American Association for Physician Leadership

Healthcare Leadership in Times of Crisis

Laura Hills, DA

May 9, 2024

Volume 2, Issue 3, Pages 95-102


Leadership is never more important than during a time of crisis, as healthcare organizations everywhere learned during the COVID-19 pandemic. This article defines crisis as it applies to healthcare leadership and suggests the various kinds of crises healthcare organizations may face in the future. It explores the psychology of crisis leadership—specifically, what it means for a leader to hold and contain during a crisis. It also explains the difference between crisis leadership and crisis management, and how the two work together. This article then offers healthcare administrators, leaders, and managers 25 practical strategies they can use to prepare for and lead through a crisis. Among these strategies are bounded optimism, circular vision, and leading by example. Finally, this article describes four key behaviors that will help leaders manage a crisis, and suggests what leaders need to do once a crisis is under control or over.

Being a healthcare administrator, leader, or manager even in ordinary circumstances can be challenging. However, taking the helm at a time of crisis elevates the challenges of leadership to a whole new level. Leadership professor Henry Laker(1) says, “The coronavirus pandemic caused usual playbooks to be thrown away, with leaders around the globe having to think quickly on their feet.” Many healthcare leaders felt as though COVID-19 had flung them headfirst into uncharted waters without the benefit of a nautical chart or a life preserver. They had to make hard and fast decisions while swimming to the surface for air, all the while knowing that everyone they led, every patient they served—in fact, every person they knew—was in mortal danger.

Fortunately, a crisis of the magnitude of the coronavirus doesn’t come knocking at our doors every day. Sreejith Balasubramanian and Cedwyn Fernandes(2) from the University of Dubai describe it as “a rare, long-haul health and economic crisis, which is global in nature, and no training or experience in previous crises could have prepared leaders for it.” Although COVID-19 was one of the most difficult crises many healthcare leaders will ever face, it is likely that if you stay in the healthcare field long enough, you will lead your organization through another crisis or several crises. And, like COVID-19, you may have to do so with little or no warning. W. Timothy Cooms,(3) Gerald Lewis,(4) and Harvard Business Essentials(5) suggest that the crisis you may face someday can take many shapes and forms, including any of the following:

  • Natural disasters;

  • Product recalls;

  • Environmental mishaps;

  • Accidents;

  • Protests against your organization;

  • Work-related deaths and injuries;

  • Disruptive and dangerous employees;

  • Security and data breaches;

  • Social media gaffes;

  • Product tampering;

  • Terrorist attacks;

  • Stock issues;

  • Corporate takeovers;

  • Ethical breaches;

  • Disruption of the supply chain and utilities access;

  • Corporate reorganizations;

  • Lawsuits;

  • Geopolitical turmoil; and

  • Artificial intelligence issues.

Waiting to see what happens and reacting to it is not a plan. Every healthcare leader must plan for crisis leadership, even for crises we can’t yet imagine. Zara Abrams(6) warns, “Disasters can make or break a leader,” the organization, the people they lead, and the patients they serve. It is imperative that you prepare and train for leading your organization through whatever happens to it, even for events we can’t foresee.

When the next crisis hits, you may not be able to wait to act until you have everything well in hand. The people you lead will be looking to you for strong leadership and reassurance, and you may find virtual and real microphones suddenly thrust at you for comment. Crises can be merciless to leaders who are unprepared for them. Some will say and do things they regret. Some may end up pouring oil onto the flames of an already raging crisis. Others may not make the decisions that were critically needed. One serious misstep in leadership during a crisis can have lasting, far-reaching, and regrettable consequences.

It can be extremely challenging to prepare for the unknown, but doing so should not be unfamiliar to you. The very practice of medicine often deals with the unknown, and people who work in healthcare are more prepared for medical crises than most people because of their study, training, and simulations. Likewise, leaders must prepare to deal with the unknown and shore up their leadership skills so they will be ready for the next crisis, whatever it may be. In the following sections we explore specifically what a crisis is and how to lead your organization through one.


While one could say that a crisis is in the eye of the beholder, a more specific definition is required. Steve Firestone(7) of Regent University explains, “With a good understanding of the definition of a crisis, we can be better prepared to lead and respond when needed.” Firestone defines crisis as “a situation that develops quickly and requires a response from a person or an organization in order to mitigate the consequences.” That’s a good beginning to a definition, but my research suggests that there is more to it than that.

