Sunday , July 25 2021

Building healthcare team spirit in the wake of COVID-19

MODERN HEALTHCARE: Hello, Dr. DeRienzo. How are you doing today?

DR. CHRIS DERIENZO: I’m doing great, Kadesha.

MODERN HEALTHCARE: This is such an interesting topic because it’s one of those topics where we’ve heard the anecdotes, and we’ve seen the comments but haven’t quite delved into how health systems can sort of recover teamwork, especially if they’ve had some missteps along the way during the pandemic.

Before we dive into the questions, I want to just share some data points. First off, we’ve heard that providers feel more support from their colleagues than from their actual health systems and institutions. Modern Healthcare reported in September 2020, on a survey of more than 2,300 physicians, that 40% believe their health system helped with their mental well being during the pandemic, but 73% said it’s their colleagues that were helpful.

Another data point is that, just one month into the pandemic, 78% of healthcare workers already felt that COVID-19 would have a somewhat negative or very negative effect on their workplace.

And lastly, a February 2021 survey from the National Nurses United said that 9,200 nurses found that 81% are still reusing single-use items like masks and gowns. Modern Healthcare reported that a survey of 1,083 infection preventionists — nearly 30% of them said that their organization has zero stock of gowns. So, these are things that translate into some teams feeling a lack of support.

We’re talking about how hospitals can recover that team spirit, especially if they’ve had these kinds of issues where they haven’t had PP properly stocked, or they haven’t been able to support the burnout and the mental well being that their providers need.

What would you say are the first three things that hospital leaders should do as they try to rebuild that spirit of teamwork?

DR. CHRIS DERIENZO: I think it has been an incredibly challenging year for anybody involved in healthcare. The past 15 months have challenged us in ways that truly, in a 100-year pandemic, nobody alive and in healthcare leadership has ever had to face before. And in walking through all of those challenges, even the health systems who I think have done exceptionally well, have made mistakes along the way. And WakeMed, we are by no means perfect.

In reflecting on the survey answers, it really is helpful, first and foremost, to focus in on purpose. As a health system, for us at WakeMed — our core purpose when we were founded and through today — is to serve the people in the community of Wake County and the surrounding region. And I think very early on in the pandemic, much like Johnson & Johnson when it faced its Tylenol catastrophe in 1982, we had to hone in on, what are we here to do? And centering on that core purpose really provided, I think, a pathway forward through the pandemic for us, and I think for many health systems. And frankly, it helps differentiate, you know, who you are and what you’re here for.

Second, I think that we’ve learned a lot over the past year about what’s worked and what didn’t. It provides a foundation on which to build and to celebrate. We can celebrate the teams that we’ve built from across different areas, the talents that we’ve pulled on, and that provides a new foundation to build upon.

And then third, I think we need to be honest, people are tired. And it doesn’t surprise me that 75% or so of providers, say their colleagues provided some of that help, that there’s some help that only a colleague can provide. You know, when you are an emergency department nurse, and you’re going through the challenges back in March and April of 2020, there are some things that only another emergency department nurse can appreciate or understand. And I think as a health system, it’s important to acknowledge and lift that up, and then to surround folks in ways that an individual teammate can’t do.

MODERN HEALTHCARE: Sometimes you just need somebody to vent to. It’s amazing how somebody who’s going through the same thing — they understand and they get it, and there’s no value judgment. And that in and of itself is a coping mechanism.

DR. CHRIS DERIENZO: Without question. I’m a neonatologist. So, I don’t see any COVID burden relative to an intensivist or an ED doc. But there are just some things that, having walked through together, I think you’re really able to provide support for. We refer to it here, in part, as the sidekick program. And we have a tremendous group, led by Nerissa Price and the president of our medical group here, Dr. Seth Brody. They’ve, I think, acknowledged that and have been trying to amplify that over the course of the year.

And that’s the role of the health system, right? We can see this magical spark that’s rising within the provider group. And we have the resources and the capabilities to lift that up and enable them to support each other.

