Abstract
The 21st century calls upon health leaders to recognize and respond to emerging threats and systemic emergency management challenges through transformative processes inherent in the LEADS in a caring environment framework. Using a grounded theory approach, this qualitative study explores key informant perspectives of leaders in emergency management across Canada on pressing needs for relevant systemic transformation. The emerging model points to eight specific attributes of transformational leadership central to emergency management and suggests that contextualization of health leadership is of particular import.
Introduction
In the 21st century, emergency management systems will require transformational leadership of an order not yet fully potentiated in Canada. The extant literature is replete with case analyses of leadership challenges in a wide range of critical events that include emergencies, disasters, and catastrophes. 1 –19 These events are integrated along a magnitudinal continuum from emergencies that are small scale, common, and manageable with regional resources; disasters that typically involve more than 10 deaths and/or 100 injuries requiring multi-regional response collaboration; and catastrophes that exact total destruction of critical community infrastructures necessitating national and international interventions. The extant literature underscores the need for effective emergency leadership in prevention, emergency preparedness, emergency response and medical care, social recovery and rehabilitation, and adaptive learning—all of which are crucial in safeguarding lives, mitigating injuries, and maintaining communal integrity. 20 –39 The 21st century brings a sense of great urgency for all health leaders to recognize and address growing emergency management challenges, such as systemic performance, stymied by limited, reactive, and silo responses; discontinuities and fragmented care; and communication delays and breakdowns—all of which result in avoidable loss of life and injuries. A holistic systems paradigm and transformational vision of emergency management is arguably more effective in anticipating, preparing for, responding to, and recovering from growing regional, national, and international threats. This key informant study explores the perceptions of emergency leaders across Canada of threats and emerging challenges in emergency management systems that call for transformative processes, as reflected in the LEADS framework. 38,39 Furthermore, the study identifies eight critical attributes of transformational leadership that would act as catalysts for effective systemic changes that would enhance performance outcomes in emergency management contexts.
Methods
This qualitative study explores the phenomenology of emergency management leadership, using grounded theory approach. 40,41 The study sought to elicit the individual perceptions and perspectives of emergency, governance, health, and technological professionals through key informant analysis. 42 –47 As with qualitative studies of human subjects, the study objectives, protocol, and research instrument required prior review and approval of an institutional research ethics board. Purposive selective and chain referral sampling were deployed to elicit relevant key informant responses within a 6-week response time limit. Professional bodies, including the Canadian Association of Fire Chiefs, the Canadian Association of Social Workers, the Canadian College of Health Leaders, and the Canadian Information Processing Society, were points of entry that consented to issue a general invitation to their membership to participate in the study. The key informant recruitment strategy was totally voluntary and confidential, as were the responses. Upon affirming their willingness to participate directly, experienced professionals in emergency management were sent a link to a confidential semi-structured questionnaire in a secured database under the researcher’s name with a reputable on-line cloud-based company. The privacy and confidentiality standards were detailed and required that each respondent sign an explicit consent statement. Only then were they given the option to either complete the questionnaire on-line or request to have the exact same instrument completed through a teleconference with the researcher. Once they stated their preference, the key informants had access to and could proceed with the completion of 26 semi-structured questions that focused on their perceptions of emergency experiences, system performance, threats, emergency preparedness, technological developments, private sector partnerships, and leadership. Given the open-ended nature of the questionnaire, these professionals responded with and elaborated on textual data descriptions of perceived systemic challenges. Evoked responses were meaningful and particularly salient to each key informant producing an array of results that was rich, explanatory, and sometimes unanticipated.
