Managing long Covid has been challenging for Lesley Macniven, but it has also presented a unique opportunity for her to develop her leadership skills in an area outside of her usual profession, and contribute to the wider recognition of, and support for, the condition. Here, she reflects on what she has learned.
It occurred to me recently that if I had to choose a specialist subject, for, say, an appearance on ‘The Wheel’ I’d probably choose ‘leadership’. More recently I’ve become an armchair expert on all things Covid- 19, but during 2021 these two topics somehow aligned in my professional life. Two years into the pandemic, I’ve been considering what we have learned about leadership in this most challenging of times.
When I delivered Institute of Leadership & Management-accredited management training courses to aspiring academic leaders in Edinburgh, I asked participants, “what is the difference between leadership and management?”
My first slide, after the group discussion, shared a quote from ‘the father of modern management’ Peter Drucker:
“Management is doing things right; leadership is doing the right things.”
Can you see the difference? Which of your work behaviours could fall under either category? Both are important, and interdependent. My instinct was that unprecedented times would call for organisations and teams to revisit and redefine both.
My experience with Covid
Covid-19 went from an existential threat to exponentially rising cases, deaths, long Covid, Alpha to Delta, vaccinations, to “we’re out the woods”, to Omicron. Earlier this year we saw record-breaking increases in new infections, and staff absences across the NHS and elsewhere.
This pandemic case study is also personal; I contracted Covid-19 in the first wave, March 2020. Relieved I only had a ‘mild’ dose, I volunteered to moderate an emerging Facebook group ‘Long Covid Support’ for people with Covid-19 symptoms, not admitted to hospital but not recovered after the prescribed two-week period either.
Sat up in my bed, I devoured news coverage. I’d recently written an analysis of workplace inequality and realised I’d need another chapter. I’m now writing a whole other book.
Prior to my venture into creative writing, I loved working as a leadership development consultant in large organisations, developing their leaders and changing cultures from authoritarian and bureaucratic to more progressive, empowering, attractive places that still got things done. After encountering both ‘bad’ and ‘good’ bosses during my career, I became fascinated by the impact of leadership and what did and didn’t work. I moved into diversity and inclusion when I realised the default template for leaders seemed to be a middle-aged white man. Many women weren’t realising their potential, especially mothers, the ethnically diverse, the too young or too old, and the disabled.
I crammed all my findings from primary and desk research into a first draft of ‘This Woman’s Work’. Long listed for an award in May 2020, it has since gathered dust.
Onset of long Covid
Despite a mild Covid infection, over time I experienced ongoing long Covid symptoms, including fatigue, breathlessness, impaired mobility and cognitive challenges. This meant long-form writing was beyond me. Instead I became a campaigner; if we highlighted this ongoing condition, I thought help would come.
Daily statistical releases that focused on infections, hospitalisations and deaths would include us once our leaders get a grip of the pandemic and notice our plight. We were patient patients.
As our numbers swelled we thought, “they can’t ignore us now”.
Long Covid
Nearly half of employers managing workers with long Covid
CPD: Long Covid – a catalyst for greater multidisciplinary working (webinar)
I led creative writing workshops for long Covid colleagues in Scotland while we waited for treatment. We have a canon of stories from our perspectives as patients. Initially written for ourselves, we now share pieces publicly with audiences interested in this invisible second pandemic they know so little about. The whole process was cathartic, healing, fun even; feeling safe, heard and understood we exceeded our own expectations.
Writing the overarching story of this second pandemic to frame others’ stories, found me analysing it for examples of effective and poor leadership, identifying the consequences of each. It felt crucial to learn lessons easily missed during a crisis when it can feel counter-intuitive, reckless even, to pause, reflect and take stock.
My ire about inequality had shifted to the long Covid cause. I’d used coaching and writing skills to support ill people, I’d found ways to use these stories to drive change; the next step saw me slip seamlessly back into my professional consultant persona, though still from my bed.
Throwing myself into advocacy work precipitated a serious relapse. I realised I had to pace to manage my own recovery too. Long Covid recovery is not linear, symptoms can be cyclical and both can be exacerbated by cognitive as well as physical effort and stress. This delayed post-exertional malaise is experienced by many. However, getting stuck into work-like projects definitely helped ‘rehab’ my brain to read, write and focus more like it used to.
Imbued with a new sense of purpose I looked for gaps I could fill and effectively assumed several different voluntary roles, setting up teams and connecting with external bodies such as the Society of Occupational Medicine (SOM) and my professional body, the Chartered Institute of Personnel and Development (CIPD).
Pivoting my career
I’m not sure when I realised I was now donning my previous professional garb. From concerned patient, to patient advocate, to organisation spokesperson to independent leadership and change consultant I seemed to find a new direction, vocation or career pivot. This new niche drew on many different experiences that helped me join dots that more focused specialist leaders seemed to be missing.
