While the effects of the COVID-19 pandemic shook the global environment, the observations and actions of healthcare professionals during that crisis serve as a defining moment for modern systems. The pandemic tested leadership, resilience, and patient care around the world, while hospitals faced unprecedented patient surges, strained supply chains, and clinicians who operated under sustained physical and emotional strain.(1-3) While the scale of the pandemic was extraordinary, the underlying dynamics it revealed — urgency, disruption, uncertainty, risk mitigation — are inherent to all crises, and we should learn from them.(4) As a smart mentor once told me in combat, never let the lessons from any good crisis go to waste!
Since the pandemic, healthcare leaders have increasingly recognized that crises are not just episodic disruptions. Rather, they have increasingly become part of a persistent operational reality. The concept of “polycrisis,” in which multiple crises overlap and interact across systems, as described in business and economics journals, may also provide a useful lens for understanding healthcare’s current environment.(5) That’s because healthcare organizations and clinicians themselves continue to confront an ever-expanding convergence of clinical threats, technological vulnerabilities, workforce challenges, and an evolving information landscape that shapes both public perception and patient behavior. A cyber event that occurred as part of a plot line for a recent episode of the popular TV series The Pitt exemplified the effects of a geopolitical threat that could potentially disrupt all healthcare systems.
Given this landscape, effective crisis management in healthcare requires a broader and more integrated framework than what has been applied in the past. While clinical expertise, operational efficiency, and patient care still make up the “triple aim” and remain essential to quality care, future crises will require greater patient–provider trust, coherence within healthcare systems, and rapid adaptability in care environments amid periods of complexity and competing narratives.
Defining Crisis in Healthcare Contexts
A crisis in healthcare can be defined as a significant disruption that threatens a clinical team, healthcare organization, or system’s ability to deliver safe, effective, and timely care. Such events are characterized by urgency, uncertainty, elevated risk, and a breakdown of normal processes.(4,6) These conditions distinguish crises from routine clinical challenges and demand a fundamentally different approach to treatment, leadership, and decision-making.
While healthcare organizations rely on structured processes, established hierarchies, and evidence-based protocols under normal circumstances, my experiences in combat taught me that crises compress decision timelines and often require action in the absence of complete information. This analogy parallels military doctrine’s transition from deliberate planning to crisis action planning, in which speed, decentralization, and adaptability become paramount.(7)
In practical terms, this means that leaders must be prepared to redefine roles, prioritize competing demands, and operate under conditions of ambiguity. Equally important is the recognition that crises amplify the human dimension of healthcare delivery. We learned during the COVID-19 crisis that fear, fatigue, and uncertainty affect clinicians and administrators equally, influencing decision-making, communication, and performance.(8) Effective crisis management, therefore, requires attention to both the operational and human factors.
Lessons from COVID-19: Foundations for Future Crises
Although the COVID-19 pandemic was unique in many respects, it reinforced several enduring principles of crisis leadership that are broadly applicable to future challenges. Team cohesion and mutual support are key examples. Healthcare professionals working under extreme pressure relied heavily on trusted colleagues, reinforcing the value of strong interpersonal relationships and shared accountability.(9)
Preparation for unexpected scenarios also proved critical. Organizations that had invested in contingency planning — whether for infectious disease outbreaks, mass casualty events, treatment of communities during natural disasters, or supply chain disruptions — were better positioned to adapt when conditions changed rapidly.(10) This preparation did not eliminate uncertainty, but provided a framework for responding to it.
Communication emerged as another decisive factor. Leaders who communicated frequently, transparently, and consistently were more effective in aligning teams and maintaining morale.(11) In an environment where information evolved rapidly, the ability to establish a shared understanding and a shared situational awareness between all members of the healthcare system team — physicians, nurses, administrators, and staff — was essential to coordinated action.
Finally, the pandemic underscored the necessity of continuous adaptation. Protocols, treatments, and operational approaches evolved in real time, requiring organizations to learn and adjust without pause.(12) Continuous adaptation and the rapid dissemination of noted procedural changes are not discrete phases but ongoing requirements.
