COVID-19: Peer-­To-­Peer, Real-­Time Learning

The COVID-19 pandemic has changed the world, likely for an exceptionally long time. In the healthcare sphere, physician leaders are needed more than ever. Yet, with all the competencies we strive to acquire during our leadership journeys, some lessons become evident only in the context of substantial and widespread change. These lessons fulfill the goals of the Physician Leadership Journal (PLJ) because they provide a platform of lifelong learning and help us to gain knowledge from other physician leaders in the trenches dealing with real-life problems.

In mid-April 2020, in the midst of the pandemic, we reached out by email to members of the PLJ’s Editorial Board, which is comprised of Certified Physician Executives and Fellows of the American Association of Physician Leadership, and asked them to respond to two questions:

1. How has COVID-19 challenged you as a physician leader?

2. What leadership pearl have you learned from your COVID-19 experience that you would like to share with other physician leaders?

Their responses have been lightly edited for clarity and length and are provided as a mechanism for real-time peer-learning to the readers of the Physician Leadership Journal.

How Has COVID-19 Challenged You As a Physician Leader?

Chad Brands, MD, CPE, Division vice president for Texas, Hospital Corporation of America, based in Tennessee

The pandemic has reflected a very rapidly changing health crisis with information that is fluid and dynamic. We must continue to adapt with our colleagues by providing new solutions, models, and thinking on a moment-by-moment basis in real time to a set of very new, challenging, and recurring problems and issues, while collectively advocating for a long-term fix to the supply chain for equipment, medicines, and vaccines.

Gregory Cooper, MD, PhD, CPE, Regional president (East Region), Baptist Health Medical Group, based in Kentucky

The biggest challenge has been the initial need to rapidly assimilate a great deal of information about the disease, including the potential public health impact and most appropriate responses to mitigate this impact. It is impossible to provide direction without a clear understanding of the threat.

Amin Hakim, MD, CPE, FIDSA, FACPE, Vice president of clinical operations for United Healthcare, based in New York

As a physician on the COVID-19 Task Force of a national healthcare organization and as an infectious disease specialist, it was hard to stay on top of the flood of science and to sort through what is relevant, hype, or misleading. This has been and continues to be essential to guide the business continuity plan (BCP), actuarial modeling, closing or opening of locations, employee health, and developing communications for patients, providers, employees, and others.

Tom Higgins, MD, MBA, CPE, FACP, MCCM, FAAPL, Chief medical officer, the Center for Case Management in Natick, Massachusetts

Perhaps obvious, but the operational aspects of ramping up and sustaining critical care services have been paramount. We went from staffing 16 MICU beds with two day-time and one night-time team (attending physician, fellow, and two residents) to covering up to 96 ICU beds on five floors in three separate buildings, including the former ambulatory surgery center, with six teams. We are asking physicians to work 13-hour shifts seven days in a row, and having to rapidly train hospitalists, anesthesiologists, and neurologists to provide critical care to satisfy the surge in demand. Meeting the 30-minute threshold for critical care billing becomes impractical with expanded caseloads, but care still has to be delivered, even at a loss.

The stress of the situation has become an X-ray machine to identify hidden flaws and obvious deficiencies in the healthcare system, from the unintended subsidy of hospitals to insurance companies (via the imbalance between the cost of physician effort versus billable care events) to supply-chain inadequacies at the national level.

Ponon Dileep Kumar, MD, FACP, CPE, President of East Michigan Hospitalists, based in St. Clair County in Eastern Michigan

We had a proactive approach from the very beginning of the epidemic. Once it was clear that there was a possibility of community spread, we cancelled all face-to-face meetings and activated social distancing. All the CME meetings at the county level were also cancelled until further notice. I was afraid of making a decision that might be unnecessary, but stories coming out of Italy and later New York and nearby Detroit validated our decisions.

J. Matthew Neal, MD, MBA, CPE, FACP, FACE, FAAPL, Assistant dean for faculty affairs and professional development at Indiana University School of Medicine in Indianapolis, Indiana

As Charles Dickens said, “It was the best of times; it was the worst of times.” I have seen the “best” in 95 percent of my physician colleagues who have rallied to the occasion to help in any way possible. Yet, I have seen the “worst” in the 5 percent who are self-centered and only care about themselves and how this affects them. Unfortunately, such is human nature. The positives far outweigh the negatives, however.

Scott Ransom, DO, MBA, MPH, CPE, Partner, Health Industries Advisory, PricewaterhouseCoopers LLP | Strategy&, in Dallas, Texas

Balancing and effectively communicating the very real business, public health, clinical, and psychological issues associated with the COVID-19 crisis has required strong and insightful physician leadership. In addition to professional responsibilities, supporting family and friends and managing personal stress during this time has presented unique challenges.

Juan Sanchez, MD, MPA, CPE, FACS, FACHE, Chairman of the Department of Surgery at Ascension’s St. Agnes Hospital and an associate professor of surgery at Johns Hopkins University School of Medicine, both in Maryland.

