Building Health Services in a Rapidly Changing Landscape: Lessons in Adaptive Leadership and Pivots in a COVID-19 Remote Monitoring Program

Abstract

Adaptive leadership has become an essential skill for leaders in health systems to respond to the COVID-19 pandemic as new knowledge emerges and case counts rise, fall, and rise again. This leadership approach has been described as an iterative process of taking a wide view of the situation, interpreting the meaning of incoming data from multiple directions, and taking real-time action. This process is also common in start-ups, which attempt to create new products or services of uncertain value for consumer markets that may not yet exist. Start-ups manage uncertainty through “pivots,” which can include changes in the target group, need, features, or intended benefit of a product or service. Pivots are large changes that account for the high likelihood of getting something wrong during development, and they are distinct from the “tweaks” or small tests of change that define quality improvement methodology. This case study describes three pivots in the launch of a remote monitoring program for COVID-19. Adaptive leadership helped inform strategic decisions, with pivots providing a framework for internal and external stakeholders to articulate options for changes to address shifting needs. There is considerable uncertainty in the appropriate design and implementation of health services, and although this case example focuses on the use of adaptive leadership and pivots during a pandemic, these strategies are relevant for health care leaders at any time.

Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity

“…Most solutions at the start of the pandemic were mainly intended to support contact tracing and symptom monitoring for self-use by individuals, without any input from clinicians [ 46 ], or remote monitoring solutions created by hospitals and health service organizations adapting to rapidly address shifting institutional needs [ 56 ]. The involvement of clinicians and close monitoring of symptoms is critical for individuals with asymptomatic, mild, or moderate disease from the standpoint of the potential for the sudden emergence of severe symptoms and unexpected deterioration [ 69 ].…”

“…A recently published viewpoint article by Laur and colleagues [ 56 ] provides an excellent case study of the challenges of building health services in the context of the rapidly changing COVID-19 landscape. The authors offer perspective through lessons learned in adaptive leadership, drawing upon their experience of developing a COVID-19 remote monitoring program, from a hospital-based health system perspective.…”

“…They draw upon the process of making “pivots” during development, a process that is commonly used by digital health startups to manage uncertainty, and explain how these strategies hold relevance for health care leaders at any time. The viewpoint by Laur et al [ 56 ] provides an excellent consideration of the decisions made by hospital-based health service providers developing a COVID-19 remote monitoring plan and this viewpoint provides readers with additional considerations in the digital health development process.…”

Implementation and Evaluation of COVIDCare@Home, a Family Medicine–Led Remote Monitoring Program for Patients With COVID-19: Multimethod Cross-sectional Study

“…CC@H was launched on April 8, 2020, and is based at the WCH, an ambulatory hospital in Toronto, Ontario, Canada. Adaptive leadership and ongoing improvement cycles were used to adapt the program to meet system needs as the pandemic evolved [ 29 ]. An in-depth description of the strategies used to adapt the program and additional contextual factors are provided elsewhere [ 29 ], as are details about the model of care [ 27 ].…”

Integrated Care’s New Protagonist: The Expanding Role of Digital Health

“…From a normative standpoint, regions, health, and social care organizations, and those delivering services had to adopt an adaptive mindset to be able to rapidly meet evolving needs of their communities [24]. One integrated model in the east end of Toronto, Canada's largest city, was able to quickly adapt; leveraging existing integration activities to mount a rapid response to the pandemic.…”