These principles — team cohesion, preparation, communication, and adaptation — form the foundation during any crisis. However, the nature of the crises healthcare may face is expanding in ways that demand a broader perspective.
A Taxonomy of Emerging Healthcare Crises
The range of crises confronting healthcare systems today extends well beyond traditional clinical emergencies. For analytical clarity, these can be categorized into five domains: public health crises, technological crises, environmental crises, systemic and workforce crises, and informational crises.
Clinical and public health crises remain central to healthcare operations, but their manifestations are evolving. In the United States and in Europe, the resurgence of measles has been linked to declining vaccination rates influenced by misinformation, demonstrating how public health challenges are increasingly shaped by social dynamics.(13) In the United States, the opioid epidemic continues to represent a sustained crisis with significant mortality and resource implications.(14) The growing threat of antimicrobial resistance raises the possibility of infections that are increasingly difficult — or impossible — to treat.(15)
Technological crises, most notably cyberattacks, represent a rapidly expanding category of risk. The 2007 cyberattack in Estonia and the 2021 ransomware attack on Ireland’s Health Service Executive disrupted healthcare delivery nationwide, illustrating the vulnerability of modern systems to digital threats.(16) Similar incidents in the United States have compromised patient data and interfered with clinical operations.(17) These events demonstrate that cybersecurity is no longer a peripheral concern but a core component of patient safety.
Environmental and climate-related crises are also becoming more frequent and severe. Heatwaves, floods, and extreme weather events have produced mass casualty scenarios and strained healthcare infrastructure across the United States.(18,19) In addition to these acute events, climate change contributes to long-term health challenges, including respiratory illnesses, vector-borne diseases, and food insecurity, placing sustained pressure on healthcare systems.(20)
Systemic and workforce crises further complicate the landscape. Persistent staffing shortages, high levels of burnout, and increasing demand for services have created conditions that can degrade the quality of care.(21,22) Supply chain disruptions, highlighted during the COVID-19 pandemic, remain an ongoing vulnerability that can rapidly escalate into crisis conditions.
Overlaying all these domains is the growing challenge of informational crises. The proliferation of misinformation, disinformation, and malinformation has profound implications for healthcare delivery. The World Health Organization has characterized this phenomenon as an “infodemic,” in which false or misleading information spreads rapidly and undermines evidence-based practice.(23) Vaccine hesitancy and resistance to public health measures illustrate how information dynamics can directly influence clinical outcomes.
Taken together, these categories illustrate that healthcare crises are no longer confined to clinical events. They are systemic, interconnected, and often driven by factors outside traditional medical domains.
Leadership Requirements in a Polycrisis Environment
Responding effectively to this expanded range of crises requires a leadership framework that integrates personal attributes, professional competencies, methods of influence, and contextual awareness.(6) At the foundation of this framework are the attributes of character, presence, and intellect. Character establishes trust and credibility, presence conveys confidence and stability under pressure, and intellect enables leaders to process complex information and make sound decisions in uncertain conditions.(24) These are the four elements that form a leadership foundation for any industry, but that are especially critical in healthcare.
Building on these attributes are the competencies required for effective action. Communication remains the most critical of these, as it shapes both internal coordination and external trust. Leaders must be able to convey information clearly and consistently, even as conditions evolve. Decision-making is equally important, requiring the ability to act decisively despite incomplete information. Adaptability ties these competencies together, allowing leaders to adjust strategies and operations as new information becomes available.(11,12)
Influence represents the mechanism through which leadership is exercised. In complex crises, authority alone is insufficient to achieve desired outcomes. Leaders must rely on influence techniques that build trust and engagement, including transparency, consultation, collaboration with all team members, and alignment of actions with shared values.(25)
Contextual awareness completes the framework. Leaders must understand not only the clinical and operational environment but also the cultural, political, and informational contexts in which they reside.(26) Decisions that are technically sound may fail if they do not account for these broader factors. In multinational or diverse healthcare systems, this awareness becomes even more critical.
