Introduction

The coronavirus disease 2019 pandemic caused approximately 7 million deaths and infected 200 million people worldwide. As in any crisis, this exceptional situation has left positive and negative balances. Among the negative aspects of this pandemic, I would like to mention those who have passed away, the physical and psychological damage caused, the economic losses, the appearance of opportunists, the poor political management, the longest “quarantine”, and the fact that the government issued isolation orders and we isolated ourselves.

Nevertheless, some good things also came out of the pandemic. We had to push the limits, adapt, be creative, learn, be innovate, leave our comfort zone, come together, show what we are capable of, appreciate more what we have, and seek to achieve a balance in life. There are two important aspects to consider and underscore in this presentation: the concept of leadership and the impact of the pandemic. Leadership goes far beyond the leader and is the result of the interaction of the leader with his/her team to achieve common targets proposed and based on motivation (Fig. 1).

Figure 1 The 4 determining variables of leadership 

Regarding the impact of the pandemic, it should be emphasized that it had to do with people, regardless of their role in the organization. No one was immune to this crisis! In previous posts I referred to the pandemic as if, so far, it was a Netflix series with two seasons and three episodes. COVID-19 pandemic series. Season 1 (2020/2021): Episode 1: Before the Storm; Episode 2: During the Storm. Season 2 (2022/?) has one episode so far: After the Storm. How long did each episode last? This varied depending on the place in the world we consider. Thus, the episode Before the Storm was very brief in China, Spain and Italy, for example, and very long in our country (“endless quarantine”). The episode During the Storm was also variable and was characterized by the spectacular nature of the serious situations, sometimes with collapse of the health system. New outbreaks and the emergence of new strains were the distinctive features. In season I, it was expected that the episode After the Storm would be a return to the previous situation, and that it would last for a relatively short time. Something completely far from reality! In this episode, we must deal with all the aspects related to post-traumatic stress syndrome, burnout, mental diseases, impact of the economic crisis and inequalities on health. We do not know how long this episode will last or if it will be accompanied by further episodes involving unexpected situations.

All these oscillations in health and their consequences are very well represented in the four waves of pandemic described by V. Tseng in 2020 (Fig. 2).

Figure 2 The four waves of the pandemic. (Modified from V. Tseng) 

In season I, physicians had to learn or refresh the principles of how to manage a crisis established by the American College of Surgeons (ACS): do not lose hope, preserve your goals, communicate clearly and concisely, maintain a sense of community, and be flexible. We had to resort to surgeons’ non-technical skills, such as decision-making, leadership, teamwork and situational awareness. In an excellent publication in LinkedIn, Dr. Carlos Pellegrini, former president of the ACS, describes 10 actions a leader should take to manage a crisis. The 10th recommendation is “Be resilient and patient”. More details of leadership during this season and its episodes are described in Liderazgo en cirugía en la era COVID-19 (2020 and 2022) of the author.

Season 2, episode 1: after the storm

While searching for the lessons learned during the pandemic, I was surprised to find in PubMed, as of January 2020, more than 6000 publications on the subject. Among them, one publication from Mexico “Lessons from COVID-19 pandemic. The reunion with human vulnerability”, drew my attention. It is of utmost interest and is very much in tune with my perception of what happened during the pandemic. All of us were and felt vulnerable to a greater or lesser extent. Vulnerability indicates greater likelihood of being injured or harmed. This concept is fully in line with one of the concepts that I stated in previous paragraphs that is important for this publication: “Regarding the impact of the pandemic, it should be emphasized that it had to do with people, regardless of their role in the organization. No one was immune to this crisis!”

In the literature search I conducted on postpandemic leadership published in 2022, I found little data in PubMed, and instead more references in blogs and publications in the business area, where the concepts of leadership were clearly born and later implemented in other areas.

If we are referring to post-pandemic leadership, we must assume that its four determining variables (leader, team, goals and motivation) have abruptly changed. Nowadays, the world lives and moves differently. Thus, we speak of a VUCA world defined by the following characteristics: Volatility, Uncertainty, Complexity and Ambiguity. This concept comes from the U.S. Armed Forces and has been already used to define crisis scenarios since many years ago. This world is characterized by rapid changes to deal with what is unknown, by multiple causal factors and by the loss of clarity of what facts mean. We currently speak of the RUPT world which means Rapid, Unpredictable, Paradoxical and Tangled and is characterized by rapid changes, by the need to know how to manage what is unknown, where logical situations do not necessarily occur and where everything has to do with everything.

The new scenarios are characterized by uncertainty, need for adaptation and social commitment. Crisis situations are still fresh. Some issues of team consolidation and communication are a consequence of virtuality and of the habit of using platforms such as Meet^® or Zoom^®. There is a perception of the need to reduce the number of personnel in different work areas where the pandemic has shown over-staffing, which reduces profits for the institution. Just recall the recent decision to cut more than 50% of Twitter’s employees by its new owner, Elon Musk.

At this point in the post-pandemic period and with most of us vaccinated, we are not concerned about the threat of the virus. We are seeking to recover from this crisis, we want to recover the losses we have suffered. We set new goals and directions. It is very simple: We want to be ok!! That’s it;to be ok!!

We simply seek to initially cover the basic part of Maslow’s pyramid that describes the expectations that people may have.

