Perspectives of primary care leaders on the challenges and opportunities of leading through the COVID-19 pandemic

Context: The COVID-19 pandemic presented new challenges to primary care, but little is known about the experience of practice leaders. Objective: Describe the experience of leaders in a range of primary care delivery organizations leading their teams during the COVID-19 pandemic. Study Design: Qualitative study using semi-structured interviews. Thematic analysis was performed using a hybrid deductive/inductive approach. Sample: Convenience sample of 15 clinical leaders in organizations in the United States that deliver primary care. Organizations included academic health centers, federally qualified health centers, non-academic health systems, and independent private practices. Results: Early in the pandemic, leaders had to make many critical decisions despite substantial uncertainty. Clinicians and staff experienced fear regarding personal health, potential workplace exposures, and job security, while also having a strong sense of purpose and wanting to help with pandemic response. Strategies leaders used to manage teams included 1) Being present, listening, acknowledging uncertainty and showing vulnerability 2) Near constant communication regarding changing conditions, 3) Strengthening trust among team members by building upon prior relationships, and 4) Changing