Three common denominators to the definitions of crisis can be found in scholarly literature. First, a crisis occurs quickly, even suddenly, or a problem reaches crisis level over time, sometimes without clear warning. Second, the event must imperil the organization’s objectives and goals. And third, the event forces the organization to take steps to mitigate the possible consequences. Specifically, here are the ways that scholars and the U.S. military define crisis:

  • Perceived or actual threat: Robert R. Ulmer, Timothy L. Sellnow, and Matthew W. Seeger(8) say that a crisis is “a specific, unexpected, and non-routine event or series of events that create high levels of uncertainty and threat or perceived threat to an organization’s high priority goals.” Notice Ulmer, et al.’s, emphasis on perceived versus actual threat. This definition suggests that leaders need to step into crisis while a threat is perceived as possible, not necessarily actualized. With such leadership, it may be possible to nip problems in the bud or at least reduce the impact of a crisis.

  • Sudden or evolving change: Harvard Business Essentials(9) says, “A crisis is change—either sudden or evolving—that results in an urgent problem that must be addressed immediately. For a business, a crisis is anything with the potential to cause sudden and serious damage to its employees, reputation, or bottom line.” Harvard Business Essentials emphasizes evolving change, suggesting that a crisis can evolve slowly but that its impact can be sudden. Leaders must become highly in tune with ongoing shifts and declines in their organizations that seem manageable in the present but that can skyrocket to crisis level through neglect and oversight.

  • Part of the human condition: Mitroff(10) suggests that crises “are more than an integral part of the human condition. They are the human condition.” This definition may sound grim. However, it is realistic and best to regard crises as an integral part of your job, not something you must handle on top of everything else you’re tasked to do. If you embrace crisis leadership as your job, you won’t feel resentful about what you must do when a crisis hits.

  • A 50-50 proposition: Steven Fink(11) describes crisis as “an unstable time or state of affairs in which a decisive change is impending—either one with the distinct possibility of a highly undesirable outcome or one with the distinct possibility of a highly desirable and extremely positive outcome. It is usually a 50-50 proposition, but you can improve the odds.” What stands out here is that Fink’s emphasis is on improving the odds. Remembering that may help you to remain optimistic and to keep pushing the needle forward during a crisis, even if at first your efforts seem to be hopeless.

  • Crises leading to other crises: The Joint Chiefs of Staff(12) define crisis as, “An incident or situation…that may occur with little or no warning. It is fast-breaking and requires accelerated decision making. Sometimes a single crisis may spawn another crisis elsewhere.” Notice The Joint Chiefs’ emphasis on the possibility of one crisis giving birth to another. That’s sobering, but it’s important for leaders to know this, yet not get bogged down because of fear of making bad decisions. Crises can multiply quickly and you don’t want to set yourself up to play a game of Whac-a-Mole.

Unfortunately, many—if not most—organizations have neither a defined concept of a crisis nor a list of what constitutes a crisis in their organization. Both would be helpful. Firestone explains, “By having a list of events describing what constitutes a crisis, the organization will be much quicker to recognize and respond and will be less likely to overreact when less severe events occur.”

All of us probably have been in situations where an event occurred and only some people, or maybe only one person, viewed it as a crisis. Although a minority of the group may want to respond to the event as a crisis, it may not be able to do so if others don’t grasp fully what the big deal is. This situation can be avoided when the organization develops a generally agreed-upon definition of a crisis. Therefore, your first act to prepare for a crisis will be to help your organization define the term, if it has not already done so, and to create a list of possible crisis events such as those listed in the bulleted points at the beginning of this article.


When you think of crisis leadership, do you think of leaders who have strong vision? Or those who are especially inspiring? Or charismatic? Those leadership characteristics are dazzling so they get a lot of attention. However, the quieter, unsung hero during a crisis is the leader who is able to hold and contain.

The American Psychology Association(13) describes holding as the way another person, often an authority figure, interprets what’s happening for us in times of uncertainty. Containing is the ability to help others make sense of a confusing predicament, and alleviate anxieties by acting as a container, or holding environment. Two psychoanalysts developed these theories in the early 1960s—Donald Winnicott(14) (holding), and Wilfred Bion(15) (containing). Their work focused largely on the mother–infant relationship, but it has useful application to leadership, especially during a crisis.

