The COVID-19 pandemic presents a complex situation, requiring multiple stakeholders in the healthcare sector to work well together.

Many healthcare workers are experiencing high levels of stress and making considerable personal sacrifices to care for patients with COVID-19. They are in essence servant leaders, putting their own interests aside.

Some are even choosing not to live at home, to save their families from possible exposure to the virus. Others may be living at their place of work for the sake of those in need.

Conditions for healthcare workers can be demanding at the best of times. For example, the public healthcare system in South Africa faces numerous challenges and constraints.

We saw evidence of these in our 2018 study of four hospitals in KwaZulu-Natal province. The challenges included overcrowding, high bed occupancy rates, limited financial resources, budget constraints and critical shortages of staff.

The infrastructure was old, and there were shortages of essential supplies such as pharmaceuticals, bandages, drugs and linen. Medical equipment and technology was outdated or malfunctioning.

The study examined the impact of leadership on the delivery of healthcare services under these difficult conditions. We believe that leadership is the key to transforming public healthcare – and to coping with the COVID-19 crisis.

Leadership in the South African healthcare sector should focus on employee engagement and fostering more meaningful relationships between staff.

Leaders in the sector need to show empathy. They should help staff acknowledge and deal with the trauma that they may be experiencing.

Challenges from the frontline

There have been numerous accounts of nurses’ concerns and fears about the pandemic, and how some feel as though their voices weren’t being heard. There is growing uncertainty and anxiety, with staff having to prepare for the potential path of destruction that may be felt when the virus peaks in South Africa.

Some healthcare workers have spoken about the stigmatisation that they are experiencing, their concerns about whether their workplaces are being properly cleaned, whether there is enough personal protective equipment being supplied, and the risks that they face on a daily basis.

Nurses have highlighted that they may be required to work even longer hours, should their colleagues fall ill, or should patient numbers rise dramatically.

They bear the additional burden of having to witness first-hand the pain and suffering of patients infected with COVID-19 and, in many instances, the resulting loss of life. Healthcare workers are also concerned about the risks that their families now face as a result of them being at the forefront of the response to COVID-19.

In the pandemic, healthcare leaders will need to consider their “soft skills” – people skills will be critical and will demand situational leadership, with the aim of genuinely being in tune with the needs of healthcare workers.

What we learnt about healthcare leadership

Our study of four South African hospitals showed that weak leadership was contributing to poor healthcare service delivery. We asked lower-level managers and employees about the executive leadership at their hospitals.

These staff were from different occupational categories such as medical, nursing, finance, systems, supply chain management, pharmacy, human resource management and radiology.

Decision-making and leadership approaches by the health care leaders were considered significant for achieving health care goals in regional hospitals.

The study revealed that training, coaching and staff empowerment are crucial to build the capacity of workers in regional hospitals.

Most respondents agreed that managers are good leaders when they communicate achievements and service accomplishments to all staff members.

They said a democratic or participative leadership style was essential in a dynamic and uncertain health care environment because such leaders encouraged collaboration and consultation and focused on problem-solving.

We found that meeting the public demand for healthcare requires innovation and creativity. It’s also important for leaders to set standards, monitor performance and take corrective action.

The surge in COVID-19 infections and the consequent admission of patients has overwhelmed all professional staff and support staff at public healthcare facilities across the country. Doctors and nurses are overstretched.

It is particularly important that the leaders in these public health facilities provide the necessary support structures for frontline workers. This is key in them rendering effective, efficient and quality healthcare.

The lack of personal protective equipment, adequate medical equipment such as ventilators and shortage of skilled professional staff were highlighted as critical factors that posed a high risk when fighting COVID-19.

Therefore, it is crucial that all healthcare leaders in senior management positions show empathy towards the frontline workers when requests are made for personal protective equipment, additional staff or essential medical equipment to cope with the rapid influx of patients.

The pandemic is causing high levels of uncertainty with the added burden of stress for the clinical staff, so it is critically important that healthcare leaders are able to work collaboratively with all stakeholders to find innovative solutions.

Responsive leadership

It is important that healthcare leaders are able to ensure that the organisational culture is responsive, proactive and focused on addressing the needs of staff.

An integrated leadership approach, acknowledging the economic, social, psychological and cultural diversity of the population, is required.

Leaders also need to be aware of their own emotions and the stress that they themselves may be experiencing.

This crisis calls for healthcare leaders to be accessible, supportive and proactive, and willing to listen to and motivate followers, in order to meet the various needs of staff, especially those at the frontline of South Africa’s response to the COVID-19 pandemic. We are reminded that leadership is about followers and leaders working together to achieve shared outcomes.