When I was introduced to occupational health, a key phrase in the definition spoke to me – “the adaptation of work to people and people to their jobs”. I realised I was still effective, despite now being disabled by long Covid, by adapting to do work I could do. Rigid job requirements have seen many capable people lose their jobs. Yet a group of volunteers, all debilitated, effectively set up an organisation that has now formed the charity Long Covid Support.
When I was introduced to occupational health, a key phrase in the definition spoke to me – ‘the adaptation of work to people and people to their jobs’. I realised I was still effective, despite now being disabled by long Covid, by adapting to do work I could do.”
As the Employment Group chair during 2021, I formed a multidisciplinary consultancy, Long Covid Work, with other occupational health professionals with extensive research, education and training skills. Our mission is to encourage business leaders, line managers, other professionals, in HR, unions, healthcare to all take this “adaptation of work to people” approach by offering phased, flexible returns to work. With so many healthcare and other frontline workers affected, we cannot afford to lose their skills and experience from the workforce.
Insights from the past two years
I have drawn a number of conclusions from my review of the past two years, using a range of leadership models, and change management techniques and insights gleaned from working in large, complex, political organisations.
Insight number 1: You can’t solve a problem with the same thinking that caused it.
“Unprecedented” was the first word to enter the Covid-19 lexicon. Guidelines, rule books, policies in place had not been drafted to cover an unprecedented global pandemic. This was the perfect example of managing in accordance with established practice (or doing things ‘right’) didn’t cut it. Can you think of examples in your workplace?
The CIPD agrees: HR badly needs to revise return to work practices to accommodate the gradual, relapsing long Covid recovery to support and retain workers who potentially contracted this new virus at work when we had no effective personal protective equipment. Healthcare workers did their job, as instructed, got ill disproportionately to the rest of us, and don’t deserve to permanently lose both their health and vocation.
We need leaders prepared to evolve previous practice to make sure the organisation does the right things in relation to its key asset: its skilled workforce. Many efficient managers doing things ‘right’ may simply dismiss an ill employee after the prescribed period without exploring occupational health interventions, reasonable adjustments or even redeployment, only to discover there is no-one to replace the worker and they are facing an employment tribunal.
We need leaders prepared to evolve previous practice to make sure the organisation does the right things in relation to its key asset: its skilled workforce.”
Leadership rather than management is needed to innovate when the context changes.
Insight number 2: Multidisciplinary working is needed when the exact cause of the problem is unknown and its effects are wide-ranging.
We have seen confusion due to oversimplification of public health messaging. Long Covid is barely acknowledged yet is a key risk factor leaders need to consider when weighing up decisions.
Even now the condition’s complexity means we have little in the way of treatment. Someone ill with long Covid needs support from many professionals, from their GP to clinicians, their line manager, HR and ideally occupational health professionals. Unions are also becoming involved. Our consultancy, Long Covid Work, works with all these professionals and more to help create cohesive guidance and support for workers from diagnosis to full return to work by looking at their entire journey.
Many organisations, including the NHS, are set up in silos that do not easily interact. This has been a barrier to setting up more effective clinical care and to supporting return to work. It is down to the already unwell worker to case manage their care and integrate findings from different specialists and advisors. Long Covid Support and other advocates are clear on the advantages of multidisciplinary clinics, now being run across England. But these have only recently, with lobbying, started to consider supporting return to work as part of their scope. Some materials developed by my colleagues and I at Long Covid Work will shortly be added to the NHS patient website.
Insight number 3: The “too difficult box” exists.
Saying “do the right things” sounds easy but every organisation has barriers to overcome, and politics that complicate decisions. There have been many, many times when the new condition of long Covid was clearly categorised as “too difficult” and not given the focus it would have if the solution had been more straightforward. Unfortunately this conscious or unconscious bias can also lead to people suffering from the condition being seen as ‘the problem’. For example, by:
- A doctor uncomfortable at having nothing to suggest to their patient
- A line manager who wants the team to get the work done
- An overworked colleague who hasn’t had any explanation who thinks ‘they look fine’.
Part of occupational health can be to educate and inform, not just about the condition but how to manage and support a worker. Many workers have their situation worsened when they interact with people who blame the patient by criticising the ways in which they are unable to ‘do things right’. Instead, a good leader can offer support by simply listening. Empathising can diffuse some of the pressure and guilt felt by those unable to work as normal, and set the scene for problem-solving conversations to take place.
A good leader can offer support by simply listening. Empathising can diffuse some of the pressure and guilt felt by those unable to work as normal, and set the scene for problem-solving conversations to take place.”
Insight number 4: Most people are attached to the status quo; if it ain’t broke, don’t fix it.
