The power of leadership in times of crisis

It is October 2021. The Netherlands is in the middle of the Corona pandemic and people are working with all their might to fight it and prevent new infections. The Amsterdam GGD has a special team working on corona prevention. When the continuous performance in crisis mode begins to take its toll and the crisis persists, it is time for a different direction of corona prevention. This should be more focused on a long-term strategy of GGD Amsterdam and tasks around infectious disease control and prevention in general. Program manager Jeannette Saatrube Vernooij and later project leader Sabine Ebbing joined the team. Looking back with client Karen den Hertog, they come to some fine observations about the function and power of various types of leadership in times of crisis.


Corona Prevention Program
A look back at corona prevention within GGD Amsterdam-Amstelland. Just before the official end of the pandemic, Jeannette, Sabine, and their client Karen den Hertog sit down with us. As head of the Healthy Living Department, Karen is responsible for everything to do with prevention at GGD Amsterdam. 'In times of crisis, we wanted to encourage the residents of Amsterdam and Amstelland to make healthy choices. That's why in the spring of 2020 we started what later became the Corona Prevention Program. This is in addition to the immense organization of vaccination, testing, and source and contact research and in close cooperation with, for example, the city districts and regional municipalities. The program, like the crisis, had several phases. In the first phase, I see a clear metaphor for the fire department. It really felt like we were running out through this building with big hoses over our shoulders to put out another fire somewhere. Leadership was mainly about implementing the national measures so that as many Amsterdammers and Amstellanders as possible could understand and apply them.'

Operating in crisis mode

There was no playbook in the world that said an infectious disease crisis would last this long. But around the summer of 2020, it became clear to the team that the crisis would be a marathon, and the team was structured more structurally. After a year and a half of operating in crisis mode, Karen looked again at the qualities and competencies needed. 'I then deliberately recruited a program manager, who had to ensure that all residents of Amsterdam and Amstelland had the right information to make a considered choice regarding vaccination and other health topics. Also, after months of stressful work, the team was in need of a new impetus.

Program Manager

This task fell to Jeannette Saatrube Vernooij, who took over the management. Jeannette is an independent interim and program manager. 'I came in during the turbulent period when we were going from lockdown to lockdown. On my first day, I encountered a very driven and also exhausted team. There was hard work and tremendous performance every day.'

Karen adds, 'Jeannette immediately took a very different approach by linking the strategic discussions to the GGD's major task. Then suddenly we had a compass again.'

'In the beginning, I managed the team in a very action-oriented way, by addressing them directly and working in a short cyclical way,' says Jeannette. 'During the crisis, we had to make sure the house was no longer on fire. When the virus finally seemed to be under control, we could look at how to rebuild on the land where that house stood. That long-term thinking requires a very different type of leadership.'

'That long-term thinking requires a very different type of leadership.'

Customization without compulsion

Data-driven work
'The fall of 2021 was all about getting the vaccination rate in our region as close as possible to the national average, says Karen. 'In that phase, we puzzled with each other how to get the best possible numerical and qualitative insight regarding vaccination motivation in different neighborhoods in the region, so that we could work in a data-driven way as much as possible to fine-tune vaccination.

Customized solutions

At that moment, when the Netherlands finally reopened after months, Sabine Ebbing was called in. As Manager Healthcare at Boer & Croon, she was given the position of project leader and later program secretary at the GGD. 'My assignment was to continue to provide customized services for target groups in a vulnerable situation and thus really reach all Amsterdam residents. On the day I started, the lockdown was lifted: everyone could go back to the hospitality industry and meet in groups, reducing the sense of urgency. So we were further challenged to take very specific actions to reach different people.'

Fair chances for health

The GGD's mobile vaccination teams were not welcome everywhere. Visiting neighborhoods created a different dynamic. 'We had to sail sharper into the wind,' says Karen. Fortunately, Jeannette knew how to translate our vision 'Fair chances for health' into insight into the task and conversations with partners and residents about the (im)possibilities of working on it together. This led to a design, image, tone and language that resonated with the neighborhood. As a result, a lot of Amsterdam residents and Amstellanders eventually found the right information to choose whether or not to get a shot. Getting hold of that undercurrent was one of the most significant turning points in our approach to the crisis.

Maintaining trust

Jeannette thinks back to her entry into the GGD: "One of the things Karen conveyed to me was 'if it doesn't help, it can hurt.' The GGD is responsible for public health. If the GGD forces you to get that corona prick, it might have a negative effect on confidence in the long run. So rather fewer pricks today and information if required, so that people do continue to trust the GGD.'

'Grasping that undercurrent was one of the biggest tipping points in our approach to the crisis.'

What are we doing? And why are we doing this?

In addition to gaining residents' trust, more awareness had to be brought into the team for the role of trusted public health partner. Working continuously in a crisis mode, everyone had become accustomed to sprinting. Sabine saw a team where everything had become a priority. 'We had to change that to first think, then do. That's why we kept asking ourselves: is it necessary that we do this now? What are we doing? Why are we doing this? In this phase, we had to make the solutions sustainable and make sure they were also good for the long term.'