Organizational professor Gianpiero Petriglieri(16) explains, “When there’s a fire in a factory, a sudden drop in revenues, a natural disaster, we don’t need a call to action. We are already motivated to move, but we often flail. What we need is a type of holding, so that we can move purposefully.” Think of a leader who, in a severe downturn, reassures employees that the organization has the resources to weather the storm and that most jobs will be protected, then helps them to interpret revenue data and gives clear directions about what must be done. That leader is holding. Petriglieri says that holding leaders “think clearly, offer reassurance, orient people, and help them stick together.” Holding is as important as inspiring people, Petriglieri says. In fact, during a crisis, it is a precondition for inspiring others because people need to feel safe before they will feel inspired. Petriglieri explains, “When leaders cannot hold…anxiety, anger, and fragmentation ensue.” Good holding, therefore, makes us feel more comfortable, reassured, courageous, and able to survive in a storm.

To hold during a crisis, Petriglieri suggests that leaders tell their employees what will happen to their salaries, health insurance, and working conditions. He suggests that you answer questions such as, “What will change about how they do their work? What are the key priorities now? Who needs to do what and in what order?” You may not be able to make predictions, but you can and should offer informed interpretations, Petriglieri says. You also can acknowledge and dispel rumors and encourage and protect everyone’s participation as you work through the crisis. Holding, Petriglieri suggests, is what will make your employees feel secure. Without it, their anxiety, rumors, and speculation are likely to escalate, and some of your employees may shut down, panic, or jump ship.

To contain during a crisis, Marianna Sidiropoulou,(17) a psychotherapist and leadership coach, says that leaders must create meaning out of chaos to “digest raw input/information and give it back in an intelligible form.” Imagine a big, sturdy pot with lots of different ingredients going into it, Sidiropoulou says. Containing is the ability to hold the ingredients together without spilling them, and then, to let them cook into something different, “allowing the chemistry to happen.” Specifically, Sidiropoulou says that you can contain during a crisis if you understand the root of the presenting problem, allow yourself to experience and not deny your own emotions, remain receptive and human, keep your center intact, prepare for change, and get the support you need. Fortunately, containing is what a good leader does unwittingly every day, Sidiropoulou says, adding, “It can range from a ‘not losing it’ attitude when faced with adversity to dealing with crises, office politics, and people problems to finding oneself in a ‘sandwich crash’ position between top and bottom misaligned strategy.”


Crisis leadership and crisis management are both important during challenging times, but they are not the same thing. The Indeed Editorial Team(18) explains, “The main distinction between crisis leadership and crisis management is that the former focuses on the organization’s long-term strategy.” Crisis management does not.

Crisis leadership in healthcare ensures positive public perception and trust during a crisis by preserving the organization’s values and prioritizing the needs of patients and employees. Crisis management on the other hand, is a more reactive approach that strives to maintain an organization’s normal operations. For instance, a natural disaster may make it challenging for your healthcare organization to obtain needed supplies. The Indeed Editorial Team suggests, “Crisis managers can ration the company’s current inventory, ensuring it lasts until vendors are once again operational.” Crisis management also may involve adjusting procedures to maintain your organization’s efficiency and ensuring that your organization can pay its employees. Managerial procedures such as these offer stability during challenging times and help crisis leaders maintain high morale.


The combination of preparation and strategic leadership will be your best defense against any crisis that comes your way. Here are 25 strategies:

  1. Define crisis for your healthcare organization and prepare a list of possible crisis events. This article can provide a good start. However, work collaboratively with other stakeholders to create a definition and crisis list that is specific to your healthcare organization.

  2. Resolve smaller concerns before they escalate to crisis level. Firestone suggests that more and more of the crises we see today are caused by human error. He says, “Typically, it is not just a simple error by one person that leads to a major crisis. Instead, it is typically a chain of errors or an overall systemic error involving humans that leads to most of the crises we see in organizations.” Keep your eyes always open to spot potential for errors and to provide training and management to help employees prevent mistakes. Trust your gut. If something doesn’t feel right, it probably isn’t.

