Nana Pokua Appafram is the Human Resources Director and Amanda Slagle is the Quality Director at Nyaho Medical Centre in Accra, Ghana. Nyaho provides inpatient, emergency, ambulance, pharmacy, and laboratory services and runs onsite clinics for dentistry, pediatrics, cardiology, family medicine, and internal medicine. Below are lessons they shared during a recent edition of the Institute for Healthcare Improvement’s COVID-19 in Africa Call Series.

COVID-19 is challenging and changing the way staff work. In a recent report, the Society for Human Resource Management found that 34 percent of employers didn’t have an emergency preparedness plan before COVID-19. Over 53 percent of employers are currently revising their emergency preparedness plan.

When you add to that the global uncertainty surrounding COVID-19, communities are operating in an environment with immense fear. In health care, frontline staff may care for patients with the disease. It is critical to manage this fear. Crisis communication must be built on four pillars to develop trust and counter fear: honesty, transparency, accountability, and consistency.  

The team at Nyaho Medical Centre created an adaptive plan for their staff during the pandemic. Their human resources team implemented robust measures to ensure that staff had clear direction in their work. This began by ensuring staff safety through contact tracing and isolation. They asked questions such as: How do we define close contacts? What happens when someone is isolated? How do we deal with isolated staff coming back to work?

By creating clear and consistent answers to these questions, the team was able to provide peace of mind to the staff. They were able to then implement a risk assessment for staff and redirected staff who were at higher risk for severe illness to non-frontline positions or to take paid leave.

Nyaho Medical Center has found that open and honest communication between staff and leaders fosters a culture of trust and reinforces psychological safety in their workplace. This is especially important during this sometimes chaotic time when empathy and clarity are needed. Leaders must clearly and consistently convey to staff what they are doing and why. Transparency allows for trust to extend throughout each level of the organization. Having a shared understanding and definition of accountability as an organization helps to prevent a culture of mistrust and blame when situations do not go as planned. The final pillar, consistency, brings these components together and ensures staff reliably communicate about their efforts and adhere to promises made to team members.

Each of these pillars contribute to building staff trust. It is important for leadership to embody these values, particularly by providing clear guidance and instruction. Having a consistent and accessible voice allows for continued faith in leadership and reduces confusion. A leader with institutional power in an organization must work to create clarity, by being specific and vocal about what is being done and why. Leaders must be intentional about easing the discomfort of staff during this time.

In addition to the pillars for organizational clarity, any staff member can demonstrate strong leadership through key behaviors, especially in crisis situations such as the COVID-19 pandemic. Here are five keys to leading during a crisis: 

• Reduce emotional contagion — During these hectic times, staff members are concerned about their jobs, their families, and our collective future. Leaders can empathetically support staff by acknowledging these fears. At the same time, it is easy for negative emotions to spread throughout an organization. A leader can play a role in modelling coping strategies. This may consist of allowing ways for staff to process complex emotions and providing solutions when possible.

• Act and learn — Proactively learn and adapt to what may be needed. Keep an open mind and adjust responsibilities and attitudes to best support emergent concerns within these ever-changing environments.

• Model leadership — The best leadership anyone can bring to an organization is being one’s authentic self and bringing all the abilities you have to offer to the forefront. This includes being reliable, skilled, and kind. Modelling these behaviors can encourage and inspire peers and colleagues.

• Rely on others — To prevent burnout, do not take on more than you can handle. As there is no guarantee a crisis will be resolved quickly, managing one’s energy is important and can be completed best through the thoughtful delegation of tasks and streamlined workflow.

• Envision the future — Being proactive when possible may ease future stress and create a common vision for those you work alongside. By anticipating concerns that may occur down the line, you can plan how to accommodate different scenarios. Considering “what if” in both one-on-one conversations and facilitated larger group settings can inspire reflection. Wherever possible, take a step back to focus on the big picture of why you’re doing what you’re doing.

After staff understood the preparations for their safety during this time, the team prioritized enhancing plans to continue business and creating a single point of contact for all COVID-19-related matters. To ensure actions were driving the right outcomes, Nyaho Medical Centre leveraged virtual communication platforms, daily huddles, and text blasts. They also launched a survey to get feedback from the staff on safety, satisfaction, communication, and overall engagement. During these uncertain times, the team worked to support staff so they could better support patients.

Dieynaba Dieng is a Project Assistant at the Institute for Healthcare Improvement. Chelsea Canedy is a Project Coordinator at the Institute for Healthcare Improvement.