Operational Approaches to Crisis Management
Effective crisis management requires translating leadership principles into operational practice. A key element of this process is anticipation. Leaders must identify early indicators of potential crises and actively seek relevant information, rather than waiting for clarity to emerge. This approach, often described as “fighting for intelligence” or taking the long view, enables rapid and more informed responses.(7)
Once a crisis emerges, organizations must transition rapidly from routine operations to crisis mode. This involves establishing clear roles and responsibilities, prioritizing critical tasks, and empowering teams to act within defined parameters.(10) The speed and clarity of this transition often determine the effectiveness of the response.
Communication remains central throughout the crisis. Consistent messaging that is reviewed, repeated, and reinforced helps ensure that teams and stakeholders maintain a shared understanding.(11) At the same time, healthcare teams are required to remain flexible, adapting their approaches as conditions change. Continuous learning, supported by structured after-action reviews, allows for real-time improvement and the institutionalization of new observations and lessons.(12)
Managing the Information Environment
One of the defining features of modern healthcare crises is the role of information. Misinformation and disinformation can spread rapidly, shaping public perception in communities and influencing patient behavior.(23) In this environment, healthcare leaders must provide accurate, timely, and credible information.
This requires not only technical accuracy but also effective communication strategies. Messages must be tailored to the audience, addressing concerns and building trust. Collaboration with public health agencies, media organizations, and community leaders can enhance the reach and credibility of these efforts.
Managing the information environment by every member of the healthcare team is not a peripheral task; it is central to crisis management within any organization. Without trust in information, even the most effective clinical interventions may fail to achieve their intended outcomes.
Recovery, Resilience, and the Future of Healthcare Crisis Management
Recovery from a crisis involves more than restoring operations. It requires building resilience — the capacity to absorb shocks, adapt to changing conditions, and continue effective functioning.(27) This requires investments in workforce leader development, analysis of infrastructure, and systems preparedness through training.
As healthcare systems continue to evolve, leaders must view the onset of any crisis and the follow-on crisis management as core competencies rather than specialized functions. Leaders must be trained and developed with this mindset, which will ensure that they are equipped to operate effectively in complex and uncertain environments.
Conclusion
Healthcare systems in the United States are entering an era defined by complexity, interdependence, and persistent disruption. Crises will be more diverse, more interconnected, and more influenced by factors beyond traditional clinical domains. While this article has defined a few domains, there are additional factors that will likely influence the actions of healthcare providers.
In a crisis environment, I have learned that leadership is the decisive factor. Effective leaders integrate professional expertise in the science and art of their position with the ability to communicate effectively, build trust continuously, and constantly adapt to changing conditions. In healthcare, these leaders must operate not only as clinicians or administrators but also as coordinators who understand complex systems and see themselves as stewards of public and community confidence.
The next crisis is not a question of if, but when. Preparing for that reality requires a commitment to growth and learning, adaptability, and leadership development. Ultimately, the success of healthcare in future crises will depend not only on resources and technology but also on the quality of the leaders who guide it.
References
World Health Organization. COVID-19 Strategic Preparedness and Response Plan. WHO; 2020. https://www.who.int/publications/i/item/WHO-WHE-2021.02 .
European Centre for Disease Prevention and Control. COVID-19 Pandemic Overview. ECDC; 2021. https://www.ecdc.europa.eu/en/covid-19 .
Ranney ML, Griffeth V, Jha AK. Critical supply shortages — the need for ventilators and PPE during the COVID-19 pandemic. N Engl J Med. 2020;382: e41. https://doi.org/10.1056/NEJMp2006141 .
Hertling M. Ten tips for a crisis: lessons from a soldier. J Hosp Med. 2020;15(5):275-276. https://doi.org/10.12788/jhm.3424 .
