(** This article is the fourth in a series on health leadership during the pandemic and is informed by more than a year and a half of national and international research projects by the Canadian College of Health Leaders (CCHL)).

Consumed by the seemingly insurmountable workload before us and led by a depleted workforce, we are in grave danger of surrendering an unprecedented opportunity.

A multitude of lessons from the pandemic thus far are available but untapped… stored – with increasing frustration – in the minds of people whose advice we haven’t yet sought. These insights could potentially inform system-wide improvements in the engagement and care of staff, the care of patients, the way services are delivered, the way we lead and learn, and how equity, diversity, and inclusion are prioritized in our organizations.

And yet, realizing this potential in the current context is no mean feat.

Even those not imminently on the brink of collapse are facing an escalating health human resources (HHR) crisis, which is more dire than it’s been in decades, and a daunting service backlog, with predictions that it could take upwards of 10 years to resolve.

We want the pandemic and all its restrictions and latent repercussions to be over, however, the hope for a near and definite end appears misguided. Accepting an endemic reality can be cumbersome and the temptation is to either postpone formal debriefs of key lessons until it’s all over (the Waiting it Out Syndrome), or to revert to the cognitive comfort of the way things were pre-COVID (the Back to Before Syndrome), at the expense of everything we’ve learned and achieved through innovation since the pandemic began.

As our nation-wide study shows, the time is now to consolidate and action lessons learned, which is an opportunity we simply cannot afford to miss.

Our study

To prepare this article, we contacted more than 100 CEO’s and senior leaders of Canadian hospitals, provincial and regional health authorities, and national health organizations, asking them the following questions: 1) Do you believe that formal debriefs/discussions of lessons learned by your leaders and staff during the pandemic thus far could potentially to lead to improvements in your organization? 2) In which areas could lessons learned potentially lead to improvements? 3) Who should participate in these discussions? 4) How can important lessons learned be best operationalized/put into practice to create improvements?

Is formally debriefing pandemic lessons learned potentially valuable?

A strong majority (84%) of respondents answered definitively “yes”, while the other 16 per cent selected “perhaps”. No one selected “No, there is no benefit to discussing lessons learned” or “No” and offered a more effective alternative.

Potential improvement areas

Remarkably, nearly 50 unique potential improvements were proposed.

The responses can be grouped into eight overarching themes: staff wellbeing, HHR, and engagement (29%), work/operations (21%), models and quality of care (19%), and leadership; emergency preparedness; communication; equity, diversity, and inclusion; and decision-making (30% combined).

Dr. Verna Yiu, CEO of Alberta Health Services, highlights potential to increase the speed of innovations, the scale and spread, the use of real-time evidence, and bringing in new technologies, which requires sharing data and analytics.

In terms of where to begin, Dr. Jackie Schleifer Taylor, CEO of London Health Sciences Centre, suggests: “We have potential learnings in all spheres but, leadership – the approaches, the models, and the key ways in which we succeeded and failed, is a worthy start. From there, listening to, and hearing from, all stakeholders whom leaders (at all levels) have supported, we can ensure there is a foundation of trust and a renewed commitment from us, as leaders, to model (with openness) and challenge (with courage) what we thought we knew was working, and/or what we have not prioritized to do better”.

Informing improvement: Who’s at the table?

To inform priority areas for improvements, 29 different groups were proposed, some of which overlapped. The most frequent were: employees at all levels (14%), senior/executive leaders (13%), all managers/leaders (9%), frontline staff (9%), and “everyone” (7%).

A diverse mix of stakeholders is important, as well as ensuring that executives and board members, those closest to the work (frontline leaders and staff), and end users (patients, families, and community representatives), among others, are at the table.

Physicians, policy makers, unions, communications experts, government, researchers, HR teams, partners, public health officials, and the Royal Colleges and universities were also mentioned.

To enhance learning and to avoid insularity, it is beneficial to compare results with other organizations who are undertaking the same process.

Building back better (actioning lessons)

How to best operationalize the lessons is “the billion dollar question”, says Dr. Tim Rutledge, CEO of Unity Health. This has a threefold implication: classic knowledge to practice challenges, the heightened prominence of sector financial stresses, and the global imperative to improve healthcare based on the pandemic.

Before exploring lessons learned, Mr. Paul Heinrich, CEO of North Bay Regional Health Centre, suggests that the starting point should be to celebrate and honour the dedication and achievements of staff and leaders as a successful launching point for improvements.

“Next, guided by clear priorities and objectives, based on stakeholder feedback, one way of determining first steps is using the effort/impact and benefit matrix to identify quick wins and concomitantly, opportunities for maximum long-term results,” says Patrick Gaskin, CEO of Cambridge Memorial Hospital.

The extent of change leadership required is contingent on the recent evidence, potential, and scope: some ideas invite a pilot, trial, or further data support, some are as a simple as “just do its” at the unit or service level, some can be implemented through HR processes, others can be supported by the Quality Improvement/Patient Safety team, some require system-wide formal change leadership processes and integration into existing systems, and some warrant lobbying government for policy changes.

The ultimate goal is to embed the best ideas in the organizational DNA. How is this achieved? Ms. Hélène Sabourin, Co-Chair of Organizations for Health Action (HEAL), clarifies that this means institutionalizing proven successes in revised policies, structures, processes, people engagement, and communication, especially using many forms of media. Another layer, as Mr. Alex Munter, CEO of the Children’s Hospital of Eastern Ontario (CHEO), adds, is to use evidence-based methods to evaluate, iterate, and spread improvement throughout the organization. Brigadier Scott Malcolm, MD, Deputy Surgeon General of the Canadian Armed Forces, reinforces that beyond vocal endorsement, this requires dedicated resources (financial and human).

A crucial point is that this should not be a one-time event. Ms. Jo-Anne Marr, CEO of Markham Stouffville Hospital, advocates becoming an adaptive, learning organization through adopting, system-wide, the process of trying new things, with management support, experimenting, and not being afraid to fail in a continuous cycle of change, testing, feedback, and re-learnings. This approach to learning and leading is the way forward, redundancy is the alternative.

Though manifold system improvement is an important and exciting prospect, Ms. Julia Hanigsberg, CEO of Holland Bloorview Kids Rehabilitation Hospital, cautions that it is vital to be cognizant and respectful of staff change fatigue and capacity limits.

Finally, throughout this process, Ms. Marianne Walker, CEO of Guelph General Hospital, contends that it is paramount to share lessons and best practices through research publications, practice tools, and guides.

Lest we forget, now is the time to gather and implement lessons learned, as one anonymous respondent stated, since, as General Marc Bilodeau, MD, Surgeon General of the Canadian Armed Forces, warns, if we do not do this in the first year following the stabilization of the crisis, it will never happen.

Looming over the potential improvements is an “or else” component to squandering this opportunity:

• We will miss ideas that could likely improve our systems and care,
• We will miss an opportunity to increase staff morale and engagement,
• We could expose ourselves to vulnerability to being devastated by future crises, and
• We will miss an unprecedented opportunity to transform our organizations by embedding a system-wide, iterative process and becoming a more agile, innovative, and effective learning and leading organization. This isn’t a one-off; it could be our DNA.

With the utmost appreciation for the strain on health leaders now and gratitude for their tireless and invaluable work, when the prospect of debriefing the pandemic and building back better is posed this way, how can anyone afford to miss this opportunity?

Jaason Geerts, PhD is the Director of Research and Leadership Development at The Canadian College of Health Leaders.