By Brian J. Bolwell, MD, FACP
The current coronavirus pandemic will likely change the delivery of health care forever, even if only because virtual visits now become widely accepted and utilized.
It will not, however, change the importance of leadership. Indeed, this crisis illuminates how important leadership is. Some states, such as Ohio and California, have governors who were, and continue to be, proactive, thoughtful, and honest in their approach, with favorable results.
A crisis tends to illuminate leadership skills.
Most cancer centers, including ours, have seen a decline in the number of new cancer referrals. This appears to be due to many things, including patient reluctance to seek care because they are afraid to go out and risk contracting COVID-19, and because some patients simply cannot receive the care that they seek. That said, we still have plenty of patients who need our care. The central issues facing most major cancer centers is how to prepare for a potential surge in COVID-19 cases at their institution, and how to maintain their center's ability to continue to deliver cancer care.
This essay will focus on the second point—how to maintain your ability to care for cancer patients.
By far, the most important issue is to care for your workforce. Your employees. Your people. Your docs, your nurses, your administrative support staff—everybody. Nothing happens without your people. Everything you do throughout this pandemic needs to start with asking yourself how this decision will affect the people who work for the cancer center. And that means that everything you do has to focus on managing fear. They are scared. Everyone is scared of this virus. The news is filled with daily stories of otherwise healthy caregivers who developed this virus and died. Many doctors and nurses, really for the first time in our lifetime, are afraid to physically be with patients. It's not just the workforce that is scared. Patients are scared. I am scared.
So how do you manage this?
I certainly do not have all the answers, but I will tell you what I am doing and what seems to be helping me.
First, you need to get the basics right. Have a straightforward process for screening everyone who enters the building with basic questions about shortness of breath, temperature taking, and supplying masks if a person does not already have a mask. Have a process for who to test for COVID-19, and, ideally, have a testing station available in your cancer center. Have the process well-oiled. The sense of calm and professionalism will in itself reduce anxiety for those who enter the building. Report out the facts about caregivers who have acquired COVID-19 at your institution, and whether there is any indication that they acquired the disease at work. Next, have your IT leaders make sure that your virtual visit system is functional, and that everyone is trained to do virtual visits. Most clinic visits these days are virtual, so you need to make sure that your system works. Much routine cancer care for the indefinite future will be via virtual visits, and you need to have your system fully operational.
More importantly, be a leader. Those who read this column know that I believe leadership development and character development are one and the same. So be a person of character. Tell the truth. Be transparent. Address challenges. Do not spin the facts—give the facts as they are. Be informed. Educate yourself every day.
For me, this means I do several things every day. First, I show up. If your nurses are coming every day and delivering infusions to your patients, it's pretty important that you show up as well. That means you need to be visible. Walk around and say hello to folks. It goes a long way.
Next, we have organized our cancer center for the current situation. We have representatives on all major organizational COVID-19 task forces. Note that you do not have to personally attend all of these meetings yourself. Delegate when appropriate. It is better for you and it empowers others. We have a daily (now three times/week) brief cancer center leadership huddle to align and report out any new developments.
Probably the single most important thing I do is to craft a daily email to the entire cancer center. I report out organizational data (how many COVID-19 patients are in our health care system, what our current modeling shows, etc.), as well as national and international data. I supply graphs and tables of national COVID-19 data. This means that every day I need to educate myself about what is occurring with the pandemic. I also disseminate information about the medicine of COVID-19 disease, about testing, and about outcomes. Anything I know I send out to everyone, with my personal commentary.
But the daily email is not just about data. I also discuss what I am feeling and what we all are feeling. I speak frankly and simply. I am totally authentic. Sometimes I try to inject humor. At one point, I said my hands were getting destroyed from all the hand washing. Later that day, I received at least 25 replies from various members of the cancer center, suggesting the best hand moisturizer for me to use. Some dropped off samples to my office. So the next day, I thanked them in the daily email. Then a bunch of people wanted to know the data about the best hand moisturizer, so the next day I sent out everyone's suggestions!
Most importantly, at least once a week I tell the cancer center workforce that they are the reason that I come to work, and how proud I am of them, and how important they are (among other things).
All this communication takes a lot of work and is time-consuming. But it is time well spent.
The daily communication seems to be useful. I have never received as much positive feedback as I have about these daily updates. Many have requested that I continue to do it after the pandemic is over.
So my advice about how to lead through these new and choppy waters is to go back to the basics. Be honest, transparent, and straight. Do not spin the facts. Ideally, educate and inform on many levels. And let people see who you are. Authenticity goes a long way.