Public Health 215 (2023) 39e41

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Public Health
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Themed Paper e Original Research

Why time matters when it comes to resilience: how the duration of

crisis affects resilience of healthcare and public health leaders
€rster a, N. Füreder b, *, A. Hertelendy c, d
C. Fo
a
Technical University Chemnitz, Faculty of Economics and Business Administration Germany, Germany
b
Johannes Kepler University, Sustainable Transformation Management Lab & JKU Business School, Altenberger Strasse 69, 4040 Linz, Austria
c
Florida International University, Department of Information Systems and Business Analytics, College of Business, Miami, FL, USA
d
Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Disaster Medicine Fellowship, Boston, MA, USA

a r t i c l e i n f o a b s t r a c t

Article history: The meaning of time, especially in crisis, where situations are likely to become even more complex,
Received 8 August 2022 uncertain, and disruptive, is crucial. Incorporating previous research on organizational crises, organi-
Received in revised form zational resilience, extreme context, and individual resilience, we know that leaders do play a crucial role
9 November 2022
when it comes to handle adversity in organizations but also that leaders might influence organizational
Accepted 28 November 2022
resilience and employee resilience. Intensified by the COVID-19 pandemic, the leaders' ability to effec-
tively deal with a critical situation becomes even more important in healthcare organizations. We argue
that time is not only important when it comes to crisis management but also that it is highly significant
Keywords:
Healthcare
when it comes to leaders' resilience. Considering the aspect of time implies that different temporal
Public health demands, especially regarding the persistence of adversity, require different resilience strategies applied
Crisis management by the leader. Therefore, we call for future research on examining how different leaders’ resilience
Time strategies (short term vs. long term) affect crisis management outcomes as well as the resilience in
Leaders' resilience strategies healthcare and public health organizations.
© 2022 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is an
open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Living in a highly globalized and intertwined VUCA (i.e. volatile, where the risks of catastrophes are omnipresent. Although the
uncertain, complex, and ambiguous) world, the meaning of time, in possibility of crisis is ubiquitous in healthcare, and hospitals, before
particular in the context of crisis, where the situation is likely to the COVID-19 pandemic, only single units of these organizations,
become even more complex, uncertain, and disruptive,1 is crucial. for example, emergency or intensive care units,5 needed to deal
Defining organizational crises as “an event perceived by managers with routine emergencies and mass casualty incidents. Further-
and stakeholders as highly salient, unexpected, and potentially more, crisis management in these specific units was largely reac-
disruptive,” the meaning of time is characterized both in terms of tive. Along this line, medical teams needed to respond to these
the unexpectedness of the crisis and “the perceived urgency of the events and mobilize resources rapidly, whereby the duration of
response.” Considering the implicit meaning of time in organiza- exposure to such emergencies events was relatively short.6 How-
tional crisis, it is not surprising that time is also incorporated into ever, the emergence of SARS-CoV-2 and the subsequent pandemic
crisis management and leadership. Derived from the “perceived changed this by moving hospitals into a temporal organization-
significance and urgency of crises,” “time pressure, risks, and un- wide emergency context, where the “potentiality of crisis” turned
certainty” are the conditions underlying leaders’ decision-making into actuality.5 In this sense, including this shift in context, we call
in crisis. Researchers have conceptualized crisis leadership for future research examining the aspect of time regarding different
around the aspect of time by referring to the time before crisis, leaders' resilience strategies and how this affects the resilience of
during crisis, and after crisis,2 whereby time has been a key element healthcare and public health organizations to contribute to the
of crisis management in the recent COVID-19 pandemic.3,4 international discourse.7,8
Globally, crisis management is crucial in healthcare and public
health organizations that are used to operating in risky contexts, Healthcare and public health leaders’ resilience

