“What We’re Doing Now…Is More Than Water Cooler”: Perspectives of Primary Care Leaders on Leading Through (and Beyond) COVID-19

Background: COVID-19 presented numerous challenges to primary care, but little formal research has explored the experience of practice leaders and their strategies for managing teams as the crisis unfolded. Objective: Describe the experience of leaders in US primary care delivery organizations, and their strategies for leading teams during COVID-19 and beyond. Design: Qualitative study using semi-structured interviews performed between 9/15/2020 and 8/31/2021. Participants: Purposive sample of 17 clinical leaders in a range of US primary care organizations. Approach: An iterative grounded review of interview transcripts was performed, followed by immersion/crystallization analysis. Key Results: Early in the pandemic, practice leaders reported facing rapid change and the need for constant decision-making, amidst an environment of stress, fear, and uncertainty, but this was buffered by a strong sense of purpose. Later, leaders noted the emergence of layered crises, and evolving challenges including fatigue, burnout, and strained relationships within their organizations and with the communities they serve. Leaders described four interrelated strategies for supporting their teams: (1) Being intentionally present, physically and emotionally; (2) Frequent and transparent communication; (3) Deepening and broadening relationships; (4) Increasing adaptive decision-making, alternating between formal hierarchical and flexible participatory processes. These strategies were influenced by individual leaders’ perceived autonomy, which was impacted by the leader’s specific role, and organizational size, complexity, and funding model. Conclusions: As the burnout and workforce crises have accelerated, the identified strategies can be useful to leaders to support teams and build organizational resilience in primary care moving forward.