Lessons Learned: A Disaster Activities Checklist

Since February 2020, physician leaders have been faced with extraordinary challenges. Providing care for a large number of patients with a new disease that is easily spread has added strain to every patient, employee, physician, and administrator in healthcare organizations.

Mount Sinai Medical Center is a 700-bed independent major teaching hospital located in Miami Beach, Florida. The only hospital serving the community, the hospital sees thousands of visitors yearly. Medical personnel cared for more than 2,000 COVID-19 positive in-patients in 2020, with an overall mortality rate of 13.1 percent. Few staff were hospitalized because of work-acquired COVID-19 infections. Nurses and physicians believed they had the personal protective equipment they needed and all residency programs continued with minor changes based on volumes of patients and risk of infection.

All hospitals and healthcare facilities have challenges to meet; the challenges can be acute and extreme during pandemic. A key factor contributing to our success has been our leadership team.

At the beginning of the pandemic in March 2020, I decided to collect my thoughts into a working document, a diary to which I added as I synthesized information. After organizing the information, it occurred to me that it might help other physicians provide leadership for their organizations.

Lessons Learned for Excellent Operational Processes

Challenges during the pandemic included providing patient care for those with a new, sometimes severe, disease; allocating adequate resources to provide care for physician and staff safety, physician burnout, and stress; maintaining education programs and monitoring physician and hospital financial performance — all in addition to maintaining the ongoing daily concerns such as teamwork, professionalism, patient safety, education, and research. The following are the lessons learned around eight Cs: commitment, critical thinking, creativity, collaboration, communication, compassion, cash, and care of yourself.

1. Commitment: Strive to become an expert and let everyone know you are there for them.

   • Start as soon as you anticipate a concern. (We started March 9, 2020.)

   • Learn continuously from experts. Read resources from reliable sources — current and historical. Listen to your in-house and on-staff subject matter experts.

   • Provide all needed resources in an efficient manner, including personal protective equipment, medication, and staff members such as nursing, respiratory therapists and phlebotomists.

   • Provide a morale boost with food and rest areas for staff to help relieve stress and exhaustion.

   • Make sure all “action items” are assigned to a person (not a committee or team) with a clearly defined deadline.

2. Critical thinking: Use your skills as a physician and leader to make optimal decisions.

   • Listen.

   • Focus on what the patients need.

   • Create reliable sources of credible information that is refreshed often.

   • Create and consult with a team of experts to assist with decisions, including pharmacists, respiratory therapists, infectious disease experts, and intensivists.

3. Creativity: Create crises-targeted measurable outcomes (Key Performance Indicators).

   • Set goals with policy and procedures to achieve them.

   • Challenge your team to innovate.

   • Provide regular, frequent feedback on progress toward goals.

   • Work closely with your information technology team to collect, track, and analyze data that matters.

   • Create changes for quality and efficiency. In this situation, we developed:

     • A COVID dashboard to track patient activity. It reports real-time admissions, test positivity rate, mortality, racial identification, and zip code identification of the patients admitted.

     • A COVID patient list. This is a real-time listing of how many patients are in each location and how many are on ventilators and high flow oxygen therapy.

     • A COVID medication administration record. This is a subset of the standard medication administration record that allows nurses, physicians, and pharmacists to easily track COVID-specific medication therapies such as corticosteroids, anticoagulation, convalescent plasma, and Veklury (remdesivir).

     • A COVID order set to speed and standardize admission and discharge. This allows physicians to admit and care for patients with an evidence-based checklist of orders that includes guideline-based tests and therapies to provide real-time reminder education, patient safety, and efficiency.

4. Collaboration: Gather input from those most involved with the patients.

   • Include at least one person from every discipline that provides care and support.

   • Document new ideas, data, etc., daily, for example using a webserver or chat room.

   • Reach out to others and other facilities. We had a citywide ICU physician call each week and a county-wide CMO call each week.

5. Communication: Make it clear, frequent, concise, useful.

   • Be proactive.

   • Work with the public relations department for communications.

   • Use phone, email, Zoom, and chat rooms.

   • Use text/SMS only when urgent or to set up a call.

   • Email physician updates twice a week.

   • Communicate up and down your “chain of command.”

   • Hold Zoom calls weekly with all residents, chairs and chiefs, hospitalists and primary care physicians, and ICU and ID physicians.

6. Compassion: Take care of patients and each other.

   • Do what is best for the patients.

   • Consider physician, nurse, staff, and administration well-being.

   • Remember, each patient has a family — treat them like your own.

7. Cash: Think about the future of the organization.

   • Focus on costs.

   • Inventory resources early and track accurately: people, including part-time; equipment, including records to track expenses; and supplies identified with secondary and tertiary vendors.

   • At daily meetings, ask all departments for input, including staffing/human resources, pharmacy, material management, lab, respiratory, emergency department, food, security, information technology, and epidemiologist/infection control.

8. Care of Yourself: Be physically and mentally healthy

   • Keep a diary.

   • Rest when at home.

   • Practice excellent public health measures to stay safe. Be an example.

   • Have someone to talk to, such as family and other physicians.

   • Exercise.

   • Take time for reflection.

Conclusions

Disasters affecting healthcare organizations may come in the form of pandemics, fires, dangerous weather, or human activities. Physician leaders need to be prepared. Checklists improve complex activity outcomes. This disaster leadership checklist, based on my experiences reading, listening, reflecting, and synthesizing during my first six months of the SARS-CoV-2 pandemic, can be adapted and used by other physician leaders.