MODERN HEALTHCARE: Sometimes, senior leaders can be so head down planning and solving problems, that it takes some effort to take a step back and try to see, how can we address the morale, the spirit of teamwork, the burnout, especially as this pandemic continues?

What would you say is the worst-case scenario? If leadership doesn’t address this and doesn’t work to rebuild the trust and the spirit of teamwork?

DR. CHRIS DERIENZO: Trust and teamwork are crucial to being able to succeed in healthcare. Healthcare is incredibly personal. We’re called to this practice. I’m here because I feel like we’re making a difference. We’ve heard stories from nurses who say, “This is one of the first places I’ve worked where my manager is coming in at night because she knew we were short. And she shows up and says, ‘Where can I go to help?'” That kind of culture is very, very difficult to re-create once you lose it.

When I look back over the past year, I think the leadership maxim around leadership and showing up has really proven itself. Our health system is small enough — within both geography and size — where our senior-most leaders have been working in the vaccine clinic, have been working in the drive-thru, have been able to round on COVID units and on non-COVID units. And I think that makes a big difference. Culturally, I think, if that begins to bleed away, the hill to regain it is, for whatever reason, markedly steeper than the hill to lose it.

MODERN HEALTHCARE: So, the sooner you work towards addressing this, hopefully the better off you’ll be.

DR. CHRIS DERIENZO: I think that’s exactly right. And I think identifying that it’s something really special. One of the things that is so crucial to us as a health system and frankly any health system, I think, is that differentiating culture.

MODERN HEALTHCARE: So, let’s talk about how this plays out for some of the team members that are often forgotten. They’re not getting the applause that the frontline and direct-patient care providers are getting in many hospitals. It’s the non-clinician folks, like food service and environmental service workers, who are not prioritized for PPE. Maybe they weren’t prioritized for vaccine rollout. These teams often feel unappreciated.

What would you say are some of the other healthcare teams, who sometimes fall through the cracks or fall out of memory, that organizational leaders should stay focused on as they try to rebuild the team spirit?

DR. CHRIS DERIENZO: Yeah, I think that risk exists anywhere and everywhere at any time. And I think it goes back to our purpose. We can’t succeed as a health system, unless and until all members of our team — whether they’re clinical or non-clinical, whether they’re frontline or backline, home office, in the field, doesn’t matter — we have to be connected to that same purpose.

I recall, a couple of weeks ago, we celebrated within the pathology department — pathology processed over 100,000 COVID tests since the beginning of the pandemic. That’s a team who has been asked to bend in ways they’ve never had to bend before. They’re in the lower levels of a hospital, not often seen by members at the bedside, but they’re a crucial linchpin to the organization.

And so to me, I think it’s acknowledging what we already know, which is that every member of our team is crucial to our success. And everybody matters as a person. When I think back to, say the early days of our vaccination rollout, when the federal and the state guidelines were not super clear yet, and our ethics team worked through, here at WakeMed, what are we going to do?

And we recursively, throughout the pandemic, have had to come up with these, you know, one-line guiding principles. With the PPE, it was, we will work to ensure that everyone has a low-risk, CDC-defined encounter in as many situations for as many different people for as long as possible. And for vaccination, it became, we’re going to get vaccine to folks with the highest number of highest risk encounters as early as possible, regardless of role. And that meant that no matter what your role was — working in the ICU or in the emergency department, if you were a frontline foodservice or EVS team member, or a nurse or a pharmacist — we put you in that highest risk category.

MODERN HEALTHCARE: Then, it’s not based on title. It really is based on your risk, and it’s based on your proximity to the threat. I also think about chaplains. You haven’t heard much about them. But there’s been a lot, especially in hotspot areas where they’ve had to counsel a lot of patient families. And they have also had a huge burden placed on them.

