Crisis leadership behaviors in healthcare: survey validation and influence on staff outcomes in primary care clinics during the COVID-19 pandemic

Michelle Yang; Jenna M Evans; Sara J Singer; Jennifer Gutberg; Tracy H Porter; Agnes Grudniewicz

doi:10.1186/s12913-024-11061-5

Crisis leadership behaviors in healthcare: survey validation and influence on staff outcomes in primary care clinics during the COVID-19 pandemic

BMC Health Serv Res. 2024 May 7;24(1):590. doi: 10.1186/s12913-024-11061-5.

Authors

Michelle Yang¹, Jenna M Evans², Sara J Singer³, Jennifer Gutberg⁴, Tracy H Porter⁵, Agnes Grudniewicz⁶

Affiliations

¹ École interdisciplinaire des sciences de la santé/Interdisciplinary School of Health Sciences, université d'Ottawa /University of Ottawa, 25 University Private, Ottawa, ON, K1N 7K4, Canada.
² DeGroote School of Business, McMaster University, Hamilton, ON, L8S 4E8, Canada.
³ Department of Health Policy, Stanford University, 615 Crothers Way, Stanford, CA, 94305, USA.
⁴ Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada.
⁵ Monte Ahuja College of Business, Cleveland State University, 1860 E. 18th St, Cleveland, OH, 44114, USA.
⁶ Telfer School of Management, University of Ottawa, 55 Laurier Ave. E, Ottawa, ON, K1N 6N5, Canada. grudniewicz@telfer.uottawa.ca.

Abstract

Background: The COVID-19 pandemic triggered an unprecedented transition from in-person to virtual delivery of primary health care services. Leaders were at the helm of the rapid changes required to make this happen, yet outcomes of leaders' behaviours were largely unexplored. This study (1) develops and validates the Crisis Leadership and Staff Outcomes (CLSO) Survey and (2) investigates the leadership behaviours exhibited during the transition to virtual care and their influence on select staff outcomes in primary care.

Methods: We tested the CLSO Survey amongst leaders and staff from four Community Health Centres in Ontario, Canada. The CLSO Survey measures a range of crisis leadership behaviors, such as showing empathy and promoting learning and psychological safety, as well as perceived staff outcomes in four areas: innovation, teamwork, feedback, and commitment to change. We conducted an exploratory factor analysis to investigate factor structure and construct validity. We report on the scale's internal consistency through Cronbach's alpha, and associations between leadership scales and staff outcomes through odds ratios.

Results: There were 78 staff and 21 middle and senior leaders who completed the survey. A 4-factor model emerged, comprised of the leadership behaviors of (1) "task-oriented leadership" and (2) "person-oriented leadership", and select staff outcomes of (3) "commitment to sustaining change" and (4) "performance self-evaluation". Scales exhibited strong construct and internal validity. Task- and person-oriented leadership behaviours positively related to the two staff outcomes.

Conclusion: The CLSO Survey is a reliable measure of leadership behaviours and select staff outcomes. Our results suggest that crisis leadership is multifaceted and both person-oriented and task-oriented leadership behaviours are critical during a crisis to improve perceived staff performance and commitment to change.

Keywords: Health systems; Leadership; Pandemic; Psychometrics; Telehealth; Virtual care.

Publication types

Research Support, Non-U.S. Gov't
Validation Study

MeSH terms

Adult
COVID-19* / epidemiology
Female
Health Personnel / psychology
Humans
Leadership*
Male
Middle Aged
Ontario
Pandemics
Primary Health Care* / organization & administration
SARS-CoV-2
Surveys and Questionnaires

Abstract

Publication types

MeSH terms

Grants and funding