A lesson on agility and innovation from Region Stockholm / Karolinska University Hospital's stand-out crisis leaders, Sara Lindholm Larsson and Martin Tegnér

"The key was our clear mission!"

When the pandemic was a fact and the global shortage of protective equipment rushed last year, Sara Lindholm Larsson and Martin Tegnér only had a few weeks to solve the task. And their mission was clear: Get the necessary protective equipment for Region Stockholm's healthcare!

"We got the assignment on a Saturday and on Sunday we were already up and running", says Sara Lindholm Larsson.

Together with Martin Tegnér, she was commissioned in mid-March last year to secure the necessary protective equipment to protect the Stockholm healthcare professionals from the Corona virus. And they were given a free hand to set up the work effectively. In everyday life, they are both operational managers at Karolinska University Hospital.

And together they had a clear plan from the start regarding the set-up. About five years ago, the Johns Hopkins Hospital in Baltimore, USA, created what they called a "command center." They gather all the necessary expertise in one room, both with key people in place but also with all the necessary real-time data on constantly connected screens to control healthcare flows.

Inspired by this approach, Sara Lindholm Larsson and Martin Tegnér created a command center at Karolinska University Hospital where the concerned healthcare staff never were further away than the distance of a corridor.

"In Sweden, we are probably the only ones who have worked in this way in healthcare", says Martin Tegnér.

 "It has been a dream for many of us who work with healthcare flows to set up a center like this. Much like an air traffic control tower that is constantly fully supervised, with the necessary expertise in place to be able to make quick decisions", says Sara Lindholm Larsson.

Their work to set up a 'command centre' started on 21 March last year. About three weeks later, they had purchased over 90 percent of all the necessary protective equipment, which was then also delivered. It is worth remembering that during the same period there was an almost global purchasing war in the market for these types of products. For example, demand for protective visors rushed when the pandemic broke out with a staggering 13,000 percent in the region!

A previously empty conference room on the 7th floor of Karolinska was quickly filled up. On the walls, computer screens were put up, that in real time showed flows and the need for different types of protective equipment such as visors, aprons and respirators. In the room, a number of key functions were gathered. They were for example people from healthcare providers in the region who handled incoming tip-offs and the private service company Coor who established a warehouse at Arlanda Airport. Representatives from the Swedish Defense were in place and Scania contributed with global logistics and purchasing as well as other competences.

"At one point Scania had as much as 25 people in place in the command center and without them we would not have succeeded", says Martin Tegnér.

In addition, a Chinese doctor and advisor was present to help with direct contacts with Chinese producers of protective equipment. In addition, a number of other partners also contributed to the work outside the room, including Medicarrier, which manages all the region's healthcare logistics. The Swedish Customs supported with a fast track for protective equipment and H&M and IKEA adapted parts of their production in Asia. Several embassies contacted the command center to donate protective equipment or assist in other ways and companies donated food and hygiene items to the healthcare staff.

Right from the start, Sara Lindholm Larsson and Martin Tegnér decided to share the leadership.

"We understood that we had an incredibly labor-intensive period ahead of us, so we chose to share the leadership primarily for two reasons, partly as a practical way to manage the workload and partly to handle the risk should one of us would be infected by the virus", says Sara Lindholm Larsson.

Then there was the fact that the two as individuals complement each other very well, which both of them confirmed, talking in each other´s mouths.

 "We also quickly established a "buddy system" at the command center, an experience I brought with me from when I was program manager for the decommissioning of AstraZeneca's research activities in Södertälje in 2012. The idea is simply to appoint a "buddy" who pays attention to how you feel during an extremely stressful work situation and who provides feedback and support. We appointed ourselves to support each other", says Sara Lindholm Larsson.

But what made your way of leading so successful?

"An important reason was that from the beginning we had an extremely clear goal. We knew exactly what to do; fix the necessary protective equipment. And it was also about protecting our own colleagues in healthcare", explains Martin Tegnér.

"And at the same time, there were no preconceived notions about how to go about this since no one had ever done anything like this before. This meant that there was great openness of all involved regarding our 'how' to solve the task."

"An important reason for the success was also that all actors were co-located. If, for example, we as leaders sometimes risked becoming a bottleneck in the process, we could quickly delegate responsibility to a team leader who could take over and solve the task. And at the same time, the structure and communication about how we worked was very transparent for everyone involved", says Sara Lindholm Larsson.

"It is also important to remember that although we worked in an extremely serious situation, we tried to maintain a positive tone in everything we did. Humor became a kind of valve to be able to handle all the hard work", adds Martin Tegnér.

Every day there were three scheduled so called pulse meetings, at 9 am, 1 pm and 4 pm, where representatives from all healthcare providers in the region, the county administrative board, representatives from the regional management office and the regional special health management participated and where everyone involved got full insight and control of the situation. Meetings that also made it possible to make informed and quick decisions and, if necessary, redistribute protective equipment between healthcare providers.

"I remember at one of our pulse meetings in mid-April when the news from the hospitals was finally 'nothing to report'. I actually shudder when I think about it", says Martin Tegnér.

"The result of our work is actually that we have never run out of protective equipment. We have filled up the region's emergency stockpile and I can safely say that we have had enough protective equipment to withstand the second and the third wave of the Covid virus", says Sara Lindholm Larsson.

What learnings, above all, do you bring with you from this period in terms of leadership?

"The importance of setting a clear 'why' at an early stage and really being transparent in terms of structures and working methods, and communicating it clearly to all concerned.", says Martin Tegnér.

"In extreme situations like this, you must work with full transparency, everyone needs to know everything so that it is also possible to make quick decisions. Then I really want to point out that this job has only been possible through extremely good teamwork where we have always made sure to delegate tasks", says Sara Lindholm Larsson.

What has been your main challenge?

"From a leadership perspective, it has probably been to constantly try to stay calm. And then it has really made it easier for us to be two and always be able to lean on each other", says Martin Tegnér.

"In a way, we also continuously had to work with our self-leadership, to make sure that we could cope and keep the direction going forward. But it's fascinating to realize that you can do so much more than you think", says Sara Lindholm Larsson.

Read about Årets Förändringsledare / Change Leader of the Year Awards here.

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