Director’s Corner: COVID-era Leadership Part 2

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Essential lessons to take once the pandemic subsides. 

(Part 2 of 2)


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The first few months of the COVID pandemic were among the most challenging of my career. I think my hospital and our ED did a pretty good job in gearing up to manage the influx of patients while protecting our staff.  Last month I shared some of the lessons I learned from COVID that I hope to carry forth in the post-COVID world. This month, I share the rest of them.

Communication is key

For the first month or so, it seemed like treatments and protocols were changing daily, if not twice a day. Communicating this to my group was challenging. It took a little time for the COVID task force to figure out its own cadence in messaging and although I’ve sent a daily email to my group for years, I’m not sure that was the best format. Between my monthly staff meeting, now via zoom, daily emails and frequent rounding with my docs, I feel like I got the info out, but I also think this is something I could have done better.


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Several chair colleagues of mine mentioned they did weekly zoom or conference calls where they rehashed the treatments, protocols and changes to events. One of the things my CMO did really well was to have a weekly conference call with the medical staff with the ED, ICU and infectious disease departments represented to give reports and answer questions.

I had good access to the ICU and ID docs and would relay this info to my team, since I don’t think many of them were calling in. I took one of my doc’s recommendations to invite the ICU medical director to a staff meeting. That update with question and answer session were among the highlights of our education over the last few months (and probably responsible for our best meeting attendance.

On the social side, a colleague and his group have been having virtual coffee breaks/happy hours—designated times for people to join a zoom and just chat with each other, with topics ranging from cool cases to what they’re streaming. Regardless of how you get there, don’t underestimate the value of communication to your team and be sure to ask them if they’re getting the info they need. And if not, be sure to get it for them.

Value of social media


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I prefer that my private life and feelings are kept private and that most of our staff probably don’t want to share their life with me either. Early in the pandemic when I thought any of us could get sick or die, I decided to open up my Facebook life to anyone I work with. I wanted to get to know more about my ED team.

Although social media posting can create risk for physicians/physician leaders, I really feel like I’ve gotten to know more about my staff and am hopefully viewed as more approachable as they’ve gotten to know me. When it comes to team building, there is value in using social media with the caveat that it does carry some HR risk. It really comes down to weighing the risks and benefits and I’m glad that I made the switch.

Information is power

At my site, I’m fortunate to work with two of the smartest docs around. They are in the weeds with best practice and algorithm development and I greatly value the work they do. COVID was a little different as none of us really knew anything in January and by mid-March, it was clear that I needed to be a subject matter expert so I could provide recommendations to our task force and have reasonable conversations with the ICU and ID teams.

An unconventional medical issue required an unconventional approach to get all the info I needed. I continued to consult the two docs in my group and also went through my network of friends and got info from former colleagues in Washington state and the New York area that were a few weeks ahead of me in the COVID surge. I’m deeply indebted to these colleagues who shared their experiences with me and helped me understand how to prepare my group and ED for what we could expect to see.

And when typical resources like UpToDate didn’t have the info we needed, I was really surprised as to how much I could learn from Facebook groups and from Twitter. While I don’t recommend patients use Dr Google, I think many of us learned via one on one tutorials, tweet-torials and by sharing experiences through social media, as well as the ACEP communications hub. If you’re not on Twitter yet, you might want to think again about what you can learn and how you can connect to others.

Use all of your assets

Good leaders take advantage of team strengths. A great example occurred during a COVID task force meeting when discussion was focused on ways to increase the hospital’s number of negative pressure rooms. Our facilities director (a mechanical engineer) and the chairman of radiology (a former engineer on a Navy Submarine) went to the hospital’s roof and devised a way to change all flow making half of the hospital negative pressure. That quadrupled our capacity overnight. That’s real teamwork and ingenuity.

On the clinical side, as each of us was struggling with the right wording for end of life conversations, during a conversation I had with one of our docs, he told me that he had an interest in palliative care, had taken additional training, and offered to present on this topic at our staff meeting thus providing everyone with an outline and list of talking points to use for these very challenging conversations.

The lesson is that leaders should be seeking expertise from within our teams to take advantage of everyone’s skill set. The corollary is that if you have something to offer your group, you should speak up and let your chair know.

Meet your PR department

At my prior job, I did a lot of television and radio appearances. These were generally filmed at the hospital in the morning and run on the news throughout the day. I knew the topic ahead of time and since they were recorded, we could usually spend an extra few minutes if I stumbled across an answer.

For a variety of reasons, including requests to do live, in-studio interviews at 6 a.m., in my current job, I’ve generally been happy to watch anyone else get the spotlight. However, when COVID hit, I thought it was important to make sure that the story was told from the ED perspective. Most hospital PR departments are really happy to have someone to offer to the media so it’s a win for you.

In my case, most of the interviews did not lead to me getting any press. Reporters wanted to hear about PPE shortages and I was talking about the positive things our department was doing. As an aside, I’ve also had regular public Facebook posts about what’s going on in the ED and have tried to use whatever platform I may have to educate about COVID and staying safe. Shockingly, my hospital PR team liked these.

At the end of the day, we are the face of the ED and need to look for the opportunities (in addition to the press, consider social media, schools and religious organizations) to educate the public and help the hospital deliver the healthcare message. Every hospital PR team gets requests for interview, but before you start charging into interviews, I highly recommend getting some form of media training.

ACEP offers it in conjuncture with other CME events and hospitals may have a connection that they use. I’ve had a fair amount of media training through the years, but I still took advantage of our PR teams offer to get prepped before a few of the interviews. These consisted of 30-60 minute Zooms with former reporters who helped me prepare answers for the expected questions and helped me develop my main messages.

Learn from the Experts

In a typical month, I probably meet with members of my C-suite for no more than five hours. During COVID, I’ve been able to spend upwards of five hours a day with them. In my case, these are experienced executives and it’s been fascinating to watch them sit back and take in information, ask a clarifying question, make a summary statement or just make a final judgement after listening to the experts discuss a topic.

It’s also been fascinating to see how the politics have played out within the executive team. These meetings have been different than how I run staff meetings or committee meetings, but watching these expert leaders has shown me that it is sometimes an effective strategy for a leader to sit back and let others discuss an issue before making a conclusion or recommendation.

Conclusion

We’ve all learned a lot from COVID and during this pandemic. While I hope there’s a day where I never see another COVID pneumonia patient, I expect to be able to take the administrative lessons I’ve learned and apply them for many years to come.

 

ABOUT THE AUTHOR

EXECUTIVE EDITOR Dr. Silverman is Chairman of Emergency Medicine at the Virginia Hospital Center. He also serves as the Chief Performance Officer with Emergency Medicine Associates, a founding partner of Alteon Health. Dr. Silverman’s practical wisdom is available in an easy-to-use reference guide, available on Amazon. Follow on Twitter @drmikesilverman

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