  3. Learn to recognize a crisis early. Crises with a gradual progression can be challenging to recognize before they impact an organization. It’s far too easy to rationalize or miss small warnings or to be lulled into a false sense of security when you are in the calm before a storm. The Indeed Editorial Team explains, “Even if a crisis develops rapidly, leaders may not recognize the extent to which it affects normal operations until later. You can implement an effective leadership style by practicing early recognition.” A good practice is to research world and local events that could possibly impact your organization and become aware of your patients’ attitudes, the Indeed Editorial Team suggests. Then, you can work with your crisis managers as soon as you notice a potential issue so you can work together to reduce its effects on your organization.

  4. Increase your ability to remain calm. Your ability to stay calm in the face of danger will allow you to recognize opportunities more clearly and develop solutions you may not think of if you are feeling stressed or anxious. Laker suggests that training and practice are the best ways to increase your ability to keep calm in stressful situations. Hypotheticals and simulations are excellent. Laker suggests, “In your future training, make sure to put examples of crisis in context to prepare for future obstacles.”

  5. Express bounded optimism. The term “bounded optimism” refers to having a positive attitude while acknowledging the severity of a challenge. The Indeed Editorial Team explains, “This approach allows leaders to comfort employees and customers while remaining sensitive to how the event affects their lives.” For example, consider a statement that a crisis leader would issue in response to a severe flood that affects the community. It would be unwise to ignore or minimize the devastating effects of the flood. Therefore, your statement might express your organization’s condolences for families who have lost loved ones and property, while proclaiming that you are confident about your organization’s and community’s ability to persevere, the Indeed Editorial Team suggests.

  6. See opportunities everywhere. During a crisis, leaders must see opportunities everywhere and make the most of them. Leadership author Glenn Liopis(19) says, “They must be open-minded enough to search within conversations and adverse circumstances for possibilities that will help better serve those they lead—beyond the obvious.” For example, Liopis says, a crisis will demand that you respect different points of view to broaden your observations and perspectives about the reality that is right in front of you. That way, he says, “You can see the glass half full, not half empty.”

  7. Establish primary and secondary priorities. Most leaders make the safety of customers and employees their first priority during a crisis, ensuring that every decision they make protects human life. However, it’s important to establish secondary priorities as well. The Indeed Editorial Team explains, “Companies can have various [secondary] values, with some of the most common being innovation, exceptional customer service, and commitment to the environment.” An organization can feel free to implement new measures to uphold its core values but only after it has ensured that it is safe to do so.

  8. Learn how to recognize and manage your internal experience first. Leaders who are hurled into a crisis may not think much about themselves. However, they will need to manage their internal experiences before they can provide the most effective direction to their teams and communities. One way to do that is to manage where your attention goes. Abrams suggests that you learn to become aware of what’s happening in your body during a crisis so you can recognize your feelings and understand your physical responses. A leader who is locked in fear will have limited ability to develop creative solutions, Abrams warns. Training and practice can help you recognize and manage your emotions.

  9. Develop trust. Leaders must strengthen trust before, during, and after a crisis so they will be able to break down barriers and forge strong bonds. Liopis says, “Trust during crisis is earned when leaders are reliable and they act on their word…when they commit to the needs of others before their own…when leaders are wise enough to enable their emotional intelligence by being vulnerable, open and honest.”

  10. Learn how to communicate well. You will need to disseminate information to your employees during a crisis by every good means possible. The information you provide will be powerful, because it can reduce emotional distress caused by the unknown, diminish fear, provide tactical guidance, and demonstrate to your employees that their leaders are concerned, involved, knowledgeable, and on top of the situation. An essential element of crisis leadership is clear and trustworthy communication. Abrams says, “Best practices for crisis communication, established through years of psychological and organizational research, include transparency, honesty and empathy.” Communicating well starts with understanding the questions your audience has, then talking to experts and reviewing data to answer them accurately. Leaders need to develop and test their messages before issuing them to ensure they don’t confuse people or inadvertently heighten their anxiety. Abrams says, “Leadership scholars agree that even in dire circumstances, honesty is the best policy.” She also suggests that leaders who withhold information essentially “shoot themselves in foot” by breeding mistrust and uncertainty.

