AUTHOR=Piel Julia , Hörold Madlen , Brandstetter Susanne , Drewitz Karl-Philipp , Hrudey Ilona , Schmitt Rudolf , Apfelbacher Christian 

TITLE=COVID-19 crisis management of German ICU clinicians in leadership – a metaphor analysis

JOURNAL=Frontiers in Public Health

VOLUME=Volume 11 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1160094

DOI=10.3389/fpubh.2023.1160094

ISSN=2296-2565

ABSTRACT=The COVID-19 pandemic coincided with an already long-standingongoing crisis in health systems around the world characterised by economic pressure and increasing staff shortage. Crisis became a global metaphor to convey collective experiences of the COVID-19 threat. Little is known on how crisis metaphors influence the thinking and speaking about crisis management and the challenging staff situation of intensive care (ICU) clinicians in leadership positions and their acting. Therefore, we were interested in (1) which metaphorical concepts ICU clinicians in leadership use to express experiences and strategies in dealing with coinciding crises, (2) how these change over time, and (3) how metaphors in speak reveal self-images of crisis management.
We conducted a systematic metaphor analysis focusing on data from three participants of a qualitative interview study with twenty-four healthcare professionals in ICUs in Germany. The participants were interviewed at two time points between April 2020 and March 2021. We identified and reconstructed metaphorical concepts of these three interviewees (ICU clinicians in leadership) with regard to the pandemic management, and developed a typology based on the dimensions of mood, modus operandi, location and scope. 
The typology consists of eight self-images (protagonists) for the crisis management of ICU clinicians in leadership, such as the figure of the soldier („to unite everyone behind this flag“), the distributor (“sometimes it is a crazy patchwork [wahnsinniges Gestückel]”) or the critic ("we are the fool for everything“). They embody different qualities of a leader, referred to intra- and inter-role conflicts within multiple crisis conditions. 
Metaphor analysis reveals different self-images of ICU leadership clinicians in relation to crisis management. This illustrates that thinking and perceptions of crisis management may strongly differ between and within leaders and may change over the course of crises. Our findings highlight the need both to improve knowledge on challenges associated with leading in crises and preparedness, and to support clinicians in their leadership by recognising and adressing differences and changes in leaders' self-image.