Leadership during the COVID-19 pandemic: building and sustaining trust in times of uncertainty

The year 2020 will be remembered as the year of the most significant global pandemic since the Spanish influenza. As Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) gradually encompasses the globe, it leaves a trail of destruction in its wake. Hundreds of thousands of direct lives lost, millions of persons affected with the disease, potentially with long-term health consequences, disruption to global travel and trade, and dislocation of communities and individual lives. At an international, national and community level, leaders across all sectors have been required to respond to both direct and indirect effects of this crisis, with little time for preparation, and in a constantly changing environment. For leaders, this significant uncertainty exacerbates the challenges associated with decision making and requires a rapidly adaptive response not usually associated with leadership in more ‘business-as-usual’ times.1 Leadership examples and frameworks during crises exist from the military and emergency management sectors. However, a key challenge of a pandemic is that an effective management of the situation requires large-scale human behaviour change. When adoption is insufficient, collective benefits are not guaranteed. A global pandemic is therefore a ‘litmus test of trust in a health system’ (p.214). 2 Trust is an individual’s expectation or belief, often in circumstances of vulnerability, that the actions or motives of another person are honest, fair and based on integrity (follow sound ethical principles).3 Trust can be at a system, organisational or individual level. It can be inspired by confidence from past behaviours, however, it is also dynamic, being developed de novo from individual or organisational relationships. Trust allows a person with less knowledge, power or ability to process complex information, to rely on another individual or institution to make decisions aligned with their well-being. Thus, trust has historically been a cornerstone of clinical care and clinician–patient …