The lost years or a spectacular 2021: Health leadership in 2021

By Jaason Geerts     

The early months of 2021 will define health leadership as it advances.

The recent approval and distribution of vaccines suggest to many that the global crisis will soon be over in a panacea-like manner.  Experts, on the other hand, estimate that international herd immunity (resolution) is years away.

This gap might encourage people to relax in, or disregard, adherence to public health directives (masks, physical distancing, etc.) prematurely, which could lead to superspread events and further community transmission, which threaten to devastate health systems.

Another risk at this stage of the pandemic is slipping into the Waiting it Out (WIO) syndrome: simply plodding along on autopilot until it’s over.  The longer this mindset persists, the more joy, passion, productivity, and mental health plummet.  The danger of an extended WIO syndrome is that the entire pandemic experience blurs into “The Lost Years”: a bleak period with little gain but the myopic passage of time.

The alternative – thriving in the midst of the pandemic – has been demonstrated by the myriad of quantum-leap like advancements in individual and collective resilience, creative innovation, collaboration, distributed leadership, and integrated care.  The extent to which organizations can thrive in this context – the challenges, leaps, and opportunities – will characterize effective health leadership in 2021.

Health leadership in action

This article is informed by ten months’ of international research on leadership during the pandemic by the Canadian College of Health Leaders (CCHL).  We also contacted nearly 60 CEO’s of Canadian hospitals, provincial and regional health authorities, and national health organizations.  The CEO’s responded to the following questions, which frame our discussion of health leadership in the coming year: 1) What is your biggest leadership challenge now? 2) What has been the most remarkable achievement by your organization in the past year? 3) What is your vision for 2021 that inspires you?

Current challenges

Nearly every CEO referenced staff exhaustion and burnout as a pressing current challenge.  Even after breaks, people are rarely fully recharged.  Ms. Julia Hanigsberg, CEO of Holland Bloorview Children’s Rehabilitation Hospital , summarizes the cause: “We have never faced a time of such uncertainty and volatility without a clear end”.

The multitude of competing priorities contest how to best direct people’s energy: preparing for additional emergencies, maintaining day-to-day operations and caring for staff, patients, families, and communities, managing the non-essential service backlog, and strategic future planning.  Concomitantly, as highlighted by Dr. Carr, CEO of the Nova Scotia Health, and others, is how to explicitly address equity, diversity, and inclusion in our systems.

Motivating and enabling staff to perform at their best in this context is a key challenge.

Achievements 2020

The two most commonly mentioned achievements in the past year were pride in the organizational response to the pandemic and the way in which people collaborated toward a common purpose.  A plethora of groups were mentioned, including nurses, physicians, frontline staff, environmental services personnel, procurement officers, HR professionals, staff who shifted roles or sites, positional and executive leaders, and others.

Other specific achievements include ensuring availability of providence-wide Personal Protective Equipment (PPE) for all healthcare workers and partners (Dr. Yiu, Alberta Health Services), near-instant pivoting towards virtual care, as demonstrated by the Holland Bloorview Kids Rehabilitation Hospital, who delivered as much virtual care in March than in the previous ten months combined, and by the Children’s Hospital of Eastern Ontario (CHEO), who launched Canada’s first pediatric virtual emergency department almost overnight.  Some organizations opened new wings during the pandemic, while Mackenzie Health has been preparing to open the first new hospital in the province in more than 30 years.  The steady influx of new Certified Health Executives (CHE’s) through the Canadian College of Health Leaders (CCHL) this year has highlighted an increasing commitment to leadership and development by health professionals across the country.  Lastly, some organizations were able to advance their Strategic Plans (The Royal Mental Health Centre, Ottawa) and develop new Strategic Plans (Eastern Health, the Centre for Addiction and Mental Health).

To summarize, Dr. Cohn, CEO of Sick Kids, concludes: “Yes, as challenging as it has been, the teams have also looked for opportunities to leverage this crisis and improve our patient care”.

One-year vision

Although no one would have wished for this pandemic, two CEO’s described this as a “once in a lifetime opportunity”, as Dr. Catherine Zahn, CEO of the Centre for Addiction and Mental Health (CAMH), describes, “to imagine a fresh start that builds on learnings and allows us to make bold changes”.  These learnings can be directed toward accelerating key priorities (Mr. Alain Doucet, CEO, CCHL), addressing long-standing systemic challenges and disparities related to social determinants of health, strengthening relationships among people across the continuum of care, and optimizing the integration of patient- and community-centred care.


Leadership priorities for 2021

  1. Prepare for the long haul in terms of mindset, staffing, and energy (Dr. Andy Smith, CEO, Sunnybrook Health Sciences Centre)
  2. Prioritize health: physical, emotional, and psychological. The longer this pandemic extends, the more important it is to ensure that staff are taking breaks without guilt and that informal and formal supports and backups are in place (Dr. Joanne Bezzubetz, The Royal Mental Health Centre, Ottawa).
  3. Reinforce the North Star and provide islands of certainty in the sea of uncertainty (Dr. Jennifer Zelmer, CEO of the Canadian Foundation for Healthcare Improvement (CFHI)) by reinforcing what is not changing: our purpose, values, and vision.
  4. Celebrate people’s crisis response achievements, resilience, innovation, and collaboration beyond their own walls (the Markham Stouffville Hospital vision). One example is at Queensway Carleton Hospital, where staff were given “QCH strong” t-shirts.
  5. Learn intentionally to improve our processes, ourselves, our teams, and our organizations.
  6. Re-focus and re-imagine which priorities are most essential… and which are not and should be dropped, parked, or managed elsewhere. Next, with a system lens, collaboratively reconsider how each can be most effectively addressed.  This is the heart of the matter and the operationalizing of the North Star.
  7. Inspiring “a spectacular 2021” (Ms. Suzanne McGurn, CEO of Canadian Agency for Drugs and Technologies in Health (CADTH))


Despite tragic experiences, many pervasive challenges, and the toll that they have taken, much has been achieved, including remarkable quantum leaps of advancing integrated care.  Overcoming the Waiting it Out syndrome and evading “the Lost Years” requires the six steps above, as well as something creative in our current work that inspires and energizes us to achieve the seventh.  Thriving in the wake of this storm by focusing on exciting next steps, along with our health and well-being, will be a key test of health leadership in the coming months.

That, in 2021, is our New Year’s wish… and resolution.

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