Introduction
A state of crisis normally results in unprecedented consequences on people and formal structures of institutions and infrastructures. Leadership for public health crises and emergencies must respond to these crises emergencies, execute crisis management plans, and demonstrate leadership strategies. Therefore, formal leadership during public health crises and emergencies is critical for effective responses. However, in some situations, formal leadership may fail during public health crises and emergencies. This could lead to unprecedented effects on humans and properties.
The word leadership has broad usages. In this context, it would refer to decision-makers, managers, and directors, or simply persons responsible for managing public health crises and emergencies. In health care emergency and crisis management, leadership is critical for an effective response system. Hence, scrutiny of the leadership on managing the response system starts immediately. The provision of leadership may start at the local levels among the community affected by the disaster.
At this point, the media can severely criticize any apparent weaknesses and failures of the leadership system in their responses. Thus, the role of leadership in managing public health disaster is essential for the victims, as well as other people that the disaster could have affected in different ways.
One major imperative aspect of disaster and crisis management is people. People include those who respond to crises and emergencies in order to help disaster victims. Such actions would result in ineffective use of available resources in order to reach the greatest number of people who need help.
One must recognize that understanding leadership in public health crises and emergencies is a complex affair under the unique prevailing circumstances, which require effective mitigation, adequate preparation, response, and recovery. There are different leadership behaviors under such circumstances. Others may be effective and imperative, whereas other leadership behaviors could face significant challenges.
Key challenges in providing leadership during public health emergencies and crises
The main source of challenge in providing leadership during public health emergencies and crises is communication. In most cases, the bureaucratic officials may take over control of the situation and hamper effective communication. As witnessed in the previous public health emergencies, political leaders and local leaders normally assume control of the situations. They want to reassure the affected people and the public that the emergency is under control even when it is impossible to manage. On the other hand, leaders can communicate information, which can aggravate the public’s panic, particularly when they exaggerate the emergency situation.
Some leaders may not be effective in providing reliable information to the public as the crises develop. They can break the public confidence by their declarations. In this regard, communication should be reliable, accurate, and effective, and it must come from an authority that has the power to communicate such updates to the public. Unfortunately, in most cases, public health and medical leaders may also lack effective communication strategies, particularly to the public.
They may use medical terminologies, which are beyond layman’s comprehension. While political leaders may be willing to communicate to the public, they may lack reliable information that the people want. On the other hand, public health leaders and professionals may not be willing to address the public. Therefore, effective coordination of communication channels between these groups is critical for reliable and accurate information during emergencies and unfolding crises (Kahn, 2009).
The decision-making process is another significant challenge during emergencies. A number of factors, including legal aspects, influence decisions during emergencies. Severe health emergencies and crises, which overwhelm the local or national capacity, may require authorities to declare a state of emergency. However, public health leaders might not be the right people to make such decisions. Such situations require political leadership to do so because of the responsibilities they owe the nation. For instance, a bioterrorism attack may require the country’s leadership to protect its citizens. On the other hand, this is also a public health emergency and crisis.
Therefore, it becomes the responsibility of the state. This situation can lead to confusion, complex affairs, and lack of communication. Therefore, it is important for public health officials and the state to declare who should take charge of public health crises and emergencies. Delaying responses due to such complexities and duality may not serve the best interest of an anxious public.
Lack of coordination among different stakeholders can negatively influence leadership during a public health crisis. Parties who recognize and understand their roles can facilitate recovery efforts and delivery of services to the affected groups. However, when there is a miscommunication among stakeholders, leadership challenges may emerge and derail all efforts. Leaders must develop a working relationship in order to coordinate public health issues.
In fact, a lack of a working relationship among leaders can affect decision-making processes. These challenges will eventually affect victims. In some cases, public health officials may show a lack of involvement in the process. Media and other stakeholders can criticize them due to their poor coordination and poor leadership. Leaders must have a clear knowledge of the crisis before making public utterances. They must also be able to coordinate all forms of activities, which go on during recovery processes.
Some public health leadership may lack a framework for strategies, methodologies, norms, and standards for responses after an emergency. In addition, they may not know how to respond to the impending humanitarian crises. Such frameworks are essential in guiding public health leaders to manage situations. However, they must recognize that no two emergencies are similar. Hence, such frameworks should only act as guidelines on general areas, which are common to all emergencies and crises. Public health leaders should have such frameworks to assist them in the coordination of various post-crisis activities. Moreover, they are also useful for the implementation of various interventions in order to curb further damages, restore normalcy, and enhance the lives of communities affected (Wright, Rowitz, and Merkle, 2001).