DR. CHRIS DERIENZO: No question. And I think for someone at a health system leadership role to recognize that requires continuous feedback loops with the team. We’ve had ICU direct care providers as part of our COVID command center from the very beginning. We’ve had emergency department providers, we’ve had nurses who are working on the floors. Because it’s impossible to know every corner of an organization well when you’re a large integrated health system.

But what you can do is ensure that continuous feedback loops from frontline into that command center help make sure you realize, “Oh, my goodness, without your feedback, we would have forgotten this group of incredibly important folks.” Not because we don’t care about them, but because it’s not our day-to-day process providing bedside ICU care. Interpreter services would be another group who may similarly be identified there.

MODERN HEALTHCARE: Absolutely. So, you mentioned the feedback loop. Let’s talk about that a little more. It implies that you’re listening to learn, you’re listening and observing your team members, so that you can learn from them.

What do you think hospital leaders can learn from their clinicians in regards to teamwork, especially since patient care has been the realm of teamwork that has shined the most brightly during this pandemic?

DR. CHRIS DERIENZO: Oh, my goodness. Examples of new and inspirational kinds of teamwork go so far beyond patient care, it’s striking to me. We’ve obviously had incredible care teams who do what they do. As a NICU doctor, there’s been some solid evidence and NICU studies that when the intensity is at its highest in the NICU is not when burnout is at its highest, because you’re sort of doing what you feel like you’ve been called to do. And as long as that doesn’t last for an exceptionally long time, you actually come out of that, sort of, stronger.

But relative to teamwork, I think what we’ve seen through this pandemic, is that we have people with latent talent everywhere in our organization. I think about the WakeMed Critical Resources Team. Within the command center, we realized very early on, that the command center could not make all the decisions needed to stay on top of incredibly rapidly changing evidence and supply chains that rose and fell apart within a matter of seconds to minutes. And so we looked to the organization and said, “We have a great supply chain team. But the ask on them is now 10x what it used to be. How do we build and support?”

So, the leadership of that group — we asked a critical care physician, we asked a pharmacy leader who had taken some operational roles throughout the organization, and we asked our performance engineering leader to step in, our pharmacists. And they created this critical resources team, with support from ID and infection prevention, from emergency management, you name it. This multidisciplinary group that organically came together to say, “What does the evidence say that we need for low-risk defined encounters today? Because it might be different from yesterday. Where are we on our things? And how do we make the decisions and take the actions needed to stay true to this guiding principle, that we will ensure a low-risk, CDC-defined encounter for as many people in as many situations as long as possible?” That kind of teamwork, I think, can be replicated in areas where we don’t face existential threat.

In some ways, it was easier during COVID, because our very survival as a health system depended on getting to some of these outcomes. And so we could hold resources from anywhere and break down any silo needed to get it done. But having learned how to do that — and just the immense amount of talent and folks who are in roles that aren’t defined by that talent — is something we can build on within the clinical care arena and far beyond.

MODERN HEALTHCARE: Let’s say you are talking to an up-and-coming leader. This is someone who has their eye on the C-suite, maybe they’re at the director, or VP level. And they’re tasked with prioritizing resources for teams. And we’ve talked about people who have felt left out, we’ve talked about people who have been so front and center that they’re experiencing burnout.

What advice would you give to help that aspiring leader become good at prioritizing without alienating?

DR. CHRIS DERIENZO: It’s a tremendous question. First and foremost, I think, as leaders, we need to be humble, and acknowledge that we are imperfect by role modeling that for our teams. This became exceptionally important to us in the early days in the command center. It’s important for teams to realize that we’re going to make mistakes. It’s crucial that we not make mistakes on the things that could cripple the organization, but that we have to collectively learn from what we’re doing to move forward. We’re going to make resourcing mistakes, we’re going to under-resource a team that needed more, and as soon as we acknowledge that and move on, the quicker the organization gets to a better outcome.