  11. Become more flexible. Crisis leaders need to be flexible so they can revise their response plans as the crisis unfolds. For instance, they may use new research to adapt new procedures or revise an existing policy. The Indeed Editorial Team says, “This adaptability also allows leaders to analyze the effectiveness of their current approach and make the necessary adjustments to prepare for future crises.” The Center for Creative Leadership suggests that leaders develop three kinds of flexibility so they are ready for a crisis: cognitive flexibility (the ability to use different thinking strategies and mental frameworks); emotional flexibility (the ability to vary one’s approach to dealing with one’s own emotions and those of others); and dispositional flexibility (the ability to remain optimistic, yet realistic). The Center for Creative Leadership suggests, “Don’t get too attached to a single plan or strategy. Have Plan B (and C) at the ready.”

  12. Identify credible information sources. Do you know which outlets will be your most reliable and truthful information sources about the crisis? That is very important because you may encounter different and conflicting reports about what is happening and what may happen in the future. The Indeed Editorial Team(21) says, “Conflicting information can confuse both you and your team, so try to avoid finding information from unreliable sources such as social media and news organizations that are not well-respected.” Instead, consult qualified experts about what is happening during a crisis, the Indeed Editorial Team says, adding, “This can help to ensure that you don’t feed staff with information that is untrue and could cause them to panic further.”

  13. Develop circular vision. Liopis defines circular vision as a leader’s ability “to see around, beneath and beyond what they seek.” For example, Liopis suggests that leaders explore employee engagement analytics. He asks, “Who are those that you can rely on now and in the future?” Circular vision is especially useful when operating in an environment of uncertainty. It also is useful when you need to reset a strategy and prepare your organization to rebound after a crisis, Liopis says.

  14. Respect your organization’s heritage and traditions. Leadership legacies are born and made during a crisis. Liopis explains, “We discover the leaders that are most respected based on how well they reacted and responded to all the chaos and uncertainty around them.” Leaders have a responsibility to uphold the heritage and traditions of the organizations they serve, but during times of crisis, they must equally hold themselves accountable for building on those traditions to strengthen the organization’s culture and the communities they serve. Liopis says, “Crisis puts our culture to the test.” For leaders, crises are culture defining moments that either strengthen the culture for future legacies or awaken leaders to realize the importance of establishing a culture. Either way, leaders must learn how to ensure that a legacy platform is in place for the future.

  15. Learn about appropriate communication channels and frequency. The channels you use to communicate during a crisis become extremely important so people will have access to the information they need when they need it. The Center for Creative Leadership suggests choosing, “face-to-face first, whether in person or through virtual channels.” Also, repeating and reinforcing key information daily via multiple delivery channels will help it to sink in and be retained. The Center for Creative Leadership warns that when information regarding what is happening is scarce or non-existent, people will revert to gossip and rumors to fill the void, or they will invent things. Invariably, they add, what people make up will be much worse than reality, no matter how bad reality is.

  16. Be present, visible, and accessible. Your first thought when thrown into a crisis may be to hunker down in your office and man the battle station from there. However, leaders need to be accessible to their employees during this vulnerable time. The Center for Creative Leadership(21) says, “Let employees know how best they can best reach you with status updates and questions.” Also, let them hear from you frequently and be sure that you are on the premises whenever possible. The Center for Creative Leadership suggests that whoever is in charge during a crisis is whoever is there. If that means leaving a vacation early to return to work, that’s what a leader will have to do. Your organization can’t be hamstrung because a key player was not there when a crisis struck, the Center for Creative Leadership says.

  17. Develop and stick to healthy habits. Laker suggests that every leader needs to maintain healthy habits all the time, including during times of uncertainty. These habits include pacing yourself, staying active, taking time to recover (sleep, rest, proper nutrition), and embracing your routines. Make it your habit to take care of yourself mentally and physically, especially during a crisis, by adding structure to your day and time to unwind.

