Connected to a crisis: Leveraging the lessons of collaboration learned during a pandemic
Click Here to Manage Email Alerts
I stood off to the side watching a physician and patient, in a long narrow room designed for testing visual acuity. I was 16 years old, shadowing at a local hospital. It was right after Valentine’s Day.
The ophthalmologist I was observing was treating a young man with a self-inflicted gunshot wound to the head. The bullet went through his left eye, requiring emergent enucleation. This was the patient’s first post-op visit, and he was only just beginning to process his future. My heart was racing — I couldn’t imagine what to say to this vulnerable person. But the doctor was calm and warm. She carefully listened to his expressed regrets and helped him begin to cope with his profound loss through reassurance and understanding.
Looking back on this moment, I realize that I was starstruck — and I was impelled. It was like a young person looking up at the sky as the Blue Angels perform and declaring, “Someday, I will fly those jets.” I fell in love that day with the power of interpersonal connectivity in medicine, and I knew I wanted to be part of it.
Now, it’s the 25th anniversary of my graduation from medical school and I find myself constantly reflecting on people power in medicine. My experiences as an infectious diseases doctor during the COVID-19 pandemic unearthed deep feelings about why I do this work and how we can leverage ourselves as people to be better providers and better colleagues.
My job has always felt incredibly rewarding and equally demanding. During the pandemic, the demanding part reached new heights. People often ask what got me through this catastrophic event. It’s obvious that the big player was science and its accelerated evolution. But what rose to the top for me was the human-to-human connection that focused everyone on the urgent goal of delivering the services needed to save as many lives as possible. In an amazing time of stress and despair, our humanity took charge.
During
Like ID teams everywhere, we threw ourselves into the pandemic. I remember getting the sense that we were metaphorically putting on our fatigues each day, gearing up for battle (see painting). We worked harder than we previously knew possible. The bond of camaraderie that comes from a shared threat and common goal is fierce. Across teams, between medical staff and administrative staff, it was like turnkey access to a newfound alliance. Our ID team was talking and meeting with everyone — everywhere — all at once. I was accustomed to feeling like I was always running toward people. Finally, it seemed they were sprinting toward me.
There was a new emphasis on collaborative medicine. We developed a system of cooperative rounding with the hospitalists, critical care doctors, other specialists and nurses during the time when there was less certainty about how to mitigate the risks of the virus to health care workers and personal protective equipment (PPE) was in short supply. Warm handoffs became the new normal as opposed to writing notes in the EHR and hoping they were read, understood and acted upon. In this new normal, providers helped patients to the bedside commode to save someone else from having to put on valuable PPE. Patients weren’t “mine” or “yours”; they were people suffering and dying from COVID-19 and its complications. We all stepped out of our silos to fight a common enemy together.
Takeaway #1:
- We don’t have to wait for the next pandemic to leverage the benefits of collaboration that it impels. Personal connectivity in medicine is needed between staff members as much as it is needed between staff and patients.
Among evolving challenges within the hospital, we were faced with the immediate need to test for this virulent new virus. As the demand for testing kept rising, I was in the lab alongside the lead microbiology technician, searching every corner, drawer and shelf for extra swabs and media. We didn’t have enough supplies. I called prior instructors and colleagues that I had built and maintained relationships with over decades. Those connections led us to quickly resource three-dimensional printed swabs and identify a nearby company that rapidly developed a SARS-CoV-2 assay. My willingness and interest back then to build rapport and network resulted in a solution for essential parts of our testing processes. It made an enormous difference for our patients. As of today, our independent, 167-bed community hospital has performed almost 60,000 tests for SARS-CoV-2. Our testing success story grew from seeds planted long ago and maintained over years of “practicing” connectivity.
Takeaway #2:
- Purposeful and collaborative problem solving brings the total problem and best solutions together for both patients and our system.
Our leaders quickly pivoted to focus on the pandemic, responding to the whole hospital’s evolving needs. I am intensely proud of how we were able to prioritize the care of our patients and safety of our staff. The team dynamically collaborated on every emerging need, such as finding and leveraging supplies, resourcing staffing, and openly disseminating and communicating changing information. One effective way transparency was achieved was through rounding on the hospital floor with a member of the ID team and C-suite to deliver and receive important information face-to-face with frontline workers.
Takeaway #3:
- Health care is a network of people with a fundamentally common goal. Truly hearing each other's perspectives is how we grow together.
The pandemic threw the necessity of the ID team into sharp relief; we were no longer a second thought. Historically, I would press leaders for the space and time to apply ID’s understandings to the other departments, advocating for changes that could decrease post-op infections, guide the hospitalists in the latest ID treatment strategies or prevent transmission of existing respiratory viruses. Now, suddenly, leaders were at my door, wanting this information and guidance on delivery. The success of this integration was particularly impactful when the COVID-19 vaccine became available — every department was involved and played an important part in creating a vaccine center where we could deliver hundreds of vaccines a day.
Takeaway #4:
- An integrated ID program facilitates program development, resulting in improved patient services and outcomes.