A total of 103 key informants were sent invitations to participate and complete the research instrument on-line or, as in seven cases, through a teleconference with the researcher within the 6-week limit. Seventeen on-line questionnaires had negligible responses and were dropped from the study. The response rate was 83.5% with 86 key informants, representing 81 organizations. Of the total respondents, 89% were senior professionals with 10 or more years of experience. Moreover, there were 28 health professionals, 15 government officials, 14 fire and rescue officers, 11 care providers, 10 military officers, 4 social workers, and 4 information system professionals—all with relevant emergency management experience. The organizations included 16 federal government agencies, 17 provincial government and regional health authorities, 16 municipal government and first responder units, 14 private sector firms, 13 healthcare facilities, and 5 national professional associations.
Consonant with the grounded theory methodology, qualitative data were collected, and repetitive concepts and elements were tagged through a process of substantive coding. Theoretical memoing and comparative analysis of the textual data of key informants followed. What emerged was a central thematic model of transformational leadership, around which evoked concepts matched with textual data in ways that were relevant and reflective of the substantive views of key informants. Moreover, eight specific attributes of such leadership were validated in the context of this domain through this qualitative study.
Key findings
The study produced a wide range of perceptions of key informants on experiences, system performance, threats, emergency preparedness, technological developments, private sector partnerships, and leadership—all of which were duly tagged, coded, and analyzed. Through the subsequent process of theoretical memoing, three interrelated significant constructs emerged.
Experiential and perceived emergency threats and performance
Table 1 summarizes five categories of threats that constitute potentially significant emergencies; highlights the experiences of 46 respondents; and identifies the perceived future threats. Seventy-eight percent of respondents reported that business continuity, emergency preparedness, and/or disaster recovery plans were in place in their organizations. Twenty-two percent reported had none. Performance management is predicated on emergency efficiency (response, transport, and discharge rates) and effectiveness (mortality, morbidity, recovery, professional burnout, and patient/family satisfaction rates). Key informants reported that the emergency care response systems were largely efficient, even if there were no survivors due to the catastrophic nature of the event. Two key informants noted that despite excellent emergency response and care provided, care providers suffered from burnout and post-traumatic stress disorder, for which there was little recognition of nor support for.
Summary of key informant emergency experiences and perceptions of threats
Perceived technological innovations and diffusion
The key informants underscored the need for technological innovations and deployment in emergency management. Advanced transportation and information technologies, including drones, robotics, telemedical applications, and ubiquitous sensor technologies, were deemed as having great potential to save lives and decrease injuries in the future. This optimism was tempered with the realization that the deployment of innovations in emergency management would be diffuse and inexorably slow in the light of sociopolitical and financial realities in Canada. The lagging progress towards common systems interoperability standards was a case in point that underscored those sociopolitical issues at hand. Nor were any key informants hopeful that partnerships with the private information technological sector would be instrumental in the diffusion of innovative technologies. Respondents maintained that entrenched differences in mission, perceptions, and values between the private and public sectors militated against any possibility of long-term cogent and stable partnerships. However, they did think that proactive engagement and collaboration of private sector stakeholders were critical in three areas: supply chain management networks, regional and national emergency preparedness coordination, and marketing of technological innovations.
Perceived transformational leadership
Key informants emphasized the importance and need of effective leadership in emergency management systems. They stressed such leadership includes relevant expertise and knowledge within legal and sociopolitical contexts; cognitive abilities, such as systems thinking, proclivity to innovation, and analytical skills in complex and uncertain conditions; personality traits; political skills that would facilitate inter-professional network building, negotiation, perspicacity, and conflict resolution; social competencies that inspire trust and respect, motivation, and professionalism; and value attributes such as service ethics, empathy, and personal integrity—all confirming the extant literature on leadership. 48 –51 Moreover, respondents emphasized the need for decisiveness under conditions of extreme stress and uncertainty, adaptability, courage, equanimity, and tenacity. Situational and self-awareness of personal limitations and the ability to delegate authority were deemed important. Notably key informants consistently underscored the need for federal governance authorities to assume accountability and responsibility for performance outcomes; promoting cogent and proactive dialogue and positive actions and, in so doing, exercise leadership in emergency management systems.
