Healthcare organizations face a myriad of challenges as the Covid-19 pandemic sweeps across the United States. While all businesses face marked uncertainty and a risk of infection within their workforce, the direct delivery of care to Covid-19 patients introduces an additional and novel level of leadership complexity for the healthcare industry. Healthcare workers—doctors, nurses, medical assistants, environmental services, and others—face unprecedented stress, and with this maintaining the morale and safety of all involved in the delivery of healthcare has become the most important task. We have observed several recurring themes from organizations that are effectively managing through the Covid-19 crisis and summarize a few emerging leadership principles.
Speed Up Decision Making
One of the biggest challenges of healthcare organizations in times of crisis are their multi-matrixed structures and their slow and deliberative decision-making processes. While these structures are organized to build and evolve consensus in times of steady-state operations, they can stymie action when rapid decision-making is needed in moments of crisis. Top leadership accustomed to consensus-based decision-making must flip to operating the institution with a “war-room” mentality, consolidating power with a few leaders, drawing input from diverse constituencies, but making swift real-time decisions based on emerging input. To borrow from start-up culture, the goal should be to move fast and break things (judiciously).
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James Hudspeth and Sachin Jain James C. Hudspeth, MD is an Assistant Professor of Medicine, Boston University School of Medicine and Associate Director for the Hospital Medicine Unit, Boston Medical Center Sachin H. Jain, MD, MBA is Adjunct Professor of Medicine at Stanford University School of Medicine and recently stepped down as President and CEO […]
In the early days of the Covid-19 crisis, many healthcare delivery organizations struggled with the balance of some leaders whose orientation was “harm reduction”—and minimizing workforce and patient exposure–and others whose orientation was “mission-focused operational,” maintaining access and availability of all services as a continuation of mission. No amount of consensus-based decision-making could resolve these different orientations—top institutional leaders needed to consolidate decision-making and adopt a consistent, united vision. Moments of crisis require different approaches to institutional decision-making; organizations that have retained full deliberative processes operate behind the demands of the epidemic and the needs of their staff.
First and Foremost, Align on Protecting Your Workforce
In the early days of the epidemic, many healthcare organizations continued to require staff to see elective appointments without appropriate protective equipment and failed to allocate available personal protective equipment (PPE) to the staff who were at the highest risk of contracting Covid-19. The inaccessibility and misallocation of PPE dramatically eroded trust between front-line staff and organizational leadership. Those organizations that immediately curtailed non-essential visits and care while allocating PPE to the staff who needed it most were able to effectively message adequate concern to staff for their personal safety. Messaging around PPE needs to be clear, frequent, and consistent across the organization – and if appropriate PPE cannot be obtained, this needs to be acknowledged, with transparency on the part of leadership teams as to what they are doing to solve this issue. To be clear, there is no faster way to destroy employee morale than to operate a workplace is dangerous to the workforce without visible, determined leadership addressing that danger.
Employee protection, of course, is not just limited to the provision of PPE. Leaders must also mind the behavioral health needs of their employees. Faced with the stress and burnout of a protean disease with no effective treatment; the labor of supporting dying patients inside hospitals which cannot allow family members to support their loved ones; and the profound volume of human loss, inside work and outside of it—leaders must apply a high degree of focus on the emotional well-being of their workforce. They must move beyond standard HR practices like “employee assistance programs,” to retaining specialized therapists, chaplains, psychiatrists and others who are available 24/7 to assist staff and managing through their traumas.
Show Up & Hold Up
Covid-19 represents a moment of crisis and therefore is a time that demands visible leadership. While the understandable impulse may be to keep the leadership team sheltered from exposures — particularly in cases where leadership is in an age or clinical category that is at high risk for complications from Covid-19 — healthcare workers on the front lines benefit heavily from seeing managers and leaders from across the organization in person. There have been a few public examples where leaders have tried to lead the Covid-19 response remotely—and these have led to poor press and accompanying morale.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Dr. Shereef Elnahal of University Hospital of Newark provides an outstanding counterexample to this. Elnahal makes regular rounds to various wards, operating rooms, and clinics — often donning his own PPE—and taking pictures of himself with staff caring for Covid-19 patients at all hours of the day and night, posting notes of appreciation to social media. Elnahal’s visibility and oneness with his team—especially mourning publicly the loss of employees to Covid-19—represents a relatable humanity that staff are able to rally around.
Gestures like free meals and simple recognition of hard work under difficult circumstances take on enhanced value and have an oversized impact on staff morale in moments like these.
Make Visible Personal Sacrifices
In a time when all health care organizations are going to have to make painful cuts because of the volume-related financial challenges associated with Covid-19, it is paramount that the leadership make visible personal sacrifices to demonstrate their personal alignment with the tough financial decision they are making; clearly shared sacrifice at least demonstrates that the burden is equitably spread.
In Denver, executives at Denver Health received bonuses last month ranging from $50,000 to $230,000 just as doctors, nurses, and others were being asked to work fewer hours. The optics of this decision were catastrophic for morale. Other institutions managed this more skillfully. As an example, Kevin Tabb, Chief Executive of Boston’s Beth Israel Lahey, took at 50% paycut along with a 20% cut for other members of his executive team. John Fox, the CEO of Michigan’s Beaumont Health System, took a 70% base pay cut and he implemented a wide group of layoffs of administrative staff. These types of sacrifices earned the respect of staff at a time when confidence in leadership is shaky.
The duration and damage of the Covid-19 crisis is impossible to predict, especially for healthcare organizations that face a double burden of direct care for Covid-19 patients and reduced volume in the remainder of their business. Staff who are under-supported and overworked in an atmosphere of risk for themselves and for their families will very easily slide into a mindset of “I need to protect myself, as no-one else willl.” The challenge for healthcare leaders in the coming months is to maintain operations — and transparently acknowledge when they cannot meet needs, working to maintain morale by creating a mindset of “we are all in this together.” With no clear end in sight, little is more imperative.
Photo: marchmeena29, Getty Images
James C. Hudspeth, MD is an Assistant Professor of Medicine, Boston University School of Medicine and Associate Director for the Hospital Medicine Unit, Boston Medical Center
Sachin H. Jain, MD, MBA is Adjunct Professor of Medicine at Stanford University School of Medicine and recently stepped down as President and CEO of CareMore and Aspire Healthcare.
