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This first phase of a three-phase action research project aims to define leadership practices that should be used during and after the pandemic to re-imagine and rebuild the health and social care system. Specifically, the objectives were to determine what effective leadership practices Canadian health leaders have used through the first wave of the COVID-19 pandemic, to explore how these differ from pre-crisis practices; and to identify what leadership practices might be leveraged to create the desired health and care systems of the future.

The authors used an action research methodology. In the first phase, reported here, the authors conducted one-on-one, virtual interviews with 18 health leaders from across Canada and across leadership roles. Data were analyzed using grounded theory methodology.

Five key practices emerged from the data, within the core dimension of disrupting entrenched structures and leadership practices. These were, namely, responding to more complex emotions in self and others. Future practice identified to create more psychologically supportive workplaces. Agile and adaptive leadership. Future practice should allow leaders to move systemic change forward more quickly. Integrating diverse perspectives, within and across organizations, leveling hierarchies through bringing together a variety of perspectives in the decision-making process and engaging people more broadly in the co-creation of strategies. Applying existing leadership capabilities and experience. Future practice should develop and expand mentorship to support early career leadership. Communication was increased to build credibility and trust in response to changing and often contradictory emerging evidence and messaging. Future practice should increase communication.

The project was limited to health leaders in Canada and did not represent all provinces/territories. Participants were recruited through the leadership networks, while diverse, were not demographically representative. All interviews were conducted in English; in the second phase of the study, the authors will recruit a larger and more diverse sample and conduct interviews in both English and French. As the interviews took place during the early stages of the pandemic, it may be that health leaders’ views of what may be required to re-define future health systems may change as the crisis shifts over time.

The sponsoring organization of this research – the Canadian Health Leadership Network and each of its individual member partners – will mobilize knowledge from this research, and subsequent phases, to inform processes for leadership development and, succession planning across, the Canadian health system, particularly those attributes unique to a context of crisis management but also necessary in post-crisis recovery.

This research has shown that there is an immediate need to develop innovative and influential leadership action – commensurate with its findings – to supporting the evolution of the Canadian health system, the emotional well-being of the health-care workforce, the mental health of the population and challenges inherent in structural inequities across health and health care that discriminate against certain populations.

An interdisciplinary group of health researchers and decision-makers from across Canada who came together rapidly to examine leadership practices during COVID-19’s first wave using action research study design.

The purpose of this qualitative research study is to explore health-care providers’ perspectives and experiences with a specific focus on supports reported to be effective during the COVID-19 pandemic. The overarching goal of this study is to inform leaders and leadership regarding provision of supports that could be implemented during times of crisis and in the future beyond the pandemic.

Data were collected by semi-structured, conversational interviews with a sample of 33 health-care professionals, including Registered Nurses, Nurse Practitioners, Registered Psychologists, Registered Dieticians and an Occupational Therapist.

Three major themes emerged from the interview data: (1) professional and personal challenges for health-care providers, (2) physical and mental health impacts on health-care providers and (3) providing supports for health-care providers. The third theme was further delineated into three sub-theses: formal resources and supports, informal resources and supports and leadership strategies.

Health-care leaders are advised to pay attention to the voices of the people they are leading. It is important to know what supports health-care providers need in times of crisis. Situating the needs of health-care providers in the Carter and Bogue Model of Leadership Influence for Health Professional Wellbeing (2022) can assist leaders to deliberately focus on aspects of providers’ wellbeing and remain cognizant of the supports needed both during a crisis and when circumstances are unremarkable.

The COVID-19 pandemic prompted changes to the terms and conditions of teachers' employment (e.g. working conditions), leading school districts to renegotiate collective bargaining agreements with teachers' unions. However, limited research has examined how these negotiations occur in times of crisis. This study aims to analyze how school district and teachers' union administrators adapted workplace policies to meet staff and student needs during the COVID-19 pandemic by using a panel dataset of Memoranda of Understanding (MOUs) negotiated in 187 large US school districts.

The authors used the partial independence item response method to estimate MOU restrictiveness measures that captured the extent to which MOUs limited school administrator autonomy in setting the terms and conditions of teachers' employment. Descriptive analyses and ordinary least squares regression models showed how the scope of collective bargaining negotiations expanded during the COVID-19 pandemic, and how restrictiveness varied across school districts based on district and union characteristics.

Results showed that school district and teachers' union administrators increased restrictions on school administrator autonomy in the spring of 2020, but these restrictions decreased by fall 2021. The level of restrictions agreed upon varied based on the strength of teachers' unions and political partisanship of school districts. The COVID-19 pandemic led to an expansion of collective bargaining negotiations to include previously unconsidered topics such as employee and student health and remote instruction.

This study is one of the first to examine the modifications made to collective bargaining agreements during times of crisis by school district and teachers' union administrators. The findings suggest that there were considerable changes to the terms and conditions of teachers' employment during the COVID-19 pandemic, and that the strength of teachers' unions and political partisanship were associated with negotiation outcomes.