The Function of Teams in Healthcare During a Pandemic
Personal Experiences in Management and Systems Thinking
In healthcare, typology of teams refers to grouping individuals by function and dimension. As a healthcare administrator, during times of challenge and change, it becomes important to thoroughly understand those teams’ typology so that work can be streamlined and redistributed as necessary to respond to a constantly evolving situation. As the coronavirus crisis has unfolded in the country, flexibility has become a primary expectation of teams. In the Healthcare Administration course in which I am enrolled, we discuss the environmental context of teams. Prior to Covid-19, our environmental influences tended to be more internal. We worked hard to define meaningful, progressive cultural beliefs and were trying to build solid relationships that encouraged free exchange of ideas and working together. Now, our environment is being controlled almost entirely by outside forces. We are at the mercy of what our patients and community need to stay healthy, what new positions and tasks are required of us as a Covid-19 diagnosis and treatment facility, and what we must do as community leaders in virus-prevention behaviors. The function of every team in the hospital has changed as a result.
Various initiatives were underway at the beginning of the year. I was involved in a few, including a major EMR upgrade, revamping the billing process of the electrophysiology clinic within one of my practices, and improving internal education opportunities for non-clinical staff. All of those projects have been put on hold in favor of our new number one priority — maintaining the financial health of my clinics, despite an over 70% drop in patient visits, while keeping staff healthy. I am also concerned with preventing staff from facing excessive personal financial strain. As a manager within the hospital’s Physician Division, I am a part of the team of other practice managers and clinical managers. We share these same new goals and continue to work together as we were before.
A few weeks ago, the managers were huddling a couple times a week and getting together for a longer meeting at least once a week. Our offices had open doors to each other and collaboration within sub-groups is common. When healthcare teams refer to time and space, they are likely alluding to the need to set times and locations for teamwork. Factors such as seating and technology can have a real impact on the productivity of face-to-face opportunities. Now, in order to stay safe, social distancing is a must. All of our meetings are now conducted via Zoom. When we gather virtually, some are working from home, some in their offices, others using empty spaces elsewhere in the hospital in order to keep distance. It took a couple of meetings before we reached a level of relative comfort with this technology, but it is working quite nicely now.
We are learning lessons about the function of time and space that will hopefully impact future practices in a positive way. Attendance is better when the physical location of each individual is unimportant. We’re taking better care of ourselves — rather than running place-to-place, skipping meals, exposing ourselves to sick patients throughout the hospital (and them to us), etc., we are able to move through our day at a more comfortable pace. There is less movement and time waste. How many in-person meetings were really needed? Was it really necessary for us to spend our day running all over the hospital? Our director of education has always struggled with room availability for educational programs, both for us and the community. If we continue to have meetings via Zoom, at least some of the time, that will help him with his programs.
Learning from our responses to current challenges is an example of team learning. We are evolving and improving our capacity to be flexible. Things are moving so fast in our world that this growth is not occurring with intentionality, and certainly without data collection to verify improvement in productivity. When we look back on this experience, we will hopefully gain insight into how to be more effective as we have been able to achieve remarkable things very rapidly out of necessity. We could analyze our team dynamics during the pandemic using the model of team effectiveness described in class. This model breaks down the components of a team and what influences functionality.
The model begins with a foundation of team definition — characteristics, the nature of the work, and the environment. For me, daily life has been consumed by our team of managers while all other teams (electrophysiology, IT, education) have been set aside indefinitely. We are defined as being the direct, “boots on the ground” leaders of the outpatient clinics, the nature of our work being to manage the finances and operations of those clinics. The environment has shifted to one in which we respond to the stressors of the coronavirus pandemic.
Team process is the next level of this effectiveness pyramid. This is how the team takes action, learning and decision making occurs, and leaders emerge. Another subject in class has been task interdependence. That flow has changed during this time of crisis-response. We used to utilize tools to document and delegate tasks, set deadlines, etc. The relationship between tasks, the order in which they needed to be completed, and who needed to engage with each other to reach the right outcomes, defines task interdependence and was a greater consideration when we had time to work through projects in a more thoughtful, democratic way. Now, decisions are having to be made more rapidly with only as much input from others as we can spit out in the moment.
