Article by Ben Ramalingam , David Nabarro , Arkebe Oqubuy , Dame Ruth Carnall and Leni Wild
The Covid-19 pandemic is constantly evolving, with leaders facing unpredictability, imperfect information, multiple unknowns, and the need to identify responses quickly — all while recognizing the multi-dimensional (health-related, economic, social, political, cultural) nature of the crisis.
Responding to the crisis requires adaptive leadership, which involves what we refer to as the 4 A’s:
- Anticipation of likely future needs, trends and options.
- Articulation of these needs to build collective understanding and support for action.
- Adaptation so that there is continuous learning and the adjustment of responses as necessary.
- Accountability, including maximum transparency in decision making processes and openness to challenges and feedback.
All of the 4 A’s are plain to see in the most successful responses to the pandemic. Take the pharmaceutical firm AstraZeneca. Thanks to their large Chinese operations, they learned about the virus early, and started working to anticipate future needs and issues, while also navigating the considerable uncertainties and unknowns. They articulated these needs to a wide range of internal and external stakeholders to garner commitment and support, and adapted a range of new business models and partnerships to effectively meet the most urgent Covid-19 needs — most notably vaccine development, but also testing and screening methods, health facility development, and the use of AI to support diagnostics and case management. Perhaps most notably, the firm has established an inclusive approach to accountability, with a commitment to support the global Covid-19 response “as economically and as equitably” as possible — including numerous agreements for the large-scale production and distribution of any successful vaccine at zero profit during the period of pandemic.
From our collective experience at the heart of WHO’s Covid-19 response (David), advising those at the top of national governments (Arkebe), leading and advising on large complex health and care systems (Ruth), and supporting crisis responses in developed and developing countries as well as humanitarian settings (Ben and Leni), we have identified five common principles to guide this kind of adaptive leadership across the Covid-19 response.
1. Ensure evidence-based learning and adaptation
Adaptive leadership means teams and organizations need to constantly assess their actions, recognizing that they will have to continuously iterate and adapt their interventions as they learn more about the outcomes of decisions. This requires clear processes for determining the best options for action; collecting, interpreting and acting on evidence, including defining a set of key measures for determining success or failure; ensuring ongoing collection of operationally relevant data; and setting out a clear process for how changes in data and trends will trigger changes in action.
Putting social learning and adaptation at the center of the response in this way has been found to be a crucial element in recent disease outbreak management, most notably in dealing with Ebola in West Africa. An analysis of the successful eradication of smallpox has shown that the success was attributable to processes of strategic adaptation and learning — more than any other single factor.
This learning process must be open and diverse to be effective. For example, the German government enlisted the advice not just of epidemiologists and medical specialists, but also social scientists, philosophers, historians of science, theologians, and jurists as it navigated the delicate ethical balancing act of reopening society while safeguarding the health of the public.
2. Stress-test underlying theories, assumptions, and beliefs
Just as institutions such as banks regularly undergo stress testing to ensure they can deal with future crises, the assumptions and hypotheses guiding an adaptive response need to subject to robust and rigorous reflection and examination, including through the simulation of different possible future scenarios.
One of the most systematic and rigorous approaches to Covid-19 scenario planning has been developed by Boston Consulting Group. Drawing on military approaches to strategic learning, they advocate that firms establish an integrated model of “anticipation, intelligence, and response” that can underpin business decision-making. Using such an approach, different scenarios have been developed for use by the automotive, fashion, and luxury goods sectors. These scenarios account for critical uncertainties in the public health situation, the impact of government measures, the wider economic environment and business-specific demand forecasts, and make use of real-time monitoring as the basis for decision-making.
3. Streamline deliberative decision making
A major challenge faced by leaders is that the data on Covid-19 is changing all the time and is often contradictory. Where decision makers feel threatened, they are much more likely to revert to risk-averse and siloed responses to ensure a degree of safety that results from narrowly defined targets.
Decision makers at different levels therefore need to be clear about what they are basing their assumptions and hypotheses on. They need to explain what is being done and why, and how a decision was made, so that if errors are identified, trust can still be maintained in the process.
The most successful national responses — in South Korea, Taiwan, and Germany; in less well-publicized initiatives, such as in Vietnam and Ethiopia; and in sub-national efforts such as Kerala, India — have used the pandemic as a catalyst for transforming the policy process, making it more open, dynamic and nimble. These responses have also improved integration across different systems — from health care to transportation to energy — which has resulted in unprecedented levels of planning, information sharing, and coordination.
4. Strengthen transparency, inclusion, and accountability
People around the world have been asked to make major behavior changes, and these bring significant costs for society, businesses, and governments. Because the stakes are so high, there is a need to examine how earlier decisions were made, bearing in mind the information available at the time. Ongoing real-time assessment of the response is needed to maximize learning. Such assessments should include all relevant stakeholders — from professionals to affected populations.
The best adaptive leaders — from business leaders to policy makers to community organizers — have recognized mistakes are likely to be made and actively used them to identify shared learning opportunities. For example, the UK’s National Health Service has held an open, honest, and challenging dialogue about how institutionalized biases in dealing with Covid-19 have led to greater levels of pain and suffering among black and ethnic minority patients and staff alike. And there has been acknowledgement at the highest levels that however difficult this process might be, this had to be seen a “fundamental inflection point” for one of the world’s largest health care providers.
The European Centre for Disease Control and Prevention has advocated the use of after-action reviews and similar processes to assess how public health decisions were taken at different points and on what basis. Given the fact that the pandemic response is increasingly being viewed as a marathon and not a sprint, it is vital to assess what has happened so far, to identify strategic priorities, and to exchange lessons learned. This means leaders need to commit to sharing their thinking at every stage and by acting in such an open and transparent way, set a benchmark for how to engage with constituencies and stakeholders as the pandemic progresses. More than that, by acknowledging their fallibility, leaders create an environment of candor, psychological safety, and mutual trust that is vital for effective crisis response.
5. Mobilize collective action
The Covid-19 crisis is not just a public health crisis; it’s also an economic, social and political crisis. It is a “complex systems” problem that requires changes in behaviors and incentives and in the relationships between different groups and organizations. Effective responses therefore need to build on collaboration across different sectors, industries and professionals and between international, national and local levels — an ambition that has often proved difficult to put into practice.
Collective action in this regard might be in the form of coordination (e.g. among businesses), partnerships among different interest groups (e.g. businesses and communities), or dialogue across a range of stakeholders. Adaptive leadership has a crucial role to play in helping to identify shared alignment of objectives and scope for collective action across different silos and levels of the response. Such interactions enrich debate, are inclusive, and improve ownership of decisions.
There have been some remarkable multi-sectoral interventions which span public, private and not-for-profit capabilities in exactly this way. In the UK, for example, shared awareness of the existing health care capacity underpinned landmark deal to rapidly commission of all private-sector hospitals for use by the National Health Service, at cost, leading to an accelerated scaling up of available beds and equipment. Civil society and citizen groups have also played a central role in mobilizing inclusive approaches the pandemic, especially in resource-constrained settings. Local responses have emerged in the form of community-led support for the most vulnerable in Bhopal, India; the repurposing manufacturing capability to enable locally produced PPE across the U.S.; and the strengthening of “social economy” approaches to rebuilding disrupted economies from the grassroots up in Canada and numerous European countries.
What we do in this crisis response will have repercussions for years and decades to come. These five principles of adaptive leadership are not just vital to guide our immediate responses; they will also be vital for shaping longer-term recovery and resilience plans. Our collective future may be uncertain, but this uncertainty is at the very heart of human creativity.