  18. Take a wider view. The human brain is programmed to narrow its focus in the face of a threat because narrowing is an evolutionary survival mechanism designed for self-protection. The trap is that your field of vision during a crisis can become restricted to the immediate foreground. Eric J. McNulty and Leonard Marcus,(22) of the National Leadership Preparedness Initiative at Harvard University, suggest that leaders “intentionally pull back, opening your mental aperture to take in the mid-ground and background.” They call this approach “meta-leadership” and define it as “taking a broad, holistic view of both challenges and opportunities.” Properly focused meta-leadership fosters well-directed management, McNulty and Marus say. Leading through a crisis requires taking the long view, not just managing the present. Leaders need to anticipate what comes next week, next month, and next year to prepare the organization for the changes ahead. McNulty and Marcus add, “They also need to delegate and trust their people, provide support and guidance based upon experience, and resist the temptation to take over.”

  19. Lead by example. Volunteer first, before asking others to sacrifice. Erin Barr(23) suggests, “If there are sacrifices to be made, and there will be, then the leaders should step up and make the greatest sacrifices themselves.” Everyone will be watching to see what the leaders do during a crisis. Will they stay true to their values? Bow to external pressures? Be seduced by short-term rewards? Or will they make near-term sacrifices so they can fix the long-term situation? Be the leader who is the exemplary team player you ask your employees to be during a crisis.

  20. Decentralize your response. Risk and ambiguity increase during a crisis because so much is uncertain and volatile. Leaders may want to control everything, but doing so risks adding layers of approval required for minor decisions. McNulty and Marcus warn that the organization can become much less responsive when more control measures are put in place, and that frustration will grow with each new constraint. They say, “The solution is to seek order rather than control.” Order means that people know what is expected of them and what they can expect of others. Leaders must acknowledge that they can’t control everything. Instead, McNulty and Marcus suggest, “Determine which decisions only you can make and delegate the rest. Establish clear guiding values and principles while foregoing the temptation to do everything yourself.”

  21. Take responsibility. Reality starts with the person in charge. Therefore, recognize and take responsibility for your role in creating or contributing to the problem. Barr says, “In order to understand the real reasons for the crisis, everyone on the leadership team must be willing to tell the whole truth.” This is especially so when that truth is hard to face.

  22. Don’t get seduced into managing. Managing a crisis can feel thrilling, but managing can become a problem if you are doing it simply to return to your operational comfort zone. McNulty and Marcus warn, “Your adrenaline spikes as decisions are made and actions are taken. You experience a feeling of adding tangible value.” Be mindful, though, that what you are experiencing when you manage a crisis can be a lot like a sugar high that will be followed quickly by a blood sugar crash.

  23. Request feedback. Employees may believe that you expect them to keep their heads down and their mouths shut during a crisis, but the opposite is true. A crisis is the perfect time for them to tell you what’s going on. Jennifer Herrity(24) says, “Ask your team to give you feedback on how they feel during the crisis and what more you can do to help them feel supported. “Your questions may be logistical, such as “How can we as an organization improve the services we are providing?” Or, they can be emotional, such as, “What can we do to make it easier or better for you to work during this challenging time?” Herrity suggests, “While you may not be able to alleviate all concerns, checking on your team confirms that you genuinely care about them beyond just their performance as an employee.”

  24. Create an organization that is built to last. It takes a lot for a healthcare organization to survive and thrive in a crisis. Create an organization for the long-haul that is designed to weather storms, just as you would if you were building a home in a region prone to hurricanes. Make sure, Laker says, that you have a strong enough foundation to endure whatever changes, stress, and challenges come your way.

  25. Don’t waste a good crisis. People often resist major changes or try to get by with minor adaptations when things are going well. Barr suggests, “A crisis provides the leader with the platform to get things done that were required anyway and offers the sense of urgency to accelerate their implementation.” Assess how your policies and systems operate after a crisis. It’s a good time to evaluate technological solutions that can help you facilitate consistent, multi-channel communication. Herrity adds, “Explore training programs that teach your employees techniques for developing their resilience, so that they can prepare for and persevere through future challenges.” Also, introduce regular team-building exercises to improve, strengthen, or possibly rebuild workplace connections after a crisis.



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Laura Hills, DA

Practice leadership coach, consultant, author, seminar speaker, and President of Blue Pencil Institute, an organization that provides educational programs, learning products, and professionalism coaching to help professionals accelerate their careers, become more effective and productive, and find greater fulfillment and reward in their work; Baltimore, Maryland; email:; website: ; Twitter: @DrLauraHills.

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