The COVID-19 pandemic challenged my ability to communicate effectively and make clear the dimensions of the threat to my colleagues. It was only after the media coverage provided a backdrop that I was able to have enough traction to make the changes that needed to be made. The crisis also allowed me to realize that this response needed to be a collective effort despite my inclination to control the entire response to the crisis.

Anthony Slonim, MD, DrPH, FAAPL, President and CEO, Renown Health, and professor of internal medicine and pediatrics, University of Nevada, Reno, School of Medicine both in Reno, Nevada

COVID-19 challenged me as a physician leader by helping me to be more comfortable with “letting go.” In the context of command center operations, both internally and externally, you have to rely on other team members and the process to get you through. Although I visit the command center often, the team and I have to realize that I am there in a support role and not to direct decision making even though I am the CEO.

As they often say in command function, leave your hat at the door. Externally, in the context of the pandemic, the public health infrastructure has jurisdiction. In both of these scenarios, while you can let go, you also have an important responsibility to lead, influence, and persuade when the team looks as though they are too far down in the details, but even though you have to perform this work from the background, believe in its importance.

What Leadership Pearl Have You Learned From Your COVID-19 Experience That You Would Like to Share with Other Physician Leaders?

Chad Brands, MD, CPE

Communication from executive leaders is very important in times of calm and vitally important in times of crisis. The communication should quickly describe the context of the challenges, concisely summarize the data pertinent to the problems, clearly identify the new priorities, and then calmly provide a clarion call to action so that individuals and groups can continue to engage collaboratively with their best efforts to achieve best outcomes.

Gregory Cooper, MD, PhD, CPE

The greatest lesson learned was to trust my fellow physicians. The key is to assemble the right people with the right expertise, create a framework to support their efforts, trust their ability to do the work and create good processes, and then facilitate their efforts. It is more important for leaders to create and support a team than to do all the work themselves.

Amin Hakim, MD, CPE, FIDSA, FACPE

Effective communication across different areas of the organization is essential to successful collaboration and to an effective BCP, even in the face of unforeseen challenges arising in the midst of the pandemic. It is also important in addressing questions about confusing information and contradictory news, and in coordinating internal and external communications.

Tom Higgins, MD, MBA, CPE, FACP, MCCM, FAAPL

Celebrate the small wins! My hospital plays the “Theme from Rocky” over the PA system every time a COVID-19 patient is discharged, and those intermittent reminders of success help balance the inevitable fatigue and disappointments.

More personally, be sure to repeatedly thank everyone on your team: the nurses, patient care techs, and housekeepers braving COVID-19 exposure; the case managers keeping patient flow moving; the cafeteria staff delivering much-needed food to teams who are too busy to take lunch; administrative staff handing out masks; and security keeping everyone safe and where they belong. This is a team effort, and everyone is a hero.

Ponon Dileep Kumar, MD, FACP, CPE

These puzzling times will challenge you as a leader. One thing I have learned is to lead from the front. Rather than confining yourself into the comforts of the conference rooms, working with frontline workers will resonate well with them. I have seen and heard resentment among various individuals and groups when this was not happening.

J. Matthew Neal, MD, MBA, CPE, FACP, FACE, FAAPL

Being able to use and deploy the existing provider workforce to achieve the maximum benefits and efficiency. Not every provider is skilled at caring for critically ill COVID-19 patients, but all can contribute something — be it virtual patient visits to cover other providers, answering messages, or performing other important tasks.

Scott Ransom, DO, MBA, MPH, CPE

Optimally managing the current COVID crisis requires fact-based and calm leadership built on a foundation of trust and credibility that balances the unique business, public health, clinical, and other human challenges. The physician leader must be a great role model, over-communicate, balance conflicting views, and inspire confidence to effectively lead a diverse set of constituents including his or her own family during this unique and challenging time.

Juan Sanchez, MD, MPA, CPE, FACS, FACHE

In the early phase, when the warning signs and magnitude of the potential harm were fuzzy, I learned that acting urgently and correcting course along the way was a more effective strategy than getting the surge plan right at the outset. I truly learned that perfection is the enemy of good and that time-to-action was key when confronting an ambiguous threat.

Anthony Slonim, MD, DrPH, FAAPL

As a physician and public health professional, I have always known how important these two lenses are to caring for our patients, our community, and our nation. What became clear to me during COVID-19 was the tension between the medical model and the public health model.

In the medical model, physicians have a duty to advocate for their patients and the families that they care for. In the public health model, particularly in times of state and federal emergencies, the needs of the community and population take precedent over the needs of the individual, particularly in times of scarcity. Physician input is still critically important in these situations, but the entire reason that the public health infrastructure exists and has jurisdiction in times of crisis is that you do not want the burden of allocation decisions to be made by individuals at the bedside because it will lead to high levels of variability.

I am certain that this tension is instructive for how we go about educating physician leaders around population health in the aftermath of COVID-19.