Leading through the Fog of the Covid-19 Pandemic

Photo of Rakesh Suri

“There are so many angles to this crisis that are unprecedented. We have never encountered anything like this in modern times, and traditional paradigms of leadership cannot fill this void.”

Dr. Rakesh Suri, CEO, Cleveland Clinic Abu Dhabi

Leaders across the globe—in business, government and the not-for-profit sectors—are struggling to lead through the crisis of the moment while also preparing their organizations for the uncertain future.

What does it take to lead through the fog of a pandemic and emerge in a position of strength? According to Harvard Business School (HBS) Professor Linda Hill, it is not about taking charge and taking everything upon oneself. Rather, it is about building an agile organization.

The leadership team at Cleveland Clinic Abu Dhabi began to formulate their strategy and prepare for the worst-case scenario, even before the first case of the virus was reported in the United Arab Emirates (UAE) on January 29, 2020.

Professor Hill has been researching Dr. Rakesh Suri, CEO of the hospital and a world-renowned cardiac surgeon, since 2019, as part of a longitudinal study on building innovative organizations. When she began collecting data, she could not have foreseen how Dr. Suri and his colleagues would be put to the test.

Photo of Linda Hill

Linda A. Hill, Ph.D.
Linda A. Hill is the Wallace Brett Donham Professor of Business Administration at the Harvard Business School and Faculty Chair of the HBS Leadership Initiative. She was named one of the top ten management thinkers in the world in 2013 by Thinkers50 and received the Thinkers50 Innovation Award in 2015. Professor Hill is the author or co-author of several award-winning books and articles including Collective Genius: The Art and Practice of Leading Innovation, Being the Boss: The 3 Imperatives of Becoming a Great Leader and Becoming a Manager: How New Managers Master the Challenges of Leadership. She is co-founder of Paradox Strategies and co-creator of the Innovation Quotient. Her research focuses on implementing global strategies and leading innovation; building innovative organizations and ecosystems; developing leaders for innovation; and the role of the board in governing innovation.

Photo of Rakesh Suri

Rakesh M. Suri, MD
Dr. Rakesh Suri is the Chief Executive Officer and Chief of Thoracic and Cardiovascular Surgery at Cleveland Clinic Abu Dhabi. Dr. Suri oversees overall strategy and operations at the first-ever US multispecialty hospital to be replicated outside of North America. In his role as Chief of Thoracic and Cardiovascular Surgery, Dr. Suri has been involved in the creation of robotic and transcatheter cardiac programs at Cleveland Clinic Abu Dhabi. As Chief of Staff, he was responsible for leading the recruitment of the first 400 physicians and establishment of centers of excellence including transplantation. Dr. Suri has completed more than 6,000 surgical procedures in his career and has extensive clinical expertise in robotic and minimally invasive cardiac surgery, mitral valve repair, and transcatheter valve therapies. Dr. Suri is an alumnus of the HBS General Management Program.

In April 2020, Dr. Suri sat down with Professor Hill to share his stories from the front lines of leadership.

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Cleveland Clinic Abu Dhabi

In 2006, the Mubadala Investment Company and the Cleveland Clinic Foundation partnered to bring the Cleveland Clinic multidisciplinary, patient-centric model of care to Abu Dhabi. Cleveland Clinic Abu Dhabi factored into the Abu Dhabi government’s “Economic Vision for 2030” and its ambition to develop a sustainable local healthcare industry. At the time, the UAE was spending millions of dollars annually for its citizens to seek healthcare outside of the nation. The hospital is a physician-led medical facility served by North American board-certified (or equivalent) physicians. It was designed to fulfill the complex and critical care requirements unique to the UAE.

World map showing locations in Nevada, Ohio, Toronto, Florida, London (2021), Abu Dhabi, and Shanghai (2024). The Cleveland Clinic’s health system includes 18 hospitals with nearly 6,000 beds and more than 210 outpatient locations.

In 2015, after nearly a decade of planning and construction, Cleveland Clinic Abu Dhabi opened its doors with a bold promise to “bring the highest international standards of care close to home,” as stated in its 2016 annual report. Since then, the hospital has come to be regarded as one of the UAE’s prized assets.