And that leads to, I think, point number two, and that’s being as transparent with shared understanding as possible. There are a small number of things that, as a senior leader, you can’t share with your team, for confidentiality or for whatever. But there’s a massive number of things that you can. And I think when you’re talking about resources and priorities, that it is crucial to get to a level of shared understanding that, “Hey, here’s what we’re working with. And here’s, from a system perspective, where we have flexibility, where we don’t. And then if we move up here, we move down here.” Getting to that baseline level set as a group is crucial, because then there’s no secret as to, and there’s no wondering, “Well, why did they do this instead of that?”

And then I think the third thing, we need to be as crisp and clear as possible about the shared outcome we’re seeking to get to. So again, harkening back to our vaccination team, you know, we want to vaccinate people with the highest number of highest risk encounters as soon as possible, no matter their role. And once we’re clear on that, from a leadership perspective, that team had broad flexibility in how to execute the outcome. So, trusting our teams to break what needs to be broken, in order to rebuild it back better, and that they have the flexibilities needed within, you know, the appropriate bumpers, that if we’re driving towards this outcome, then decisions can be made faster and better by folks closer to the frontline. Getting to a state of comfort with that, and having the feedback loops to know what’s going on, and for that group to be comfortable reaching out and saying, “Hey, we’re not going to get there unless we do X” is crucial to now, anyone who’s aspiring to be in healthcare leadership, given everything that we’ve learned.

MODERN HEALTHCARE: And when you start with that result, it kind of gives people permission to say “no.” Distractions will come up, and there might be things people want to focus on that don’t support that result. And you now have a reason to say, “No, we need to stay focused on this, at this time, because this is the result we’re going for.”

DR. CHRIS DERIENZO: That’s exactly right. And again, I think through COVID, that was easier than it’s going to be two years from now, God willing. Because when you’re in this existential fight, in a 100-year pandemic, your focus really narrows. It’s like you’re trying to escape the tiger who’s chasing you.

MODERN HEALTHCARE: Yeah.

DR. CHRIS DERIENZO: Mercifully, we are getting so close in this country to getting in a place where we’re over that hump, and we can see the post-pandemic future. It’ll be hard organizationally for leaders to build on lessons we’ve learned from this hyper-focused state and apply them to the universe of multimatrix priorities that inevitably we walk back to. There’s a lot of complexity that can be cut through when your life depends on it.

MODERN HEALTHCARE: Yep.

DR. CHRIS DERIENZO: We’ve learned that we don’t need the high level of complexity that we had had in place pre-pandemic to get things done.

MODERN HEALTHCARE: Wow. It’s really about kind of having grace upon grace for those fumbles that have happened, being able to learn from them, and move forward.

DR. CHRIS DERIENZO: I think you’re exactly right. We have been so incredibly fortunate at WakeMed, for the teams we had in place well before the pandemic, our level of community support, for partnerships with independents in the community, with businesses with public leaders, you name it.

We, again, by no means, are perfect. But I also think that having walked through this together and being focused on our core purpose, and learned the lessons that we’ve learned together, the foundation, I think, that that gives us — and many, many other health systems around the nation to bounce off of — into our post pandemic future really is tremendous. We can’t let all of the incredible learnings that we’ve gained through pain for the past 15 months be forgotten.

OUTRO COMMENTS: Thank you, Dr. Chris DeReinzo, for that advice on how to overcome any fumbles that health system leaders have made during this pandemic. We have all needed grace and forgiveness from our various team members because we were all sort of figuring it out as we went along.

COVID-19 has definitely left some healthcare workers distrusting their organization’s leaders and feeling like their organization lacks team spirit. But with the right approach, leaders can rebuild that trust and instill that team spirit that makes an organization run smoothly—and provide the best patient care.

Again, I’m your host, Kadesha Smith, CEO of CareContent. We help health systems reach their growth goals through digital strategy and content.

Look for more episodes of Next Up at modernhealthcare.com/podcasts, or subscribe at Apple podcasts, Google podcasts, or your preferred podcatcher. Thanks so much for listening.

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