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The authors lead the University of Oxford Evidence-Based Healthcare Leadership Programme.

Spring.

A huge operation is at hand, involving hundreds of thousands of people, in multiple sites, watched by the world. Despite their planning, teams of highly trained people are working in a situation that they never thought would happen. All the teams had run through different scenarios, but nobody ever thought this would happen across so many sites, so much of the organisation. There was little warning and events were evolving at an uncontrollable pace.  All routine activities were cancelled; the only focus now was survival.

Sound familiar?

The situation described above happened in 1970, to NASA and involved Apollo 13, the seventh mission of the Apollo space programme. Many will know the desperate fight to keep the crew alive after an explosion on board resulted in unfathomable technological challenges. Here was a space craft, floating in space, with no significant power, freezing and damp. attempting to re-enter Earth’s atmosphere and return home. It took a collaborative effort, over a 200,000 mile distance to attempt to stabilise the craft, run real time simulations, create new protocols and procedures and with only one acceptable outcome – a safe return.

That was the crisis.

How did NASA handle it internally? What happened to Crisis Leadership?

As soon as Mission Control realised that the sensors and numbers they were seeing were real, and that took a period of time, shock, denial and doubt crept in to a highly trained and stressed team unit. Gene Kranz, Flight Controller called his team together at the end of their shift “on watch”. Kranz handed over to a new Flight Controller, having had the realisation and confidence to understand that new eyes, new perspectives, new energy was needed. The Kranz team made their way to his ‘Tiger’ room. In this room, no bigger than a typical meeting room, with a few spare tables, he asked each specialist for their view on the current situation and future plans. Clear, succinct, no long explanations. At this point, 27 year old John Aaron stood up, as a junior team member, his next words changed the mission; ‘ Gene, if we don’t cut the power we won’t get home’.

A 27 year old, junior team member has just interrupted a room full of senior flight engineers and NASA’s most senior Flight Director, with utter confidence and told him his view. Kranz paused, thought about what he had said, turned to Aaron and told him ’John, you are now in charge’. Kranz then left the room.

In the middle of NASA’s greatest challenge at that point, with a live Moon mission going disastrously wrong, a 27 year old junior team member raised his hand, spoke clearly and calmly, in a room of senior staff and peers. Gene Kranz immediately understood the ramifications of what he was being told, and instantly made a decision that ultimately saved the flight and the crews lives. All in real time, in a crisis.

Crisis Leadership in NASA was built, reinforced and maintained over many years.

It was the product of trial and error, a product of trying new things, inventing new disciplines, new ways of working, new materials all without many policies and procedures. It was building a ‘culture’.

The NASA culture was a culture of innovation, support, training, pushing forward and giving people opportunity to try; permission to try things and see things fail. After all nobody had ever flown outside of the Earth’s orbit when the programme started and the goal was to go from there to the Moon and back, safely, within ten years.

Mistakes along the way had led Kranz to form the motto (after the Apollo 1 fire and death of three astronauts) Tough and Competent’.  Spaceflight will never tolerate carelessness, incapacity and neglect. Nothing we did had a shelf life but nobody said ‘stop’. Tough means we are forever accountable for what we do or what we fail to do. Competent means we will never take anything for granted.

The Crisis Leadership employed a number of clear lessons. Some of them may be applicable now.

  1. Build a great team. Not a team that pleases you, one that challenges you and the organisation’

On the morning the Moon mission, Kranz said to all members of Mission Control;            ‘I will stand behind every decision you make. We came into the room as a team and we’ll go out as a team.”

Kranz immediately gave his team trust. A vital element in decision making communication staying positive and focussed. All the team energy was directed toward doing a great job-not double thinking or worrying about what might happen afterward.

  1. Leaders keep learning. Keep asking questions, keep pushing yourself to learn.

As each new step in the crisis unfolds keep asking questions, look for possible answers and look at the ramifications of the questions and answers – ask yourself what they might mean in context of this crisis?

  1. Build, develop and sustain a culture that keeps pushing forward, takes chances and realises, truly realises, that getting things wrong is a key learning point.

If this culture is part of the team before a crisis, it’s much easier to sustain in a crisis. Many teams talk about support-in our experience very few mean it! Ask yourself now, “as a leader, what am I doing to build that culture in my team?”

  1. Pause, reflect but then make decisions.

Don’t rely on pushing decisions upward. Build in layers of decision making so that in real time people can move, take action without waiting for a signal from the centre. Use the collective intelligence of your team to help you.

  1. Have a strategy and a clearly articulated end-point of where you want to be.

Know what you and the team are doing in real time, where you are all travelling to, clearly communicated timescales and what the key goals are along the way. For Kranz, the strategy and end point was clear. He had to get the mission crew safely back to Earth – no deviations, no room for compromise, and he communicated that to everyone. His team was therefore able to rely on each other, trust each other, find a way out of the situation when just about everything that could go wrong, did go wrong.

As Kranz said;

A job as flight director is to take the actions necessary for crew safety and mission success.  My line of work there is neither ambiguity or a higher authority. It is go, or no go. And I am accountable for the mission.”

Much later on, Kranz since said;

‘’In many ways we have the young people, we have the talent, we have the imagination, we have the technology. But I don’t believe we have the leadership and the willingness to accept risk, to achieve great goals’’.

There may be lessons for us all.

Sean Heneghan is a Chartered Organisational Psychologist and Senior Tutor at the University of Oxford.

Kamal R. Mahtani is a practising NHS GP, Associate Professor and Co-Director of the Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, and Director of the MSc in EBHC Systematic Reviews.

Both authors lead the University of Oxford Evidence-Based Healthcare Leadership Programme.

Disclaimer: The views expressed in this commentary represent the views of the authors and not necessarily those of the host institution, the NHS, the NIHR, or the Department of Health and Social Care. The views are not a substitute for professional medical advice.