From these three interrelated key constructs, using grounded theory methodology, emerged one overarching paramount theme of transformational leadership that fosters systemic collaboration; strengthens emergency prevention, preparedness, response, and recovery; and promotes proactive strategies in the face of emerging threats.
Transformational leadership attributes in emergency management
Transformational leaders engage and motivate professionals and communities to integrate their vital efforts leading to improved systemic improvements in emergency management, thus underscoring transformation as a critical process in the LEADS in a caring framework.
38,39
Furthermore, the key findings of this qualitative study point to eight attributes of transformational leadership that are contextual and specific to emergency management systems. Strategic cognition. Transformational leaders must be able to think the “unthinkable.” Emergencies incubate silently and mask dangerous warning signals, latent problems, and potential failures. Denial of red flags of smoldering crises continues to be one of the greatest emergency leadership challenges and remains political and psychological by nature. The consequences are manifold and include shock, disbelief, paralysis, panic, disregard, inappropriate and delayed responses, and chaos that often prove disastrous for individuals, organizations, and communities. Emergency events challenge set beliefs, expectations, and sensory perceptions of reality and alter the normalized view of ordered entities of reality, convoluting them into the unthinkable. To be effective, transformational leaders require strategic cognition aptitudes to withstand shock, as well as sensory and information overload in critical events. Environmental perception. Transformational leaders must remain astute and constantly vigilant to a dynamic set of threats, risks, and vulnerabilities that trigger emergency events. Such leaders also recognize that threats often compound and escalate into new risks and threats. Environmental scanning and monitoring, situational awareness, risk assessment, and resource analysis must be continuous. Mitigating risks through the strengthening of public safety legislation and regulations; judicious land zone planning; closing socio-economic gaps; health promotion; emergency preparedness; well-resourced medical response, care, and recovery systems; community resilience; and strengthening of critical emergency infrastructures are important outcomes of effective environmental perception. Strategic potentiation. Transformational leaders must forge dynamic collaborative networks between diverse professional communities in emergency management. The survivability of individuals and viability of organizations and communities ultimately depend on the diversity, strength, and vitality of stakeholder engagement. Emergency first-responders, public safety professionals, care providers, governance authorities, community groups, the defence sector, non-governmental organizations, and the private sector must all be proactively involved in the evolution of emergency management systems. Synergistic collaborative networks built through positive dialogue, understanding, and trust enhance community resilience and system performance. This happens when transformational leaders potentiate, motivate, and coalesce the diversity of stakeholders towards the singular mission of emergency management. Social value engagement. Transformational leaders must engage individuals, organizations, and communities in emergency preparedness and service to others as a recognized social value and responsibility. This remains the vital core of planning and the praxis of emergency management. Without effective business continuity, emergency response and recovery plans, individuals, organizations, and communities are far less able to respond to, cope with, and fully recover from emergency events. Emergency preparedness is not just the domain of the trained emergency professionals and governance bodies but central to the mission and integrity of all organizations and communities. Engaging and creating social consciousness and motivation to serve others enhance community resilience. Emergency system performance depends on the integration of emergency preparedness and the ethos of service to others as a social value in the body politic. Transformational leaders have a responsibility to articulate, inspire, and engage others in this social mission. Strategic engineering. Transformational leaders must strive to create high-reliability systems through systems engineering in the emergency management domain. Adaptive learning and commitment to continuous systems improvement are the hallmarks of high-reliability organizations. Moreover, such organizations are forged through effective critical telecommunication infrastructures built on universality and commonality in system standards, policies, and operations. Systems interoperability remains the sine qua non of information, knowledge, and resource sharing in the emergency management domain. Systems engineering techniques, such as benchmarking, Kaizen (continuous improvement) techniques, lean methodologies, root cause analysis, simulations, and quality management are germane to high-reliability organizations, forming important knowledge bases and skill sets for transformational leaders. Logistical strategizing. Transformational leaders must strategize logistically to assure access to effective supply