How COVID accelerates change: Bridging business principles with emergency medicine

Over the past year, we have experienced massive organizational change at an unprecedented pace. Traditionally, we could spend weeks planning how to best make a change in our workplaces, but COVID-19 was anything but traditional. Our emergency department at Saint Barnabas Health System in Bronx, NY, needed to pivot on a daily and even hourly basis, and to do so took planning and effort. In general, change is difficult, and we like routine as human beings.

Change can cause us inner turmoil, we’re not sure how we will feel after it, or we may not understand it or why the change is even necessary. Sometimes, people within our organization, department, or team may not agree with the change, they may not feel the urgency, or the change may represent something contrary to their values. Even if the change will bring about a better future, we still may encounter resistance along the way. To overcome these types of resistance, we need to educate, inspire, and team up with others, but this often takes time, and with COVID at our door, we needed to change quickly. Our emergency department disaster team planned and communicated using many aspects of change expert John Kotter’s eight-step accelerate model, allowing us to instantly create effective and sustainable change in our department.

The first step was creating a sense of urgency. We didn’t need to do much in this realm as COVID-19 did it for us. We heard reports from other countries, states, and cities and knew we needed to act as change was coming whether or not we wanted. People’s hearts and minds were aligned, and they were ready for instruction. The second step happened very early on in the pandemic when we created a guiding coalition. This step was key to getting buy-in from all layers of our department.

We created a core team of individuals from different levels and functions who met daily. This team’s purpose was to receive and synthesize department-wide information and transform it into new ways of working for our doctors, nurses, ancillary and support staff. We had a compelling vision which was shared with our department. We made it clear to everyone that they were supported and valued and that we would do everything we could to save as many lives as possible. We knew the importance of making sure that our staff felt heard, and we communicated our change while building upon the positive in our department. We used the facts in combination with the sentiment and feedback received from our co-workers prior to making decisions.

Decentralized decision-making motivated people to take action and helped us enlist a volunteer army. We implemented in-person department leadership check-ins at every shift where anyone could bring up any issue they encountered. Because everyone had the opportunity to participate, people felt like their voice mattered. They were empowered to speak up and help direct the changes we needed to make. We made sure to remove barriers that could negatively impact the change we needed to create by opening direct communication lines from all employees to departmental leadership and strengthening relationships with other key departments in the hospital. Through our command center we were able to get in contact with whomever we needed on an instant basis and were able to address any issue that came up in real-time.

We worked closely with our colleagues in other specialties to utilize staff in the most efficient way possible and created connections that had never been in existence. We could not afford to accept “it’s not done this way” or “we always do it like this,” and all staff pitched in to create innovative and thoughtful solutions to issues that were not immediately solvable. It was important for the staff to know how well our department was performing, so we made sure to create short term wins. No win was too big or too small, no matter what it was, we wanted people to feel the win, and we wanted the wins to be meaningful. We engaged the community to send letters of appreciation, developed relationships with corporations who donated goods and services to our staff, and ramped up our wellbeing initiatives. We implemented weekly groups to discuss the emotional aspects of practicing medicine during a pandemic and developed a personal and professional development curriculum to help build confidence, develop strengths, and teach new ways of communication. We made a point to show our appreciation to all workers in our emergency department and the EMS crews that were bringing in patients and proudly showed the daily numbers of discharges and extubations. We are at the point of sustaining acceleration in that we have shown how as a department, we can improve our systems and processes, and now our job is to make sure to keep the momentum.

As we continue moving forward, as individuals and institutions, we need to be ready and willing to change. Just like we study and prepare to best take care of our patients, we need to understand the dynamics of change and how to implement it effectively. When so much is up in the air and with new information coming at unprecedented speed, we need to prepare ourselves and our colleagues to be open to thinking and behaving in new ways. Organizational change is by no means easy, but COVID-19 has given us the ability to bypass many of the difficulties. We are tasked with caring for people in the midst of a new disease with much to learn. We have seen billion-dollar businesses fail because they were entrenched in their ways and responded too late to their changing environments. In the ER, we can’t afford to fail. We must keep going forward and care for those in need. We can take yesterday’s lessons and better ourselves for tomorrow, and inspire those around us. We can tap into our creativity, change our perspectives and see the present in a different light. We can embrace the unknown and be the leaders in taking the next step forward. Each one of us has the ability to institute the change that we’ve been looking for and use what we’ve been through to ingrain that change into the fabric of our lives.

Josh Schwarzbaum is an emergency physician.

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