In the past month and a half, our actions have involved reviewing the latest from Incident Command — a small team that includes infection control leaders in the hospital, senior leadership, and both inpatient services and outpatient clinic representation. They are the ultimate decision makers with regards to Covid-19 response. That information comes as email updates, sometimes so many in one day that it becomes confusing and frustrating. We also receive revenue reports daily now and have to strategist staffing based on that. We also need to compare work done in the clinic to billed services to make sure we’re not missing charges which would further hinder our ability to staff appropriately. Unlike in past months, when we would delegate tasks then reconvene to merge those efforts, we now take actions in real-time. We share our staffing plans with each other, trying to place individuals in other clinics as necessary to give employees the most number of hours possible. We consider alternate workflows in which tasks (such as patient check-in, running prior-authorizations, taking medical history) are done by different employees or in an alternate sequence. This is to reduce or redistribute staff and improve efficiency. Action often occurs before we even conclude meetings in the form of emails to our employees.
At the top of our Team Effectiveness Model we reach team effectiveness itself as assessed by the quality of work, member satisfaction, and sustainability. In this era of coronavirus response, we are not reaching a satisfactory outcome in this regard. The repercussions of not following organized project management are obvious. Our process changes, communication of updates and new policies is not always effective. We are making changes too frequently and seemingly changing our minds constantly. However, I do believe we are performing as well as possible under the circumstances. We know we’re not being the type of leaders and innovators we strive to be in “real life”, but we have little choice as our reality changes day-to-day and we must flex our resources, actions and policies accordingly. We are having to engage in real-time team learning. I am proud of our management team’s ability to work with new data rapidly and respond in logical ways, but it is certainly not ideal.
I will further elaborate on this as an example of team learning as it is a topic explored in our Healthcare Administration course. Team learning is when data and information is obtained and absorbed by the team and it evolves its function and objectives as a result. Prior to Covid-19, we were interested in recovering from the financial struggles faced by many medium-sized hospitals as a result of low insurance reimbursement and increased costs of materials. However, in the last few weeks, we have been responding instead to the pandemic. One of the biggest challenges has been the onslaught of ever-changing information. On the news, recommendations of local health agencies and the CDC come out pretty regularly. Behind the scenes, it is more chaotic. We get an update every day of the most recent patient-contact and PPE recommendations, best practices for outpatient clinics, and current data tracking the spread of the virus such that we can predict surge dates for our own facility.
For example, there was one 48 hours period in which the initial recommendation was to call all patients over the age of 60 and cancel their appointments. The following day, we were told they could come in so long as they were screened at the door, and so we called all the patients back who had been cancelled. By the next day, we were charged with the task of implementing telemedicine. By the end of that week, the physicians decided we should indeed still risk bringing some folks in for visits, so we started developing guidelines for when and if… Imagine how difficult it has been for staff to try and follow the latest version of clinic workflows! Employee teams of clinical and non-clinical staff are scrambling to reevaluate interdependence and interconnectedness of their tasks within clinics to help each other and utilize everyone’s skills in different ways. We as managers are constantly trying to be conscious of our relationships with Incident Command, Human Resources, Payroll, Patient Accounts, and other teams throughout the hospital. How we tweak our processes are directly related to data we receive from them and changes to internal policies.
In some ways, the function of teams within the hospital has not changed. Our goal remains to put patients first above our own workplace comfort and financial strength. That balance has tipped, however, in recent weeks. Although we are proud of the work we are doing, it certainly is a struggle, even for those of us without direct patient care in areas not specifically impacted by the virus. We are exhausted and frustrated, but the patients are being cared for to the best of our ability. They are struggling with scary conditions alone at home — heart failure, COPD, heart attack recovery in my clinics, cancer treatment, chronic pain, terrible migraines, important surgeries, etc. in the other specialty and surgical clinics. The specialists are working together in newly-defined teams to keep these patients stable while they wait to move forward with treatment. Our time and space has altered to keep us safely separated from each other and patients. Luckily, we have a solid understanding of our team relationships from months past when we were able to be more formal and intentional in our interactions and we are evolving and learning at an extraordinary rate.