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,
uncertain, complex, and ambiguous) world, the meaning of time, in
particular in the context of crisis, where the situation is likely to
become even more complex, uncertain, and disruptive,1 is crucial.
Defining organizational crises as “an event perceived by managers
and stakeholders as highly salient, unexpected, and potentially
disruptive,” the meaning of time is characterized both in terms of
the unexpectedness of the crisis and “the perceived urgency of the
response.” Considering the implicit meaning of time in organiza-
tional crisis, it is not surprising that time is also incorporated into
crisis management and leadership. Derived from the “perceived
significance and urgency of crises,” “time pressure, risks, and un-
certainty” are the conditions underlying leaders’ decision-making
in crisis. Researchers have conceptualized crisis leadership
around the aspect of time by referring to the time before crisis,
during crisis, and after crisis,2 whereby time has been a key element
of crisis management in the recent COVID-19 pandemic.3,4
Globally, crisis management is crucial in healthcare and public
health organizations that are used to operating in risky contexts,
where the risks of catastrophes are omnipresent. Although the
possibility of crisis is ubiquitous in healthcare, and hospitals, before
the COVID-19 pandemic, only single units of these organizations,
for example, emergency or intensive care units,5 needed to deal
with routine emergencies and mass casualty incidents. Further-
more, crisis management in these specific units was largely reac-
tive. Along this line, medical teams needed to respond to these
events and mobilize resources rapidly, whereby the duration of
exposure to such emergencies events was relatively short.6 How-
ever, the emergence of SARS-CoV-2 and the subsequent pandemic
changed this by moving hospitals into a temporal organization-
wide emergency context, where the “potentiality of crisis” turned
into actuality.5 In this sense, including this shift in context, we call
for future research examining the aspect of time regarding different
leaders' resilience strategies and how this affects the resilience of
healthcare and public health organizations to contribute to the
international discourse.7,8
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: nina.fuereder@jku.at (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
when it comes to handling adversity in organizations but also in-
fluence resilience through a trickle-up (i.e. organizational resil-
ience) and trickle-down effect (i.e. employee resilience).
Intensified by the COVID-19 pandemic, the leaders' ability to
effectively deal with a critical situation becomes even more
important in healthcare and public health organizations. Derived
from Foerster and Duchek's12 process-oriented model, leaders'
resilience can be understood, as three successive stages of the
resilience process, namely, precrisis, during crisis, and postcrisis,
whereby each stage requires a specific behavior of the leader to
master these stages successfully. While, in stage 1, the leader must
anticipate critical developments and prepare for potential crises; in
stage 2, the leader must cope with an acute crisis. In stage 3, the
leader must finally reflect on and learn from the crisis.
Although this dynamic process provides us with some notion on
how leaders effectively deal with critical situations, the under-
standing of time primarily refers to the general division of crisis
into the three phases of pre, during, and after crisis1,2 but leaves us
with a lack of understanding about the influence of time within
each of these stages. Along this line, longer “coping” phases during
crisis, as was the case during the pandemic, might require a
different approach by healthcare leaders than during shorter
“coping” phases, which are more common in hospitals, especially in
terms of non-routine emergencies, such as mass casualty incidents
or disasters.
Time and temporality in resilience
As we know that a crisis can last for a long time, temporal
conditions for managing crisis become increasingly salient. Ancona
et al.13 define time as “a non-spatial continuum in which events
occur in apparently irreversible succession from the past through
the present to the future.”14 Time is increasingly considered an
important resource in organizational research.15 Scholars have
called for a sharper focus for understanding temporality in orga-
nizational relationships, employee interactions, and performance,
whereby time has an important influence on organizational and
social practices.16
Regarding resilience, time has multifactorial impacts relating to
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-
ience long before the pandemic, the COVID-19 pandemic has
exacerbated this situation. During the pandemic, healthcare leaders
were stressed in multiple ways; they had to handle a high work-
load, manage many changes in a short time and tolerate a high
degree of uncertainty. Therefore, resilience emerged as a prereq-
uisite for overcoming the pandemic not only in a productive but
also in a healthy manner.
Incorporating the aspect of time, Bardoel and Drago17 propose
two types of resilience, namely, acceptance resilience and strategic
resilience. Originating from the conservation of resources theory,
acceptance resilience is built on a “resource-preserving” strategy
and is therefore probably more suitable for short-term minor
adversity, strategic resilience involves a “resource-enhancing”
strategy, and it is thus probably more suitable for major long-term
adversity.17 Although both strategies are successful coping mech-
anisms, they differ fundamentally in their use of resources. Along
this line, individuals who are predominantly used to acceptance
resilience will experience declining resources over time, whereas
those who rely on strategic resilience will gain resources over time.
Referring to the emergency context in healthcare and public
health, where crises are usually short but intensive, it can be
assumed that the crisis structure in healthcare might favor a
“resource-preserving” acceptance resilience strategy. However,
40
Public Health 215 (2023) 39e41
long-term adversity, such as the pandemic, or persisting overwork,
where the work demand constantly exceeds the individual re-
sources,18 which is typical in healthcare and public health organi-
zations, might require “resource-enhancing” strategic resilience
strategies. Otherwise, the institutional and organizational con-
straints are likely to cause the healthcare leaders’ resilience to
erode throughout time,19 whereby consequences can be severe.