'In the beginning it was very necessary to just act,' says Jeannette. 'Real crisis leadership and really taking the lead and responsibility in this. With crystal clear agreements, because you don't have time to discuss who makes the decisions. What we were looking for was the right balance between the medical piece and the social interests, especially for the long term.'

'What we were looking for was the right balance between the medical piece and the societal interests, especially for the long term.'

Looking with fresh eyes at established patterns

Coordinating and balancing interests
During the program, continuous switching between the various departments and stakeholders was necessary. At the same time, we had to respond to the government's recommendations.

I found it challenging but especially interesting to find alignment and weigh the interests of all parties," says Sabine.

'And if that made it even better, then you really had done it together. Then there was the support for the solution,' Jeannette adds. 'What we constantly did was ask the doctors of Infectious Diseases, ' What does the clinical picture look like now? What is going on? What is your advice? Then, based on this picture and advice, we talked about possible actions with, in addition to IZ colleagues, behavioral experts, linking pins to the areas, communication experts, etc. By organizing all the knowledge and expertise, you make the decision together. After implementation, you see the effects and that takes time. And yes, then anything may have happened that wasn't okay. But not making a decision is worse than not making the best decision.'

Think first then do

Sabine: 'What I also had to get used to was the working method within the team. When I started, everyone was in 'run mode' so they said yes to everything because they thought it was necessary. I had to challenge people to first think about whether it was actually necessary and contributing to our goal.'

Jeannette experienced the same challenge: 'Working in a crisis for a year and a half, a new pattern had emerged in the organization. 'This is the way we do things, so why change it? ' It's very human to look for footing, especially in a crisis period. But on a thinking level you have to be able to be agile, otherwise logistical arguments will be used not to make a strategic move. My biggest task was to keep the team vital and sharp and get the mindset from crisis to long-term. But for me, of course, that was very easy, because I came in with fresh eyes. Every now and then you have to switch some pawns to get that fresh look.'

'That reminds me of another metaphor from the fire department,' Karen says. 'While putting out fires, someone regularly has to literally stand on a tile a little further away from the fire for a moment. 'Zooming out for a moment'

'Looking at what is really needed and always keeping the end goal in your mind.'

Leading at the right pace

Distinguishing between main and secondary issues
Working in the crisis taught Sabine to distinguish even more and more quickly between main and side issues. 'By looking at what is really necessary and always keeping the end goal in your head. I also became aware that sometimes you have to be patient or let something go.'

'Acceleration sounds good, but if you go too fast, you just lose people,' Jeannette responds. 'Who then think: Good luck with your own thing. Meanwhile, the crisis forces you to act fast. You base your choices on what you do know and always do what seems best at the time. I have also always said, "Good is good enough. And if it's not okay, they can call me. That's how you take responsibility and protect your team.'

'What I also learned is that everything that is said about crises is true,' Karen says. 'When you read literature about crises or have one of those crisis organization trainings, you think coolly, 'Well, that's not going to happen to us.' But what it's really like and how you act then yourself and as an organization, you only experience when you're really in it.

Naming the end of the crisis

By the end of the crisis, the program had to be perpetuated in the organization. 'It is also real leadership to name a kind of end game in the crisis and secure the program,' says Karen. 'That's why there was a very deliberate winding down and organizing a moment,' says Jeannette. 'We stood together to reflect on the effect and results of our work, the pride and gratitude for it and how it is invested in the regular organization for the future. That was very important, so everyone could also bring closure to themselves.'

By-products for the GGD and health care system

Healthy choices and long-term gains
The Corona Prevention Program not only enabled Amsterdam residents to make healthy choices around Corona, but also provided long-term gains. For the GGD and for health care in general. 'During the process it became clear to whom you had to leave certain tasks,' Sabine says. 'For example, behavioral expertise works very well in combination with medical expertise and knowledge to arrive at the right approach to reach diverse groups. For health care, it's nice to see how agile you are then when something really needs to be done.'

Karen nods in agreement. 'We got ourselves a methodology for working on prevention in a short-cycle evidence-informed way. And I also thought it was great to witness what we have achieved together, as an entire organization and with all those partners in the city. I am also very proud of that.

Customized solutions

'The fact that the GGD has reached many people in the region (Amsterdam Amstelland) to make healthy choices is partly due to the targeted customized solutions for different groups and neighborhoods,' says Jeannette. 'Through that fine-grained approach and how to steer behavior, we have established a new way of combating infectious disease with demonstrable effect. We couldn't have done it without the tremendous effort of the team! On a societal level, the importance of healthy living became clear: prevention, prevention, prevention! Corona has shown the world that taking responsibility for your health is crucial and that we must continue to focus on all those who are not so easily able to do so themselves.