• Jaason M Geerts, Donna Kinnair, Paul Taheri, Ajit Abraham, Joonmo Ahn, Rifat Atun, Lorena Barberia, Nigel J Best, Rakhi Dandona, Adeel Abbas Dhahri, Louise Emilsson, Julian R Free, Michael Gardam, William H Geerts, Chikwe Ihekweazu, Shanthi Johnson, Allison Kooijman, Alika T Lafontaine, Eyal Leshem, Caroline Lidstone-Jones, Erwin Loh, Oscar Lyons, Khalid Ali Fouda Neel, Peter S Nyasulu, Oliver Razum, Hélène Sabourin, Jackie Schleifer Taylor, Hamid Sharifi, Vicky Stergiopoulos, Brett Sutton, Zunyou Wu, and Marc Bilodeau.
• Research and Leadership Development, Canadian College of Health Leaders, Ottawa, Ontario, Canada.
• JAMA Netw Open. 2021 Jul 1; 4 (7): e2120295.

ImportanceThe COVID-19 pandemic is the greatest global test of health leadership of our generation. There is an urgent need to provide guidance for leaders at all levels during the unprecedented preresolution recovery stage.ObjectiveTo create an evidence- and expertise-informed framework of leadership imperatives to serve as a resource to guide health and public health leaders during the postemergency stage of the pandemic.Evidence ReviewA literature search in PubMed, MEDLINE, and Embase revealed 10 910 articles published between 2000 and 2021 that included the terms leadership and variations of emergency, crisis, disaster, pandemic, COVID-19, or public health. Using the Standards for Quality Improvement Reporting Excellence reporting guideline for consensus statement development, this assessment adopted a 6-round modified Delphi approach involving 32 expert coauthors from 17 countries who participated in creating and validating a framework outlining essential leadership imperatives.FindingsThe 10 imperatives in the framework are: (1) acknowledge staff and celebrate successes; (2) provide support for staff well-being; (3) develop a clear understanding of the current local and global context, along with informed projections; (4) prepare for future emergencies (personnel, resources, protocols, contingency plans, coalitions, and training); (5) reassess priorities explicitly and regularly and provide purpose, meaning, and direction; (6) maximize team, organizational, and system performance and discuss enhancements; (7) manage the backlog of paused services and consider improvements while avoiding burnout and moral distress; (8) sustain learning, innovations, and collaborations, and imagine future possibilities; (9) provide regular communication and engender trust; and (10) in consultation with public health and fellow leaders, provide safety information and recommendations to government, other organizations, staff, and the community to improve equitable and integrated care and emergency preparedness systemwide.Conclusions And RelevanceLeaders who most effectively implement these imperatives are ideally positioned to address urgent needs and inequalities in health systems and to cocreate with their organizations a future that best serves stakeholders and communities.

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