Leadership in the Time of COVID-19: Building Strong Teams for Optimal Agility

The COVID-19 pandemic has brought unprecedented challenges. Consult QD sat down with Beri Ridgeway, MD, Chair of Cleveland Clinic’s Ob/Gyn & Women’s Health Institute, to discuss reactivation, telehealth, caregiver safety and agility in leadership amid the pandemic.

A team approach with phased reactivation

What processes are in place to help Cleveland Clinic leaders understand the evolving COVID-19 pandemic, as well as the needs of our patients and caregivers in this time of crisis?

Dr. Ridgeway: Early in 2020, Cleveland Clinic leadership created a taskforce to proactively address the potential risk of COVID-19. This task force has already been through several iterations; the most current rendition is a COVID-19 Operations and Recovery Task force (CORT), headed by the President of Cleveland Clinic’s Main Campus Hospital, Edmund Sabanegh, MD, and Cleveland Clinic’s Chief Caregiver Officer, Kelly Hancock, DNP, RN, NE-BC, FAAN.

In terms of surgical operations, our first task as a team was to work with the government to limit our surgeries to those that were essential. Prior to the pandemic, we performed about 800 cases each day across Northeast Ohio. During the shutdown, we did roughly 200 cases per day – emergent cases that could not be deferred. During this time, we redeployed many of our caregivers and repurposed equipment from our ambulatory surgery centers in preparation for the anticipated surge in COVID-19 cases.

When Ohio’s curve appeared to flatten in May, we worked with the government to reopen as quickly as possible, as a slew of people with very serious diagnoses had been deferring care. Our reactivation strategy was a phased approach based on pre-operative testing of all pre-surgical patients. We reactivated in early May and have seen increasing cases each week – we’re probably at about 90% of our pre-COVID levels now.

With the significant number of changes we experienced in a short period of time, we increased our communication with all clinical leaders, having twice daily calls when necessary. We also worked with our Corporate Communication colleagues to cascade messaging to the entire staff.

How do we support Cleveland Clinic caregivers across the globe?

Dr. Ridgeway: Our executive team, Chief Executive Officer and President Tom Mihaljevic, MD, Chief of Staff Herb Wiedemann, MD, MBA, and Dr. Sabanegh began meeting with other Cleveland Clinic leaders from infectious disease, surgery, medical operations and public relations, twice daily (at 7:00 and 14:00). These meetings also included leadership from Cleveland Clinic Florida, Cleveland Clinic Abu Dhabi and Cleveland Clinic London. In each meeting, we discussed what was happening at main campus, in our Northeast Ohio regions, and at Cleveland Clinic sites around the world. We were kept constantly abreast of the number of cases in each region, as well as in our hospitals and ICUs. We discussed safety precautions — including masking, hand hygiene and physical distancing — and how they would impact different populations. We aligned our shutdown and reactivation plans as much as possible, fully knowing that the infection rates and laws varied from location to location.

Keeping caregivers safe

Very few Cleveland Clinic caregivers have been diagnosed with COVID-19. For those that have tested positive, the infections have been traced to community transmission. What safety precautions have we put into place to keep our caregivers safe?

Dr. Ridgeway: Even while we were still learning about the virus, we put a number of safety measures in place. We restricted visitors, closed multiple entrances to facilitate universal screening protocols, streamlined our communication around symptoms and encouraged caregivers to stay home when they weren’t feeling well – something that medical doctors haven’t been great at historically. All caregivers and visitors are required to wear masks, and we request that patients wear them as well. We have increased hand hygiene. I think that these measures combine to help keep our caregivers are safe in the workplace. As we reactivate, we are testing every patient who doesn’t have an emergent case, and expect to begin testing all patients coming for inpatient stays as well.

Expanding telehealth access

In the span of 6 weeks (from March 7 to April 11), total Cleveland Clinic outpatient visits went from 2% remote (virtual or phone) to 75% remote. What kinds of issues arose as we made this transition and how were they addressed to ensure the highest quality care?

Dr. Ridgeway: In just a few weeks, thousands of providers were newly trained or retrained in the available virtual platforms. To organize the effort, several steps were taken almost simultaneously. We expanded telehealth privileges, trained and reorganized our workforce, and created new documentation and workflows.

When we found that our previous telehealth platform could not sustain the rapid volume growth, we quickly switched platforms, and then developed the infrastructure to support it. In a perfect world, we’d have spent years building and testing the product and standardizing our processes. In the pandemic, we didn’t have the luxury of time. The bottom line was that we needed to provide access to our patients, and we decided that it would have to be on a “good enough” platform at first.

As federal laws changed, we added options for access on different platforms. We immediately developed a playbook on how to do virtual visits, which included step-by-step instructions on how to bill, how to document dot phrases, etc. We also maintained an option to switch to a telephone call if either the patient or provider experienced internet issues. In the background, our IT colleagues developed an improved platform, which is now embedded in Epic (for providers) and MyChart (for patients).

In Ob/Gyn specifically, we had already been conducting a small percentage of low-risk prenatal visits via a remote platform. We expanded this platform and also effectively offered these visits for infertility consults, preconception counseling, post-partum checks, birth control, preoperative counseling, and follow up for laparoscopic surgery.

Some patients really love telehealth, while it was more challenging for others and not how they’d like to receive care going forward. It is nice have options for our patients as we continue to emphasize how important it is to seek medical care. We remain concerned that there will be public health issues related to deferred diagnosis and care for patients with cancer or heart disease, and we’re looking at strategies to minimize these effects.

Building teams and staying agile

How has your leadership changed since the beginning of the pandemic?

Dr. Ridgeway: Prior to the pandemic, we had the luxury of time. I feel like we had the opportunity to review and revise communications or presentations many times over. Now, we just don’t have that kind of time. As leaders, we’ve had to stay agile, make the best decisions with the limited amount of data available, and move forward with the plan to iterate once new data is available.

I think it’s really impossible to over-communicate right now. That’s an illusive — yet worthwhile — goal I feel as though I’m constantly working toward.

Finally, I rely heavily on others. I rely on my colleagues in leadership; and I rely on the leadership structure we’ve implemented and the fabulous caregivers in the Ob/Gyn & Women’s Health Institute. We’ve created fantastic teams, and as a consequence of that, we’re able to come to the best possible solutions.

Beri Ridgeway, MD, (@beridgeway) is Associate Chief of Staff and Chair of Cleveland Clinic’s Ob/Gyn & Women’s Health Institute.