chain networks regionally, nationally, and internationally before emergency events occur. Deploying vital emergency personnel, resources, and supplies in situ efficiently and effectively to emergency events is of paramount importance, yet remains the Achilles heel of in many emergency situations. Forging cogent supply linkages with suppliers in the private sector, the defence sector, communities, governance, and non-governmental agencies are vital, as are maintaining secure critical communication and transportation infrastructures. Innovative transformation. Transformational leaders must advocate, create roadmaps, and lead transformative changes associated with innovative technology deployments. The potential of technological innovations to revolutionize emergency management practices is massive. Such innovations include global satellite tracking systems, autonomic and intelligent systems, big-data systems, cloud-computing, driverless vehicles, drone technology, holography, intelligent grid technologies, nanotechnology, robotics, simulation systems, telemedicine, tele-surgery, and virtual incident command centers. Leaders must be astute to the need for and power of technological innovations and have capabilities in change management to effect positive outcomes in emergency management systems. Intuitive foresight. Transformation leaders must possess intuitive foresight with a compelling vision that inspires and motivates others. Leaders must have an intuitive understanding of the interrelatedness of environments, emergency events, and responses and possess powerful insights into complex human and socio-political behaviour in the face of seemingly insurmountable challenges. Empathy and compassion must inform and drive that vision. With the humility to recognize that the forces at work may at times be beyond comprehension and control, leaders must still persevere in that vision and inspire others in the continuous struggle of “the human condition.”
52
Conclusions
The contextualization of transformational leadership is a potent area of leadership research. 53 Mass emergencies, disasters, and catastrophes will undoubtedly increase during the 21st century in the face of burgeoning populations in regions exposed to growing threats in vulnerable environments. The results of this qualitative study with its grounded theory approach underscore the importance for transformational leadership and identify eight specific attributes that are contextual in the emergency management domain. Transformational leadership requires high-order skill sets that include strategic cognition, environmental perception, strategic potentiation, social value engagement, strategic engineering, logistical strategizing, innovative transformation, and intuitive foresight. Moreover, this study underscores the relevance of contextualization as a means to isolate specific leadership attributes, thus opening the door to other such qualitative leadership studies in diverse public health domains, including chronic and infectious diseases and mental health. Potential action plans for effective transformational leadership in the emergency management domain point to a panoply of possibilities, including knowledge diffusion, where universities and professional colleges deliver emergency management studies, focused training, workshops, and self-learning programs for emergency leadership in Canada and internationally. Professional mentoring of potential leaders is another—identifying, encouraging, and mentoring future leaders early in their professional careers. Sectors such as those in the academic, defence, governance, and technology worlds have responsibilities to innovate and diffuse appropriate technological innovations in this domain. Federal governance leadership is also indicated to foster productive dialogue and proactive action plans in light of highly probable mass emergencies, disasters, and catastrophes that threaten lives and communities in Canada. One nexus of possible national action is the potential need for effective civil defence systems, comparable to those in Denmark, France, Sweden, and Switzerland, given the emerging realities of a global 21st century. Moreover, the Federal Government is in a prime strategic position to foster emergency coalitions, mutual aid agreements, and harmonization of emergency management infrastructures with North Amercian Free Trade Association (NAFTA) and North Atlantic Treaty Organization (NATO) nations. Furthermore, as part of its global humanitarian responsibilities, Canada is morally bound to assist the international community in the construction of effective emergency critical infrastructures, particularly those in nations with significant vulnerabilities. All of these proposed actions require the exercise of transformational leadership. Finally, this qualitative study also suggests that transformational leadership may be triggered through experiential catalysts and shocks that compel the exercise of that leadership in specific contexts. The actualization and contextualization of such leadership remain a titanic and promising area for future research.
Footnotes
Acknowledgments
The author is deeply appreciative of the time and support of all the participants in this key informant study, as well as the Canadian College of Health Leaders, the Association of Fire Chiefs of Canada, the Association of Social Workers of Canada, and the Canadian Information Processing Society for their kind cooperation and assistance.