Considering previous research on organizational crises,9 orga-

* Corresponding author. nizational resilience,10 extreme context,6 and individual resilience
E-mail address: [email protected] (N. Füreder). in the workplace,11 we know that leaders do play a crucial role

https://doi.org/10.1016/j.puhe.2022.11.024
0033-3506/© 2022 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is an open access article under the CC BY license (http://
creativecommons.org/licenses/by/4.0/).
 €rster, N. Füreder and A. Hertelendy
C. Fo Public Health 215 (2023) 39e41

when it comes to handling adversity in organizations but also in- long-term adversity, such as the pandemic, or persisting overwork,
fluence resilience through a trickle-up (i.e. organizational resil- where the work demand constantly exceeds the individual re-
ience) and trickle-down effect (i.e. employee resilience). sources,18 which is typical in healthcare and public health organi-
Intensified by the COVID-19 pandemic, the leaders' ability to zations, might require “resource-enhancing” strategic resilience
effectively deal with a critical situation becomes even more strategies. Otherwise, the institutional and organizational con-
important in healthcare and public health organizations. Derived straints are likely to cause the healthcare leaders’ resilience to
from Foerster and Duchek's12 process-oriented model, leaders' erode throughout time,19 whereby consequences can be severe.
resilience can be understood, as three successive stages of the Previous studies suggest that an overload due to psychological job
resilience process, namely, precrisis, during crisis, and postcrisis, demands can be associated with negative events, such as near
whereby each stage requires a specific behavior of the leader to misses and injuries.20 At the individual level, constant stress and
master these stages successfully. While, in stage 1, the leader must overload can be related to both psychological as well as physical
anticipate critical developments and prepare for potential crises; in health problems, such as heart disease and other chronic ailments.
stage 2, the leader must cope with an acute crisis. In stage 3, the
leader must finally reflect on and learn from the crisis. Conclusion
Although this dynamic process provides us with some notion on
how leaders effectively deal with critical situations, the under- Building on previous research on resilience, especially on
standing of time primarily refers to the general division of crisis leaders and in the healthcare setting,8 we argue that time is not
into the three phases of pre, during, and after crisis1,2 but leaves us only important when it comes to crisis management but is also
with a lack of understanding about the influence of time within highly significant when it comes to leaders' resilience, implying
each of these stages. Along this line, longer “coping” phases during that different temporal demands, ely regarding the persistence of
crisis, as was the case during the pandemic, might require a adversity, require different resilience strategies applied by the
different approach by healthcare leaders than during shorter leader. Future research might examine how different leaders’
“coping” phases, which are more common in hospitals, especially in resilience strategies affect crisis management outcomes as well as
terms of non-routine emergencies, such as mass casualty incidents the resilience in healthcare and public health organizations. As we
or disasters. know that individuals' coping resources decline over time, we must
expect that those who stay with acceptance resilience may expe-
Time and temporality in resilience rience deleterious effects such as burnout or chronic sickness, and
those who switch from acceptance to strategic resilience will seek
As we know that a crisis can last for a long time, temporal new opportunities for occupational engagement. From a practical
conditions for managing crisis become increasingly salient. Ancona point of view, this could end up in precarious leadership shortages
et al.13 define time as “a non-spatial continuum in which events where leaders either are on long-term sick leave or, what we
occur in apparently irreversible succession from the past through already observe, voluntarily relinquishing their leadership posi-
the present to the future.”14 Time is increasingly considered an tions and returning to clinical practice.
important resource in organizational research.15 Scholars have
called for a sharper focus for understanding temporality in orga-
Author statement
nizational relationships, employee interactions, and performance,
whereby time has an important influence on organizational and
Ethical approval
social practices.16
Regarding resilience, time has multifactorial impacts relating to
None sought.
anticipating, coping, and how to recover and learn from a crisis.
Although healthcare leaders have been threatened by a potential
vicious circle of stress endangering the healthcare leaders’ resil- Funding
ience long before the pandemic, the COVID-19 pandemic has
exacerbated this situation. During the pandemic, healthcare leaders This work emerged from a research project supported by the
were stressed in multiple ways; they had to handle a high work- High Impact Program of the JKU Business School. There are not any
load, manage many changes in a short time and tolerate a high ethical, approval, funding and competing interests because of the
degree of uncertainty. Therefore, resilience emerged as a prereq- conceptual nature of this short communication paper.
uisite for overcoming the pandemic not only in a productive but
also in a healthy manner. Competing interests
Incorporating the aspect of time, Bardoel and Drago17 propose
two types of resilience, namely, acceptance resilience and strategic None declared.
resilience. Originating from the conservation of resources theory,
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