Crisis Leadership during the COVID-19 Pandemic: A Review to Inform Policymaking

Context: The COVID-19 pandemic has placed unprecedented stress on health care systems worldwide. The global scale of the outbreak and its unpredictable nature has put a significant leadership burden on health care leaders and decision-makers. Predefined emergency preparedness plans are no longer working. Evidence-based guidelines and crisis communication plans are insufficient. There is an increased amount of pandemic fatigue among the general population. Businesses are suffering. A financial crisis is looming. Health systems leaders need new leadership behaviors and mindsets to help them lead during the next phases of this dynamic crisis as well as in future pandemics. Despite a proliferation of perspectives on the topic, given the novelty of the situation there is no aggregated resource distilling the evidence about how to lead under crisis conditions. Objective: The aim of this paper is to systematically examine evidence from research on public health crisis leadership to determine what competencies are explicitly needed to better respond to pandemics like COVID-19. Specifically, we sought to map and assess published studies on pandemics (a) to characterize core competencies required to lead in the health sector during a pandemic, and (b) to identify contextual enablers and barriers to leading during a crisis. Methods: We conducted a rapid review using the methodological framework of Arksey and O'Malley (2005), the World Health Organization Rapid Review Guide, and the Joanna Briggs Institute 2020 guide to scoping reviews (Peters et al., 2020; Tricco et al., 2017). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SR) guided our reporting of study findings. Data Sources: We performed a systematic and comprehensive search of MEDLINE (via Ovid), EMBASE, PsycINFO, Business Source Premier, and Canadian Business & Current Affairs for studies published between 2003 (since SARS) and July 28, 2020. Study Selection, Extraction, and Synthesis: We selected all empirical articles (quantitative, qualitative, and mixed methods) that discussed crisis leadership during a pandemic. Data Synthesis: The literature search identified 8,044 citations. A review of abstracts led to the retrieval of 749 full-text articles for assessment, of which 30 were selected for review. Conclusions: Our findings show that crisis leadership competencies commonly fall under three categories of leadership capacity: task, people, and adaptive. In pandemic-related leadership literature, task-related behaviors such as preparing and planning, establishing collaborations, and crisis communication often receive more attention. Our analysis revealed that during a crisis, people-oriented capacities and adaptive capacities are equally important for leaders to successfully lead in a dynamic situation shaped by structural, political, and cultural contextual factors.