Cleveland Clinic Abu Dhabi, 2019
4.2 million square feet, 364 beds expandable to 490. Centers of Excellence: Heart & Vascular, Neurological, Digestive Disease, Eye, Respiratory, Critical Care, Multiorgan Transplants,Oncology. 55-plus medical and surgicalsubspecialties. 5 clinical floors, 3 diagnostic and treatment levels, 13 floors of critical and acute inpatient units.

In coordination with Mubadala, the executive team at Cleveland Clinic Abu Dhabi developed a novel way to look at hospital performance metrics. The global hallmarks for the Cleveland Clinic Foundation were safety, quality, and patient experience, as well as research and medical education. Without the type of grant and supplemental funding available in the US to perpetuate the mission as they grew the hospital, the partners at Mubadala instilled the vision that Cleveland Clinic Abu Dhabi would move along a path to sustainability.

Dr. Rakesh Suri performed heart surgery on a patient at Cleveland Clinic Abu DhabiDr. Rakesh Suri performed heart surgery on a patient at Cleveland Clinic Abu Dhabi.

In 2015, Dr. Suri became Cleveland Clinic Abu Dhabi’s Chief of Staff, just as the hospital was preparing to open. He hired the first 400 caregivers and created a culturally diverse team of talent from the Cleveland Clinic network and other iconic medical institutions. Everyone he recruited believed whole-heartedly in the Cleveland Clinic Foundation’s commitment to safety, quality and patient experience, as well as its innovative DNA.

In 2017, Dr. Suri took over as CEO with a mandate to grow Cleveland Clinic Abu Dhabi into a cutting-edge academic medical center with the aim of sustainability in mind. By December 2019, the hospital had become a thought leader in the region and globally. They were also ahead of their 5-year ambition to break even. Little did they know that their business would be turned upside down in a matter of weeks.

In late January, just after the first cases appeared in Dubai, Cleveland Clinic Abu Dhabi started testing its first patients. The UAE government mandated hospitals to treat Covid-positive patients free of charge, including those without insurance.

Cleveland Clinic Abu Dhabi received its first cases of Covid-19 on February 28, 2020. Dr. Suri and his executive team began to learn about the dynamics of the disease and how to manage it in real time. As the UAE government continued to coordinate national resources, take steps to limit travel, adopt social distancing, and introduce new measures to address the pandemic, the hospital adapted its workflows, policies, and procedures in line with the government’s direction.

On March 4, 2020, Dr. Suri left for two-week international business travel to the US. He had no idea that, upon his return, he would have to enter into mandatory home quarantine and be away from the hospital for an additional two weeks.

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Leading With Agility

Even before the city of Abu Dhabi received its first cases, Dr. Suri and his executive team had determined that prudent risk management required that they build out additional isolation capacity and expand their emergency care footprint.

When they started treating Covid-19 patients, they shared what they were seeing across their local and global networks and ramped up their internal preparations. To align on priorities, Dr. Suri engaged in “very frank conversations” with the Chairman of the Board, Waleed Al Mokarrab Al Muhairi, who also serves as Mubadala’s Deputy Group Chief Executive Officer and Chief Executive Officer of the Alternative Investments & Infrastructure platform, overseeing the healthcare sector. While the Chairman agreed, “It was about doing what is right by the patients and the community,” he underscored the need to ensure that “efforts translated into impact.”

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Cleveland Clinic Abu Dhabi was built to be a tertiary and quaternary academic medical center that could treat patients requiring complex medical support. Over the course of two months of preparation for the Covid-19 pandemic, the hospital shifted core activities from their Centers of Excellence to the emergency department. The closing of the UAE’s borders in March, however, made Cleveland Clinic Abu Dhabi the center of last resort for a range of emergency procedures. The Covid-19 Task Force and the executive team made daily assessments about which of their core activities they could deliver while continuing to prepare for a surge in Covid-19 patients.