Closing my eyes now, I can visualize our makeshift command center: masked staff, computers scattered, daily stat discussions underway. While infection numbers climbed and new spike proteins emerged, what gave me hope was being part of our institutional rally that held up collaboration and relationship-building as significant mechanisms of changing our local system of health care. All the incremental successes we held onto amid the turbulence were manifestations of humans coming together.
Connectivity had emerged as our lifeline.
After
Fast forward through the pandemic. With the return of normalcy, I felt like all eyes were deliberately looking away from me. Everyone wanted to look toward something else — anything else. I hadn't anticipated the feeling of loss that continued. Things were taken away — resources, acknowledgment, time. I felt like a woodpecker hammering against brick (see painting). Our newfound appreciation for interconnectedness faded, replaced by the familiar barriers of siloed activities. Now, once again, I’m leaning forward into the wind of business as usual, shouting about collaboration, empathy and communion, exhaustedly trying to dig my boots into slippery ground.
Business-as-usual medicine distracts from personal connectivity. Our norm is like gradual frostbite — slowly increasing health care workers’ tolerance for disconnection. We are rewarded for keeping pace via Relative Value Units (RVUs) and complimented for our efficiency, while internally we become more exhausted and isolated. We “communicate” and “connect” via the EHR and email, which is like the bait and switch of social media: holding up a false sense of relationships and authentic interactions, but actually damaging human connectedness.
The realization during the pandemic that ID is part of every aspect of medicine, and the recognition of our significance, felt so promising. We demonstrated the value of thoughtfully integrating ID homogeneously into hospital operations and showed the value of collaborative real-time solutions based on the most up to date research. This needs to continue to accommodate the ever-increasing complexity of medicine so that we can advance patient care and hospital safety to its full potential. Why can't it?
Sustaining the momentum
I watched people and teams across our community hospital grow into something more connected and more self-aware as we fought a common pathogen. This evolved, highly collaborative version was capable of rapid learning, effective information exchange — real symbiosis. Our sense of community swelled, we communicated more openly and more often, we pivoted with feedback. I saw how much more effective we are when we take that form. Now, how can we sustain it?
1. Integrate systems that support growth and connection. We need structural changes that allow for working more interconnectedly, and space to pursue areas where we can share the life-saving knowledge that supports our colleagues and our institutions. It is critical to have the opportunity and time to ask one another more questions and listen more closely to the answers. Specifically, there should be more space for tandem rounding — both inter- and intradisciplinary — at the hospital. It facilitates insights within and between teams, which, in turn, supports truly collaborative patient care. It also, so importantly, allows us to see one another’s intangible and probably most valuable skill sets — how we work with people — and choose what to incorporate into our own practices.
2. Support for integrated ID. Our small ID group has evolved over time to use collaborative strategies. Across departments, there are individuals I can count on to promote the needs of ID. We need established channels for collaborating with microbiology, pharmacy, infection prevention, surgical services and many others — and the time to use them. Without the appropriate support in the form of time and real resources, the people who tend to always create points of connection and engage in system improvement become exhausted.
The efforts of ID-integrated teams can save hospitals money by reducing patient stays and improving outcomes, but this often receives less attention than increasing income through added surgery lines. Shouldn’t a dollar of profit retained be just as compelling as a dollar of revenue generated? If we truly, collectively appreciated the potential for improved outcomes, ID would see an increase in resources and less emphasis on RVUs.
3. Restoration time. Institutions must also find more space for their warriors to recover. People experiencing uncontrolled stress, fatigue and exhaustion will weaken a team’s unity, and providers experiencing this don’t perform as well for their patients. This low energy and greater apathy limit a person’s ability to slow down, hear what others are saying or fully communicate a problem. We need to build our people up so they can be better health care workers. Time away from work is the only thing that has been found to generate a sense of genuine restoration. This industry lacks openness about what is really needed for recuperative time, and we are constantly trying to assuage the guilt of burdening our teammates with our absence. To achieve a full recharge there needs to be more contiguous time off and a structure in place to reduce the burden on colleagues who cover our workloads. This could include increased use of per diem providers, scribes, outsourcing help with clinical inboxes or programs that use AI.
Conclusion
We simply cannot afford to look away (see painting) from the importance of connectivity between people at all levels in a health care system and the integration of ID in health care because these two things are critical to optimizing the care of our patients. We are all trained to prevent suffering — that's what we signed up for. Let's facilitate that mission with connectivity and real communication, because the chart and emails are not doing it! And, most simply, we can choose not to turn away, and to keep looking at how we can be a better team and run toward each other. Don’t write off change because it feels too overwhelming to even ponder. Let’s value what we gained during the pandemic and pull it forward. Change will spread — it’s contagious.
References:
- Garcia P, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.3201.
- Schmitt S, et al. Clin Infect Dis. 2013;doi:10.1093/cid/cit610.
- Sinsky CA, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2023.51635.
For more information:
Amie L. Meditz, MD, is an infectious diseases specialist at Boulder Community Health in Boulder, Colorado. She can be reached at ameditz@bch.org.
Collapse
Expert Submission
Read more about
Click Here to Manage Email Alerts