Tooze A. Welcome to the world of the polycrisis. Financial Times. 2022. https://www.ft.com/content/498398e7-11b1-494b-9cd3-6d669dc3de33 .
Hertling M. Leadership frameworks in crisis environments. Unpublished teaching materials; 2022.
Joint Chiefs of Staff. Joint Publication 5-0: Joint Planning. U.S. Department of Defense; 2020. https://www.jcs.mil/Doctrine/Joint-Doctrine-Pubs/5-0-Planning-Series/ .
Shanafelt TD, Ripp J, Trockel M. Understanding and addressing sources of anxiety among healthcare professionals during COVID-19. JAMA. 2020;323(21):2133-2134. https://doi.org/10.1001/jama.2020.5893 .
Edmondson AC. Psychological safety and learning behavior in work teams. Adm Sci Q. 1999;44(2):350-383. https://doi.org/10.2307/2666999 .
Kaji A, Koenig KL, Bey T. Surge capacity for healthcare systems: a conceptual framework. Acad Emerg Med. 2006;13(11):1157-1159. https://doi.org/10.1197/j.aem.2006.06.032
Reynolds B, Seeger MW. Crisis and emergency risk communication. J Health Commun. 2005;10(1):43-55. https://doi.org/10.1080/10810730590904571 .
Argyris C, Schön D. Organizational Learning II. Addison-Wesley; 1996.
European Centre for Disease Prevention and Control. Measles outbreaks in Europe. ECDC; 2023.
Centers for Disease Control and Prevention. Drug overdose deaths in the U.S. CDC; 2024.
World Health Organization. Antimicrobial resistance. WHO; 2023. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance .
Health Service Executive. Conti cyberattack on the HSE. Government of Ireland; 2021. https://cyberireland.ie/wp-content/uploads/2022/02/conti-cyber-attack-on-the-hse-full-report.pdf .
Cybersecurity & Infrastructure Security Agency. North Korean state-sponsored cyber actors use Maui ransomware to target the healthcare and public health sector. Cybersecurity & Infrastructure Security Agency Cybersecurity Advisory. July 7, 2022. https://www.cisa.gov/news-events/cybersecurity-advisories/aa22-187a .
IPCC. Climate Change 2022: Impacts, Adaptation and Vulnerability. United Nations; 2022. https://www.ipcc.ch/report/ar6/wg2/ .
European Environment Agency. Climate-change as a threat to health and well-being in Europe: focus on heat and infectious diseases. European Environment Agency; 2022. https://www.eea.europa.eu/en/analysis/publications/climate-change-impacts-on-health .
Romanello M, McGushin C, Di Napoli C, Drummon P, et al. The 2021 report of the Lancet Countdown on health and climate change. Lancet. 2021; 398(10311):1619-1662. https://doi.org/10.1016/s0140-6736(21)01787-6 .
NHS England. NHS long term workforce plan. Workforce shortages and staffing report. NHS; 2023. https://www.england.nhs.uk/wp-content/uploads/2023/06/nhs-long-term-workforce-plan-v1.2.pdf .
West CP, Dyrbye LN, Shanafelt TD. Physician burnout. Lancet. 2018;388(10057):2272-2281. https://doi.org/10.1016/S0140-6736(16)31279-X
World Health Organization. Managing the COVID-19 infodemic: promoting healthy behaviors and mitigating the harm from misinformation and disinformation WHO; 2020. https://www.who.int/news/item/23-09-2020-managing-the-covid-19-infodemic-promoting-healthy-behaviours-and-mitigating-the-harm-from-misinformation-and-disinformation .
Northouse PG. Leadership: Theory and Practice. 8th ed. Sage; 2018.
Yukl G. Leadership in Organizations. 8th ed. Pearson; 2013.
Meyer E. The Culture Map: Breaking Through the Invisible Boundaries of Global Business. PublicAffairs; 2014.
National Academy of Medicine. National plan for health workforce well-being. National Academy of Medicine; 2022. https://nam.edu/publications/national-plan-for-health-workforce-well-being/ .