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The Executive Leadership Team at Cleveland Clinic Abu Dhabi
Photo of Rakesh Suri
Rakesh Suri, MD, DPhil

CEO, Chief of Thoracic & Cardiovascular Surgery

Photo of Jorge A. Guzman
Jorge A. Guzman, MD

Chief of Staff

Photo of Fahed AlMarzooqi
Fahed AlMarzooqi, MD

Chief Administrative Officer

Photo of Madhu Sasidhar
Madhu Sasidhar, MD

Chief Medical Officer

Photo of Sue Behrens
Sue Behrens

Chief Nursing Officer

Photo of Bill Baddour
Bill Baddour

Interim Chief Operating Officer

Photo of E. Murat Tuzcu
E. Murat Tuzcu, MD

Chief Academic Officer, Chair of the Heart & Vascular Institute

Photo of Glenn Zirbser
Glenn Zirbser

Chief Financial Officer

Photo of Bryan Lord
Bryan Lord

Chief Information Officer

Photo of Nizar Luqman
Nizar Luqman

Chief Human Capital Officer

Photo of Michael Makarem
Michael Makarem

General Counsel

To enable agility, Dr. Suri and his team, working with the support of Chairman Al Muhairi, provided clarity of purpose and defined a new operating paradigm for the organization.

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An Ecosystem Approach

As Covid-19 spread across the globe, Dr. Suri and his executive team came to appreciate that the behavior of the disease and how to best mitigate it varied by local context. A team of internal data scientists developed a novel approach to model the trajectory of the disease, which factored in the specific demographics and cultural practices in Abu Dhabi. This enabled them to forecast with greater accuracy how the disease might evolve in their community. Their findings suggested that a surge in patients was imminent.

Map of the Middle East and parts of Asia showing Abu Dhabi, United Arab Emirates and Wuhan, China.

Recognizing the systemic nature of the pandemic, the hospital’s leadership knew from the beginning that they couldn’t go it alone. Cleveland Clinic Abu Dhabi worked in close coordination with the Department of Health, Abu Dhabi, the UAE government, the other 6 medical facilities in the Mubadala healthcare network, and even their "traditional competitors." In addition to interfacing with regulators, Chairman Al Muhairi helped to ensure adequate stock of medicines, ventilators, protective equipment, and ICU beds across the Mubadala healthcare network.

The Department of Health, Abu Dhabi led the way; they instituted a central task force and began to build pop-up hospitals and repurpose factories to make masks and gloves. They also divided their locality into Tier 1, Tier 2, and Tier 3 medical institutions. Cleveland Clinic Abu Dhabi (Tier 3) was being reserved for the patients with the most severe symptoms, the “sickest of the sick,” due to its advanced capabilities in isolation, sophisticated ventilation, and cardiopulmonary bypass support. While hospitals across the globe were bringing elective procedures to a halt, the effective coordination of care enabled Cleveland Clinic Abu Dhabi to continue performing what they referred to as “urgent-necessary” and “delayed-necessary” procedures.

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Photo of Waleed Al Mokarrab Al Muhairi

“We have to realize that what we’re experiencing right now is a scientific problem with a scientific answer, but it is also a human problem with a human answer. It’s true that were seeing lots of patients, but at the end of the day, everybody needs to feel like they’re being cared for and feel like they have the attention of the best minds who are able to deal with this.”

Waleed Al Mokarrab Al Muhairi, Chairman, Cleveland Clinic Abu Dhabi

Chairman Al Muhairi and the executive team checked in regularly to stay aligned on how to protect the physical and mental well-being of caregivers and ensure they had the resources, including cash flow, to weather Covid-19. The executive team communicated relentlessly and honestly to respond to the emotional challenges caregivers were facing; they provided sleeping rooms, meditation rooms, nutritious food, online workouts, and new stress management resources, including apps and onsite grief counseling, among others. They offered childcare and food delivery for those in quarantine.

“Part of leading through crisis is about managing yourself,” said Dr. Suri. He exercised daily, maintained a balanced diet, and meditated more frequently. His leadership team modeled the same behavior. Taking care of themselves created the foundation that enabled them to take care of their teams and lead the organization. Dr. Suri and his colleagues were energized by how the caregivers responded: surgeons volunteered to work on the frontlines of the emergency department and junior doctors stepped up to coordinate ICU services and supplies.

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By the end of March, the hospital’s business plan, budget, and KPIs no longer seemed relevant. In an organization that typically measured its performance against well-defined balanced scorecards, Dr. Suri acknowledged “very few metrics that we held ourselves accountable to in January were still being discussed” in their daily executive meetings. Scorecards were reformulated and a dashboard that measured preparedness in terms of caregiver health, facility capacity, and supplies was introduced. It provided data about global and local trajectories of the disease.