Lack of data to act upon can derail leadership actions. Emergencies and crises create new situations with a sense of insecurity, confusion, and anxiety. This could result from a lack of adequate information. It becomes difficult to allocate scarce resources when key facts of the events are not known. This suggests that assistance may not reach the victims in a timely manner. Moreover, it may also be difficult to request help since the magnitude of the disaster or the number of resources required may not be known immediately. Still, there are no adequate infrastructures to allow leaders to mobilize resources for effective responses.
Differences in challenges between expected or ongoing public health crisis or emergency and sudden or an emerging crisis or emergency
An ongoing emergency or a crisis differs in many from a sudden crisis. Hence, leadership challenges in these scenarios may be different, but some may have close relations.
Crisis communication is a constant process that public health leaders must maintain throughout the period of the emergency or crisis. Ineffective communication results in poor management of a crisis. In poor communication systems, public health leaders may commit some fundamental mistakes. First, a lack of a “formal organization among stakeholders and leaders can hamper communication” (Yilmaz, 2011). Some stakeholders can decide to withhold information from other stakeholders and the public. After a few days into the crisis, stakeholders can be able to coordinate and assemble a team to manage communication processes and information dissemination to the public. Public health leaders and other government officials should not make opposing statements.
Second, during crisis management, the message should be clear and accurate. Public health officials should ensure transparency and provide available data. They should not hide any information from the public due to a lack of adequate information. Third, “communication processes require synchronization” (Yilmaz, 2011). It is important to consider all details of the disaster before any public announcement.
The usages of new strategies as the crisis unfolds may not present challenges. Leaders may be familiar with the new requirements because of information they may aid in the allocation of resources. Moreover, there would be aid from different sources. These contributions normally lessen the pressure on leaders and reduce the vulnerability of the victims and the community.
Leadership challenges in an ongoing crisis may rely on available information to mitigate health challenges, reduce the loss of lives, properties, and other health risks to the public and communities affected. Ongoing projects have robust systems of assessment and decision-making processes. Moreover, leaders can monitor the progress of the situation.
It could be easier to coordinate activities in an ongoing process rather than in a sudden emergency. Leaders may find it easier to work with other interested bodies and other health partners. They may adopt an inclusive model to facilitate the inclusion of all stakeholders in the process. This could result in a coordinated process rather than in a sudden state of emergency.
Challenges in an ongoing crisis could have low-levels of impacts because leaders may have logistics support hubs, infrastructure, experts available, and frameworks for the system. In this manner, they can manage supplies, water and sanitation, nutrition for victims, and effectively manage funds and other key areas during emergencies.
While leadership challenges in both cases may be similar, they differ based on the intensity and impacts on the emergency. A sudden state of an emergency or a crisis presents significant leadership challenges than an ongoing one. Crisis communication remains the single constant factor that is necessary throughout the process.
Potential solutions to the challenges
The most important aspect of managing a crisis or an emergency is to have a plan and implement it effectively. Most disasters result in severe damages and humanitarian crises because public health officials and leaders may fail to plan and implement their plans. Normally, effective preparation begins with the identification of a crisis or emergency. A country should have a communication guideline for managing crisis communication.
It is also necessary to have a response team with working knowledge in their roles. A readily available framework can provide guidelines on how leaders can organize their roles and communicate the same to other members as soon as the emergency or crisis starts. An effective plan should borrow from the best practices in crisis communication management. Such a crisis communication plan normally stipulates communication procedures, teams, and provides a centralized way of communication and exchange of information. A crisis communication plan allows public health leadership to overcome systemic challenges and actively assess information presented by all parties before making public announcements. This can prevent cover-ups and possible communications of inaccurate information.
Moreover, no public health official would have the opportunity of relaying unverified information to the public. Slow communication from public health leaders can make the situation worse than anticipated. In such cases, the media may seek news or information from untrustworthy sources that could do further damages to a crisis management process. Such sources can only cause confusion and heighten the public’s anxiety about a crisis.
At the same time, trained public health leaders would have known how to “react quickly, tell the truth, explain technical data to laymen, and harmonize crisis management and crisis communication” (Yilmaz, 2011). The aim of communication from public health leaders is to develop trust with the public. Proper preparation remains the most important aspect of managing all crises and emergencies.
Recognition: local authorities and leaders must recognize a hazardous event that results in an emergency or a crisis. For instance, a bomb explosion may trigger leaders to recognize an event as a health hazard. The response effort then commences in earnest in order to save lives.
