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Leading by virtual interaction: an application of cultural-historical activity theory
  1. Ana Sjaus1,
  2. Krista Corinne Ritchie2
  1. 1 Dalhousie University, Department of Anesthesiology, Pain Management and Perioperative Medicine, IWK Health Centre, Halifax, Nova Scotia, Canada
  2. 2 Faculty of Education, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
  1. Correspondence to Dr Ana Sjaus, Dalhousie University, Department of Anesthesiology, Pain Management and Perioperative Medicine, IWK Health Centre, Halifax, NS B3K 6R8, Canada; asjaus{at}


Introduction The pandemic spread of SARS-CoV-2, a novel, highly contagious and easily transmissible pathogen, has profoundly affected all aspects of human interaction. Guided by the need to reduce face-to-face contacts, medical organisations have rapidly shifted group activities to virtual platforms. Over 1 year into the pandemic, the necessity to maintain public health restrictions ensures that virtual meetings will be the norm for the foreseeable future.

It has yet to be understood how virtual technologies shape healthcare and academic cultures, affect interactions, or influence strategic decisions and policies within these systems.

Conclusion In this article, the authors reflect on the move from historically situated activity systems of team leadership in healthcare to ones that now exist in virtual formats. Cultural-historical activity theory (CHAT) is a framework that explains complex human actions, and how they unfold over time through interaction with mediational tools (eg, technology) and various people representing their own communities, roles and perceived divisions of labour. The authors use the lens of CHAT as a framework to understand the shifting dynamics at play and offer strategies for leaders to co-establish activity systems with team members to make goals of group activities explicit and to deliberately work toward them. Five specific strategies proposed are: (1) use software platforms that fit your needs and give voice to all attendees with technical support present in meetings; (2) converse explicitly about roles and emerging role fluidity during times of change and pandemic response; (3) co-construct something new intentionally; (4) engage in implementation science at this time; and (5) lead intentionally while honouring cultural norms and values. It is imperative that any changes, even the ones that are a part of the pandemic response, are made consistent with the core shared values of the medical community as this necessary new way of coming together is embraced with collective wisdom.

  • COVID-19
  • communication
  • clinical leadership
  • insight

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  • Contributors AS identified the topic and planned the manuscript providing the first draft. KCR developed further theoretical considerations, discussed, summarised and iteratively revised the manuscript with AS into its current form. AS designed and produced the illustrations.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.