Surveys of populations’ personality preferences, for example by organisations that produce leadership development questionnaires, have shown that in business, even the ‘business’ of healthcare, there is a general bias towards factual, known, concrete, evidence-based practice.
Many working practices have not evolved significantly and can hamper progress even when progressive legislation is passed. My research clearly showed this was one reason behind limited progress in regards to workplace equality. In the 50+ years since the Equal Pay Act was passed, working hours and culture, initially designed for men who worked full time with wives at home to take care of all their other needs, still prevailed. Anything else is perceived as an adjustment to the norm.
In other words, change tends to be incremental rather than transformational. Covid-19 has decimated our normal way of living and working. One significant silver lining could be to seize this chance to revolutionise and build back better without first having to persuade the traditionalists to break what’s already there. We’ve already disproven the myth that to be effective we all have to be sat in the same room all at the same time for the same amount of time. The normalising of flexibility working paves the way to greater inclusion of those who previously had to request specific adjustments, taking the onus off an individual identified as having special needs.
OH’s leadership role
OH applauded for ‘absolutely amazing’ response to the pandemic
Insight number 5: Black and white thinking is the enemy of complexity.
We also easily fall into binary thinking. People went to hospital (and possibly died) or stayed at or got discharged home (presumably recovered). Died or recovered; nothing in between. However, in January 2022 an estimated 1.3 million people in the UK with long Covid are currently hovering “somewhere in between”; 400,000 now disabled for over a year.
It’s important to remember that not everything can fit in a soundbite, one-page checklist or standard report. Leaders look at the spirit rather than the letter of policies and procedures to exercise discretion as to the right thing to do, based on culture, values and priorities.
With Covid-19 and long Covid people rarely look beyond the headlines to appreciate the devil in the detail. The current “hopium” that omicron variant is mild, despite very little evidence, flies in the face of insight number 4. It’s interesting how much less accountability accompanies those things that are not visible, which is why they are ignored, hidden away in the “too difficult box”.
Insight number 6: Many leaders were appointed as they were the best researchers, clinicians or technicians, but leadership requires a different skill set entirely.
One niche aspect of my specialist subject was a dissertation I wrote on transitioning from an academic to an academic leader. To successfully lead others you need to let go of factors that made you individually successful.
Do we measure leadership, from top down or bottom up? Both perspectives can look quite different. Sometimes the best leadership is as invisible to the team as when leadership is absent. A leader’s job is to set things up, find the right people, offer support then get out their way, coming back to celebrate the success and credit the team, or to pull out the personal and team lessons for next time.
Insight number 7: The age of competition needs to be replaced with greater collaboration.
I’ve worked in organisations training managers to use performance reviews, performance related pay, bonuses and succession planning effectively and fairly. This is not the default. Much inequality uncovered while researching ‘This Woman’s Work’ stemmed from unconscious bias, unhelpful stereotypes, organisational politics and the perpetuation of advantage, when managers favour people like themselves.
One solution was to encourage team-based, ideally multi-team goals. Otherwise unhealthy competition would stifle cooperation and collaboration. Together everyone can achieve more than if working alone, if the team is required to produce cohesive, consistent outputs for a shared purpose.
Whether it’s sharing vaccines or allowing vaccine production free of patents to avoid further outbreaks and mutations, or tackling climate change, the lethal threats we face have no borders. Globalisation is no longer about open markets but potentially our only means of survival.
Insight number 8: We can learn from patient-led groups like Long Covid Support and now Long Covid Work who have worked as outlined above, while debilitated, during a global pandemic.
It has been a privilege to work with and lead peers I’ve still never met in real life. We didn’t apply, or exchange CVs; we trusted each other to judge what we could each do then did it. Tangible rewards weren’t there; the biggest unifier and motivator was to make a difference to our community, feel useful when the world may view us otherwise, and be distracted from pain, discomfort and concern about the future.
We disagree, respectfully. We discuss and build on ideas. We help each other and always work in teams so no-one feels overloaded. We work when we are able and can ask for more time if we need it. And the work gets done. We fit the work around the people.
Our results are evident. We recently received a Special Recognition Award from the Vocational Rehabilitation Association UK with testimonials from SOM, the TUC and other clients. We enjoy working together and have become good friends who can share anything without being judged. Most of all we value feeling valued, safe and included.
We know that good work is good for people so it makes sense to keep people functioning productively, ‘in work’ (however defined). We all agree 2021 was better for the chance to contribute, even unpaid. It allowed the transition back to the careers we loved. We weren’t ready to compromise our health to return to a job role we no longer fitted. Instead, we redesigned our own.
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Lesley hosted our CPD webinar Long Covid: a catalyst for greater multidisciplinary working. Watch it on-demand now.
