By Mark Hertling, DBA, Lieutenant General, US Army (retired)
Vaccination rates have risen, hospitalization rates have fallen, and the nation and healthcare profession face what many perceive to be the start of a return to normalcy.
What faces us as we transition from a year of operating in a crisis to the resumption of the habitual? What will linger from a long, tough fight against COVID-19, and how might physicians best approach the many post-crisis challenges they will face?
My experiences in the military may help those in the profession of medicine prepare for what’s next. The challenges healthcare professionals face in recovering from the COVID-19 fight are comparable to what soldiers experience when they leave a battlefield. As we return to normal (however normal is defined), healthcare providers should assess where they are, what they have learned and the lessons they want to apply to their future healthcare operations.
Heading home from my last combat tour, I found myself gazing out the aircraft window and thinking about the myriad challenges I faced during a very long combat tour and how I would use those lessons. Some of my experiences mirror the kinds of challenges healthcare professionals may face coming out of the COVID-19 crisis, so I thought it might be beneficial to share those thoughts.
First, I was exhausted. Leaders are always expected to be at the right place at the right time with the right answers. They must have more energy than others; they must be upbeat and exhibit behaviors that will motivate those who depend on them. During the pandemic, most healthcare providers have reported similar exhaustion brought on by increased stress, sleep deprivation, little personal time, and having less time for reflection, exercise, growth or even prayer.
What to do about this? As soon as possible, physicians must conduct a personal assessment to determine the state of their emotional, intellectual, physical and spiritual well-being. Make a plan to bring yourself back to normal. Plan an extended vacation (without email or phones). Get a personal trainer to help you achieve your fitness goals. Enjoy a long talk with a spiritual advisor over coffee. Make a concerted effort to renew relationships. Be in the moment! Most of all – and here’s advice I give to all the physicians I know – GET A PHYSICAL EXAM, as most of you are amazingly lax in caring for yourselves.
While there is a big difference between post-traumatic stress and post-traumatic stress disorder, it is important to be aware of the warning signs of PTSD. Many believe PTSD only exists in soldiers returning from war, but it can occur in anyone who has gone through a traumatic event. And that certainly describes what many of you have been through in treating COVID-19 patients.
Second, take pride in what you accomplished, but also assess what you need to do when you return to your normal operations. Research shows organizational fault lines drive teams to perform at less-than-optimal levels. Research also shows that such rifts exist between physicians, nurses and administrators for a variety of reasons. They may be the result of communication disconnects (extensively reported on in research). Sometimes various members of healthcare teams just don’t trust each other because of their training, culture or place within the organization. But during a crisis, research of various organizations also shows fault lines dissipate and trust evolves.
Many healthcare organizations are reporting that while COVID-19 cases surged, their people came together and worked better as a team. Most personality conflicts, communication disconnects and organizational dysfunctions receded, and organizations saw smoother coordination and collaboration. Have you seen examples of this in your organization during the pandemic? If so, what is your plan for ensuring you maintain the effectiveness your team gained during the crisis? How do you ensure your new, high-performing teams do not revert back to what they were before?
If you are a formal healthcare leader (someone with a title and a position on your team), it is your responsibility to provide feedback on people and processes. If you are an informal leader (someone who is a member of the team but does not have specific leadership responsibilities outside your clinical role), and you don’t see this happening from the direction of the formal leader, volunteer to run the review session for your formal leader.
Be candid in assessing your team’s leadership and your team’s systems and processes. Determine strengths and weaknesses by asking for feedback on communication, behaviors, medical knowledge, emotional intelligence and execution of tasks. Then determine the processes and systems that did and did not work and drive change in what you want to incorporate. Don’t go back to the old ways if they were not effective under critical conditions.
Drive the conduct of an organization-wide after-action review (AAR). The successful conduct of any AAR requires asking – and getting answers to – four questions:
- What happened?
- Why did it happen the way it did?
- What needs to be fixed or “polished” in the processes, systems or leadership approach?
- Who is responsible for ensuring the fixes or adjustments occur?
The facilitator, and the key leaders of the organization, must ask the right questions, must be deeply involved in getting the right people to comment on the issues and must “pin the rose” on someone who will be responsible for carrying through on the fixes. At the end of the AAR – after the key topics, and a plan for addressing each, are discussed – the person in charge of the organization must publish any action plans with a suspense for ensuring the fixes.
During my three combat tours, 253 soldiers under my command or in my organization sacrificed their lives for the mission. Many more were wounded in action. There are times when bad dreams remind me of some of the circumstances surrounding the incidents that took their lives, and I often wake with a start, in a sweat. The question I always ask myself in the middle of the night when this happens is why did they die and why did I not? And I wonder what I might have done differently to prevent those deaths.
As we draw down from treating patients during the COVID-19 crisis, healthcare providers must also be wary of survivor’s guilt. Survivor’s guilt is a strong emotion for anyone who has been through a crisis, especially when their friends or loved ones have not. Many healthcare providers have lost patients. They have also lost colleagues, friends and family members to this disease. Because you are in the healing profession, many of you will question what more you could have done to prevent the loss of life. Does your healthcare facility have plans for a memorial service for all those who passed while in your care? Is there a special tribute in your hospital to those healthcare providers who paid the ultimate sacrifice in caring for patients? Most importantly, have you rededicated yourself to your profession, knowing that what you learned during the pandemic will help you be a better physician – a better human being – in the future? Do you have the knowledge that you are making a difference every day you serve in healthcare?
Like citizens all across our nation, my family and I are grateful for the skill and professionalism exhibited by clinicians and healthcare providers during this devastating pandemic. While many are breathing a sigh of relief as they see the end in sight, professionals take the opportunity to learn and grow from any crisis. Hopefully, the reflections and recommendations in this paper – learned from a different profession – will provide ideas to my new colleagues in healthcare.
Mark Hertling, DBA, Lieutenant General, US Army (retired)
Mark Hertling retired from the Army in December 2012, finishing his Army career as the Commanding General of US Army, Europe. Hertling received a BS from West Point, an MS from Indiana University’s School of Public Health and an MA from the National Defense University. In 2019, he received a Doctor of Business Administration from the Crummer School of Business, Rollins College, defending research addressing physician leadership in the healthcare industry. Hertling was a Senior Vice-President at AdventHealth, where he created a physician leadership course. After writing “Growing Physician Leaders,” he now teaches at several health care facilities. He is an Adjunct Scholar Of Strategic Leadership at the Crummer School of Business, Rollins College and he serves on the Dean’s Alliance at Indiana University’s School of Public Health. He is also a military and national security analyst for CNN/CNN International.
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