Previous studies suggest that an overload due to psychological job
demands can be associated with negative events, such as near
misses and injuries.20 At the individual level, constant stress and
overload can be related to both psychological as well as physical
health problems, such as heart disease and other chronic ailments.
Conclusion
Building on previous research on resilience, especially on
leaders and in the healthcare setting,8 we argue that time is not
only important when it comes to crisis management but is also
highly significant when it comes to leaders' resilience, implying
that different temporal demands, ely regarding the persistence of
adversity, require different resilience strategies applied by the
leader. Future research might examine how different leaders’
resilience strategies affect crisis management outcomes as well as
the resilience in healthcare and public health organizations. As we
know that individuals' coping resources decline over time, we must
expect that those who stay with acceptance resilience may expe-
rience deleterious effects such as burnout or chronic sickness, and
those who switch from acceptance to strategic resilience will seek
new opportunities for occupational engagement. From a practical
point of view, this could end up in precarious leadership shortages
where leaders either are on long-term sick leave or, what we
already observe, voluntarily relinquishing their leadership posi-
tions and returning to clinical practice.
Author statement
Ethical approval
None sought.
Funding
This work emerged from a research project supported by the
High Impact Program of the JKU Business School. There are not any
ethical, approval, funding and competing interests because of the
conceptual nature of this short communication paper.
Competing interests
None declared.
References
1. Bundy J, Pfarrer MD, Short CE, Coombs WT. Crises and crisis management:
integration, interpretation, and research development. J Manag 2017;43/6:
1661e92.
2. Wu YL, Shao B, Newman A, Schwarz G. Crisis leadership: a review and future
research agenda. Leader Q 2021;32(6):1015e8.
3. Hertelendy AJ, Chekijian S, McNulty E, Mitchell CL, Grimes JO, Durneva P, et al.
Crisis leadership: a case for inclusion in accredited master of public health
program curricula. Publ Health 2022;209:14e8.
4. Kunisch S, Blagoev B, Bartunek JM. Complex times, complex time: the
pandemic, time-based theorizing and temporal research in management and
organization studies. J Manag Stud 2021;58(5):1411e5.
5. H€allgren M, Rouleau L, De Rond M. A matter of life or death: how extreme
context research matters for management and organization studies. Acad
Manag Ann 2018;12(1):111e53.
 €rster, N. Füreder and A. Hertelendy
C. Fo
6. Hannah ST, Uhl-Bien M, Avolio BJ, Cavarretta FL. A framework for examining
leadership in extreme contexts. Leader Q 2009;20(6):897e919.
7. Yu M, Wen J, Smith SM, Stokes P. Building-up resilience and being effective
leaders in the workplace: a systematic review and synthesis model. Leadership
Org Dev J 2022 [Nr. ahead-of-print].
8. West CP, Dyrbye LN, Sinsky C, Trockel M, Tutty M, Nedelec L, et al. Resilience
and burnout among physicians and the general US working population. JAMA
Netw Open 2020;3(7). e209385-e209385.
9. Pearson CM, Clair JA. Reframing crisis management. Acad Manag Rev
1998;23(1):59e76.
10. Buyl T, Boone C, Wade JB. CEO narcissism, risk-taking, and resilience: an
empirical analysis in US commercial banks. J Manag 2019;45(4):1372e400.
11. Foerster C, Duchek S. Leaders' resilience-A systematic literature review and
future research agenda. Acad Manag Proc 2018;1:13879.
12. Foerster C, Duchek S. Leaders' Resilience: what leaders can learn from the
COVID-19 crisis. In: Dhiman S, Marques J, editors. Leadership after COVID-19
working together toward a sustainable future. Cham: Springer; 2022.
p. 17e30.
13. Ancona DG, Okhuysen GA, Perlow LA. Taking time to integrate temporal
research. Acad Manag Rev 2001;26(4):512e29.
41
Public Health 215 (2023) 39e41
n C, Parida V, Frishammar J, Wincent J. Time and time-based organizing of
14. Sire
innovation: influence of temporality on entrepreneurial firms' performance.
J Bus Res 2020;112:23e32.
15. Berends H, Antonacopoulou E. Time and organizational learning: a review and
agenda for future research. Int J Manag Rev 2014;16(4):437e53.
16. Langley ANN, Smallman C, Tsoukas H, Van de Ven AH. Process studies of
change in organization and management: unveiling temporality, activity, and
flow. Acad Manag J 2013;56(1):1e13.
17. Bardoel EA, Drago R. Acceptance and strategic resilience: an application of
conservation of resources theory. Group Organ Manag 2021;46(4):657e91.
18. Sandhåland H, Oltedal HA, Hystad SW, Eid J. Effects of leadership style and
psychological job demands on situation awareness and the willingness to take
a risk: a survey of selected offshore vessels. Saf Sci 2017;93:178e86.
19. Foerster C, Duchek S, Geithner S. Resilienz von Führungskr€ aften in pan-
demischen zeiten: St€ arkung oder Erosion? In: Zerth J, Garkisch M, Nass E,
editors. Leben und Versorgung gestalten nach Corona: lernen und Lehren aus der
Krise. Stuttgart: Kohlhammer; 2022. p. 149e66.
20. Li F, Jiang L, Yao X, Li Y. Job demands, job resources and safety outcomes: the
roles of emotional exhaustion and safety compliance. Accid Anal Prev 2013;51:
243e51.