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Publications

Leadership in Times of Crisis: The Example of Ebola Virus Disease in Liberia

Future Health Systems

Nyenswah T, Engineer CY & Peters DH (2016) Leadership in Times of Crisis: The Example of Ebola Virus Disease in Liberia, Health Systems & Reform, 2:3, 194-207, DOI: 10.1080/23288604.2016.1222793

Abstract

The Ebola epidemic of 2014–2015 was one of the most significant public health threats of the 21st century, a crisis that challenged leadership in West Africa and around the world. Using the experience of Liberia's epidemic control efforts, we highlight the critical role that leadership played during four phases of the epidemic response: (1) crisis recognition and early mobilization; (2) the emergency phase; (3) the declining epidemic; and (4) the long tail. We examine how the decisions and actions taken in each phase of the epidemic address key crisis leadership tasks, including sense-making, decision making, meaning-making, crisis termination, and learning, and assess how leadership approaches evolved during the different epidemic phases to accomplish these tasks. A contingency leadership theory lens is used to identify situations where strong leadership, good leader–member relations, and well-structured tasks can facilitate different leadership approaches. The first phase of the epidemic was hampered by insufficient attention to sense-making and weak decision making, in part because of the existing hierarchical leadership approach. This contributed to amplification of the epidemic. The emergency phase of the epidemic brought a change in leadership that focused on sense-making, decision-making, and meaning-making tasks. A distributed leadership approach replaced the old hierarchies. In addition to sharing leadership responsibility and authority, the distributed leadership approach involved strategically engaging stakeholders and communicating intensively. Although much of the hierarchical leadership approaches returned in the latter phases of the epidemic, there remain more empowered leaders at different levels across the country. Systematically tackling crisis leadership tasks, recognizing situations where different leadership approaches can be used, and employing a distributed leadership approach are helpful lessons to prepare for and respond to future crises.