Allocation of scarce resources: emergencies raise issues concerning scarcity of resources. Both sudden and ongoing cases are no exception. Therefore, public health leaders must allocate scarce resources using ethical and clinical guidelines. Critical supplies that may be in short supply include medication for the survivors, surgical supplies, and rescue team personal protective gear. Public health leaders must ensure that these resources have controlled distribution to serve the majority.
Disaster assessments: public health leaders must assess the extent and impacts of an emergency situation. They must begin collecting data for information needed to facilitate the response processes. Public health leaders must be able to know at any given moment what is taking place, where it is taking place, what the survivors need, and what resources are available. The nature of any emergency or a crisis may increase in complexity due to its size and scope.
In order to ease the task, public health leaders must categorize the assessment into two groups. Situation or damage assessment to determine what has happened as a result of the emergency or crisis. This will allow public health leaders to determine the geographical scope of the disaster, how it has affected people and structures. Therefore, they must seek data related to the area affected, number of people affected, number of injured (morbidity) and killed (mortality), types of injuries and illnesses, conditions, and characteristics of the victims. At the same time, data on medical, health, nutritional, water, and sanitation conditions of the victims are also necessary.
The need assessments also involve a collection of data on ongoing or emerging hazards because of the spread of health concerns and humanitarian crises. They must also assess damage to infrastructures and critical facilities, residential and commercial structures affected, the vulnerability of the affected population to ongoing or expected related and unrelated hazards, and current response effort in progress. The need assessment involves collecting data on services, resources, and assist public health leaders will require in addressing the emergency.
The consequences of an emergency or a crisis may persist for a long duration because of emerging concerns that result from damages caused. Hence, treating the hazard is critical for the process. However, public health leaders must ensure that people who respond to the emergency must limit or eliminate danger to survivors. Public health leaders must call in specialists with special equipment and training on the emergency.
Coordination: public health leaders must develop an action plan for disaster coordination. Coordination is a vital and immediate component of disaster response because of the number of responding agencies that come to rescue the victims. In order to save many lives, property and alleviate suffering, public health leaders must ensure successful coordination and cooperation in safe and efficient use of response resources. The coordination process ensures that there are limited wastage, infighting, nonparticipation, confusions, and inefficient use of resources during emergency situations.
In order to ensure the most effective coordination, public health leaders should ensure that the local government administration, emergency manager, fire officer, and police department should maintain leadership at all times. This happens because the local response leaders may be familiar with the case, the area, affected people, infrastructure, geography, and other issues necessary for a successful response. In case the local leadership is unable to take leadership coordination, then public health leaders should ensure that the national government takes charge.
Declaration of disaster: crises and emergencies usually cause a public scare. Public health leaders must arrange for a disaster declaration plan. The government must acknowledge that response resources are limited, and more support is necessary, particularly to manage emerging cases. Public health leaders must also put in legal requirements depending on the laws of the land as established in emergency operations and planning.
Planning: public health leaders must ensure that the planning section provides support through gathering, evaluating, disseminating, and using available and accurate information about the progress of the incident and the functional status of all the available responders and resources. Public health leaders must create an Action Plan (SAP) to provide overall guidance and management for response operations. They must focus on collecting, evaluating, and displaying incident information and intelligence. This part also looks into preparation and documentation of APs, doing long-range contingency plans, creating plans for demobilization, and tracking incident resources.
Public health leaders must allow the local government, who has the primary responsibility, to respond to the emergency. The approach must be step-by-step as it goes high to the national government. This should happen when the local authority cannot handle the disaster at the local level. The local authority must communicate this information to the local executives, who then decide to declare the emergency or crisis as a disaster and appeal to the next level of authority for assistance.
Logistics: the response to an emergency or a crisis depends on all the support and logistical provisions, which start as soon as the resources are deployed. Response tools include rescue team, equipment, facilities, and vehicles. The Logistics section looks into acquisition, transport, and distribution of resources, provision of water, food, and medical attention. The Logistics section also ensures that there is personnel to operate equipment and perform other logistics tasks.
All these aspects of crisis and emergency management require effective planning and communication among all stakeholders. This would eliminate several leadership challenges.
References
Kahn, L. (2009). Leadership in a public health crisis. Web.
Wright, K., Rowitz, L., and Merkle. A. (2001). A Conceptual Model for Leadership Development. J Pub Health Man Prac., 3(5), 72-79.
Yilmaz, S. (2011). Fukushima Nuclear Disaster: A Study in Poor Crisis Communication. RSIS Commentaries, (93), 1-3.