Considering all that has been said, one wonders: Does the post-pandemic pose a new leadership? The answer is simple and short: yes! Physical distancing was the common denominator in all scenarios and there is much uncertainty about the future. This is something we should manage differently. Since the scenario has changed, the type of leadership must change. We must rethink our work, our roles, and the internal and external requirements of our service or institution.

I will describe how I consider the 4 leadership variables are today.

c. Leader

Leaders should be aware of and manage several situations in the post-pandemic period. Toxicity in the workplace and individualism are two situations that have increased. Fear makes us more irritable and even aggressive at times. Uncertainty about our job situation and future makes us more demanding and, at times, conflictive. Finally, infantilization already mentioned in previous paragraphs makes us ask our immediate superior to solve our problems instead of getting involved and working together (“let daddy solve the problem for me”).

Several publications express the characteristics that post-pandemic leaders should have. They should have the courage to manage uncertainty and be willing to make open-ended decisions. They must be curious to look for new market opportunities and be clear in the decision-making process.

Christian Harrison describes the four key rules for leadership: be empathetic, be decisive, recognize and exploit opportunities, and build effective teams. In turn, Fernando Avilés Molina describes the 5 domains of post-pandemic leadership: talent manager, human capital developer, strategist, executor and personal proficiency. Table 1 summarizes the main statement of both publications.

Table 1 New leadership 

The post-pandemic leader is also allowed to be vulnerable and not the big macho guy. Leaders are asked to tell the truth, ask for help, step out of the comfort zone, acknowledge mistakes and apologize, and involve others in the goal of self-improvement. Two words probably summarize what a leader must have in the post-pandemic era: empathy and decisiveness. In a systematic review of 54 publications performed by Porkodi on post-COVID-19 leadership in the business area, the author describes the challenges for future leaders, which are summarized in Figure 3.

Figure 3 Challenges of the future leaders according to S. Porkodi 

Experience of the Department of General Surgery of Hospital Italiano de Buenos Aires

In the post-pandemic recovery phase, the Department of General Surgery works in line with institutional policies. The priority was the health of all members of our service and healthcare team. The next step was the recovery of the production capacity that had been seriously compromised during the pandemic. We focused on fighting with our skills by generating new products while seeking the highest profits and efficiency. We were very concerned about the welfare of our resident physicians, so we proposed several 4 key rules for successful postpandemic leadership (Harrison C,) 5 domains of post-pandemic leadership (Avilés Molina) Be empathetic Talent manager Be decisive Human capital developer Recognize and exploit opportunities Strategist Build effective teams Executor Personal proficiency Keys and domains of new leadership strategies to contain and help them. To evaluate the effectiveness of our strategy, we conducted surveys among them at three different times during the pandemic and thus achieved that feelings of safety and motivation, which at the beginning of the pandemic did not exceed 40% of the respondents, improved to 90%, and feelings of frustration, paralysis and discomfort, which at the beginning were 60%, decreased to 10%.

We supported the institutional post-pandemic reactivation proposed by the managers of our hospital, which is based on eight mainstays. One of them is to exert transformational leadership, using different strategies for this purpose. The watchword is to break paradigms and propose new goals, products and strategies. Our actions must be efficient and costeffective. To overcome the difficulties in this postpandemic period, we proposed several modifications for the administrative staff. We determined that they could assign one day a week to work from home as a way of reducing their workload. We took closer care and were better informed about their health issues. We kept our specific chat with them more active. We were more alert to important personal dates (birthdays) and group dates (Secretary’s Day) to greet them and have small celebrations. We worked in close communication with the human resources and legal areas to manage unforeseen situations.

We reinforced goal-oriented work of staff physicians, which is already a routine practice in our department, rather than work based on hours. For the morning rounds, teaching activities, case conferences, and morbidity and mortality meetings, we adopted a hybrid system combining onsite with online attendance using the Zoom platform. To improve the quality of communication, we proceeded to install a sound system in the classroom of our department with several microphones and acoustic panels to avoid reverberation and echo. Every member was free to choose how to attend these activities. We sought to encourage interpersonal relationships that had been so affected by the pandemic. To improve communication between the groups and their members, we used the specific chat to announce and celebrate the achievements of the members of the department and to stimulate interpersonal contact.

In terms of healthcare services, we were able to correct the situation of patients admitted per day, number of surgeries performed per month, and number of scientific publications indexed in PubMed per year. We have exceeded the figures for the respective indicators prior to the pandemic (Fig. 4,5,6).

Figure 4 Changes in the number of patients hospitalized per day and type of medical coverage 

Figure 5 Variations in the number of surgeries per month, before, during and after the pandemic 

Figure 6 Number of publications indexed in PubMed per year decisions at times. 

What have we learned? What must we change?

Finally, I will answer the two questions I was asked when I was invited to give the lecture that gives the title to this publication.

What have we learned?

1. The pandemic was a crisis of humanity (of the “Human being”).

2. Human vulnerability was revealed.

3. We are no longer the same persons. Changes in scales and goals.

4. Sensitivity/susceptibility/overreactions.

5. Need for empathetic leadership and with quick

6. Resilient leadership.

7. Entrepreneurial leadership.

8. Serotinous leadership.

9. Transformational leadership.

10. New goals/new strategies/new benchmarks (?).

What must we change?

1. Listen more than ever before.

2. Always put ourselves in someone else’s place

3. Be more patient with the arguments.

4. Count to 100 and not 10 before answering.

5. Let things flow a bit.

6. Participate in teams, without strict supervision.