Play Button Tearing Up the Business Plan Overnight

In April, as the national volume of hospitalizations grew, Cleveland Clinic Abu Dhabi pivoted to focus on ACU and ICU care for the most severely afflicted by Covid-19 in collaboration with the Department of Health Abu Dhabi. The hospital activated additional ICU and ACU beds, redeployed more than 240 caregivers to priority areas, and increased its stock of extracorporeal membrane oxygenation machines (ECMO) and mechanical ventilation equipment. In addition, it began preparing for life after the peak of the disease, instituting plans to continue to provide critical care for Covid-19 patients in isolated units, at the same time as opening up areas for non-infected patients requiring world-class Center of Excellence care.

By late May 2020, the trajectory of Covid-19 was still evolving. Cleveland Clinic Abu Dhabi expected to remain on alert and ready for the possibility of new surges in the weeks and months to come. As they prepared for the “next normal,” the focus of the executive team was to continue to build the agile and resilient organization needed to deliver on their long-term vision and address the inevitable challenges to come.

7 Lessons in Agile Leadership

In navigating this crisis, Dr. Suri and his colleagues have come to learn that these are truly unprecedented times, which call for unprecedented leadership. While they do not claim to have all the answers, we believe that the lessons they have learned about how to deal with today while preparing for tomorrow are relevant to healthcare leaders in particular and leaders in general.

The ambition of all leadership teams should be to build an agile and resilient organization. No one knows what the future will hold, but the world is not going back to pre-Covid-19 days. To achieve their purpose and long-term vision, organizations will have to re-imagine what they are doing and how they are doing it.

1. Over-prepare and consider everything a working hypothesis
Leaders have to be willing to be criticized for over-preparing. They must imagine the worst-case scenario and prepare in ways that will allow their organizations to have the greatest impact. Not doing so risks people’s lives and livelihoods. Leaders have to be concerned about cash flow, but they may have to throw out their business plans and budget targets.

2. Set the stage for people to work in coordination and with speed
Leaders must provide clarity of purpose and empower their organizations to engage in innovative problem-solving. Leaders cannot know minute-by-minute what their people are doing, but the minute-by-minute decisions are critically important. Leaders must trust their people to do the right thing and enable nascent leadership to rise to the challenge.

3. Act and learn as quickly and thoughtfully as possible
This is no time for command and control leadership. Leaders and organizations cannot plan their way out of a fog. To act their way forward, leaders must clarify decision-making and communication rights, encourage their organizations to be data-driven, and pivot when necessary. Leaders must create spaces in which diverse perspectives are heard and candor is encouraged.

4. Leverage the ecosystem
This is a systemic crisis, and it requires a systemic response. The success of the organization depends on the success of the weakest member in its ecosystem. Leaders must proactively engage their customers, vendors, regulators, community organizations, and even their “traditional competitors.” They must encourage frequent, two-way communication, data transparency, and, as appropriate, coordinate efforts and offer assistance.

5. Protect physical and mental well-being
This is a marathon, not a sprint. Everyone is learning how to work differently in these extreme conditions, and the emotional burdens of leadership can be overwhelming. Leaders must watch out for burnout in their workforces and in themselves. They must role model the behavior they expect from their people by taking care of their health and reaching out for emotional support.

6. Build trusting relationships in virtual settings
Leaders must be conscious of how others perceive them and how others perceive themselves when they connect with them over virtual platforms. Small, non-verbal cues, like a genuine smile or a nod, are powerful tools in a video call. Leaders need to experiment with their own body language, perhaps even receive coaching, and be intentional about their communication. They must also be attentive and respond to the “virtual body language” of others.

7. Reimagine the business
Through this crisis, leaders are learning about their organizations’ culture, capabilities, and leadership. Now is the time for leaders to address limitations and put plans in place to develop the agility, resilience, and the next generation of leadership needed to succeed in the future. New business models will be necessary. Leaders must develop appropriate metrics to help their organizations measure progress in the interim and keep focused on their long-term vision.

HBS Professor Linda Hill and Research Associate Emily Tedards prepared this article in collaboration with:

HBS IT Multimedia Team
Ruth Page, Director of Multimedia Development
Dave Habeeb, Senior Multimedia Producer
Ivan Audouin, Senior Multimedia Engineer
Katie Leone, Senior User Interface & Instructional Designer

HBS Leadership Initiative
Karina Grazina

Copyright ©2020 President and Fellows of Harvard College.

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