson,* CEO of Region Halland’s Network of Hospitals, Sweden.

Driven by curiosity

Alumni were curious to find out why Carolina chose to move away from the practical side of her role in healthcare and into leadership and management. “I have a scientific brain, one that always questions how we can do things better and get the best out of every coworker“, states Carolina. Complex problems intrigue me and the interconnectivity of the systems within the body really mimic the interconnectivity of the systems within a healthcare organisation. Small changes in one area may have knock-on effects across the wider organisation. As a leader in healthcare, you need to take a broad perspective, use a holistic approach and take large scale responsibility for a diverse set of stakeholders and systems. You need to be able to solve problems whilst getting optimum performance from both staff and the resources you have available within the hospital.” Carolina clearly relishes complexity and makes good use of her communication skills co-operating with different types of people, from patients, politicians, medical professionals, and others.

“As a leader in healthcare, you need to take a broad perspective, use a holistic approach and take large scale responsibility for a diverse set of stakeholders and systems. ”

The time of uncertainty

The pandemic changed Carolina’s leadership role overnight. “At first,” recalls Carolina, “we did not know if Covid-19 was to reach pandemic status, we did not know if it would arrive in Sweden even, there was so much uncertainty. It became fundamentally important to keep a cool head, to analyse the information coming in from countries such as China and Italy and model scenarios from best to worse case and detect the changes that would indicate an escalation in the crisis.” To do this Carolina took the decision to put aside the ‘business-as-usual’ tasks both on a personal and a corporate level. “In my personal life I early realised I had to focus solely on the fundamentals that I needed to get through this crisis: sustenance, sleep and the little time outside work was spend with my closest loved ones. Her leadership of the hospital again paralleled this approach with the prioritisation of the life-saving fundamentals staying and less pressing hospital activities such as elective surgery put on temporary hold.

Rallying the leadership teams

“In the first few weeks we initiated daily digital meetings for key stakeholders and all of our leadership teams at the different levels.” says Carolina, “The objectives were to analyse what we were hearing, establish the facts from what we were seeing, identify the issues we needed to act on and assign responsibilities across the leadership.” Carolina recalls how one of the earliest signs of the looming crisis, was the widespread disappearance of sanitiser solution from the hospital buildings as visitors and staff alike removed it for their personal use in a fit of panic. What might initially seem a trivial matter further illustrates the interconnectivity of hospital systems. “We needed sanitiser to perform emergency surgery, we needed sanitiser to prevent infection spread between staff and patients. Its disappearance from the wards and rest rooms was an example of unprecedented and unpredictable seemingly trivial challenges that just needed to be solved.”

Inspiring confidence

“It was immediately apparent that it was important for the leadership of the hospital to take a balanced approach, not overreact and inspire confidence in the staff, patients and citizens.” determined Carolina, “We set up a small team dedicated to scanning the national and global data on Covid-19. It was important to demonstrate that leadership was still in command and answer the questions arising from the media, staff and governance as confident as possible. Showing that we were in control and were doing all that was possible to make decisions based on sound research, provided an important psychological safety net for staff, patients and citizens alike. This approach lent credibility to our decision-making processes.” The continuous sharing of information and analyses to as many as possible also empowered leaders at all levels to predict and suggest the next appropriate steps. “I recall how impressed, proud and happy I was when we were presented with a detailed escalation plan at the very meeting where I had planned to ask for it. Our wards managers had proactively taken action and were already engaged!”

Reskilling the workforce

“We needed staff to step up to the challenge of infectious medicine and critical care and to learn skills that may have only featured in their training as their careers took on different areas of focus. Reminding them that they had the skills to make a difference was paramount.”

The pandemic necessitated the widescale redeployment of staff and resources to focus on the critical care of patients presenting with breathing difficulties. “We needed staff to step up to the challenge of infectious medicine and critical care and to learn skills that may have only featured in their training as their careers took on different areas of focus. Reminding them that they had the skills to make a difference was paramount. They may not have had direct experience of the equipment and processes demanded that day, but they were qualified and capable and would be saving lives by acting out of their comfort zones. You can help. You can do this. Both became well-used mantras.” remembers Carolina. “Despite working through something that was unprecedented and unwanted, the inspiration of seeing visible difference being made through personal contribution will be a lasting memory for many.”

Personal support

For her own part, Carolina worked closely with a few colleagues who were able to sanity-check her decision making through the crisis. “It was important that my leadership was balanced and non-reactive, it had to be based on sound facts and not supposition. The volume and speed of decisions to be made might have felt overwhelming without the steadfast support of my peers. The more perspectives you can bring to decisions, the better those decisions will be. I very much valued their insight and they allowed me to take a more holistic approach to decisions that were by necessity required fast.”

Pandemic positivity

Whilst acknowledging the overwhelming human tragedy evidenced by the pandemic, Alumni wondered if Carolina could share some lasting positive effects from the crisis that she has seen within Region Halland. “Employee satisfaction is high,” states Carolina, “I believe that leaders and teams within the hospital actually feel empowered through their management of the pandemic. People perhaps did not realise how strong they were until that strength was put to the test. Decision-making had to happen at a lower level in the management hierarchy through necessity during 2020 but I believe that is a shift that can, will and should stay. The co-operation horizontally across work teams has also strengthened. There is more understanding of the issues that affect all of us and the symbiosis across teams and departments that predicate a fantastic healthcare organisation. Oh… and we will be keeping the large leadership digital meetings where we can speedily relay important information and updates which are relevant to many. Not as frequently, but they are an excellent way for leadership teams to stay connected, supportive and aware.” she concludes.

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