When COVID hit us at the University Health System in San Antonio, we found ourselves building the airplane as we flew it. Everyone was terrified in their own way—about the virus, the welfare of our patients, the economic impacts to our health system and our community, and the impacts on our families, too. My personal and professional journey helped me identify eight strategies any hospital system can implement to better manage the turbulence of catastrophic and inevitable challenges:
- Overcommunicate: Give your ear and your attention to all stakeholders. Talk with and listen to everyone—hospital executives, federal entities, state agencies—all the community organizations that deliver health care on the frontlines. Health care administrators need to do more to foster communication with laboratory medical directors. While pathologists and administrators may appear to live on planets in separate galaxies, good lines of communication can uncover areas of overlapping understanding—think Venn diagram. A key component of overcommunicating is remembering that good questions lead to good information, and good information informs good decisions, all of which are critical to delivering positive health care outcomes efficiently and cost effectively.
- Know what you don’t know: In many hospital systems, health care executives don’t fully understand what pathologists know and do—and how their work is integral to hospital operations. When hospital executives understand what their partner physicians in the laboratory are doing, they can leverage that understanding to balance fiscal concerns with improved patient outcomes. The COVID crisis has highlighted the importance of laboratory testing for day-to-day health system operations—and that’s been a great reminder for a lot of health care administrators.
At San Antonio, our administrators put this perspective to good use. When our health care administrators engaged the pathologists as testing experts, they came to understand how much the details mattered, for instance, that one particular COVID test wasn’t equivalent to another. Armed with that enhanced awareness, those operations-oriented administrators were then better able to assess the different costs of tests and the various vendor and supply chain issues involved. Such insights have been critical to meeting the challenges of the current pandemic—and will be just as critical for managing the next health care crisis.
- Be relentlessly curious—resist confirmation bias: Being curious mitigates the tendency to dismiss streams of information that don’t fit our world view. Sometimes, especially when we’re moving at a really high speed and under a fair amount of pressure to perform, the default position is to turn away from incoming information that doesn’t fit a familiar rubric. Instead, aim to embrace information even when the inflow feels foreign or overwhelming. If health care executives and physicians can listen even in the face of dissonance and distraction, people with information to share become essential allies.
Another benefit of listening inspired by curiosity: Real listening validates people. When people feel validated, they are more likely to bring you more information—and more information promotes a richer, more informative, and productive dialogue and tamps down stress for everyone.
- Manage your fears: Most health care executives and physicians will readily admit to being Type A overachievers, driven by perfectionistic, often unrealistic expectations—and often by a fear of failure as well. Such egotistic fears stifle good decisions. No one committed to delivering good patient outcomes or ensuring fiscal solvency is omniscient, and no single individual is ever going to have all the answers. We are all like blind men touching a bit of the elephant—the tail, the trunk or the flank; but as individuals, we will never have all of the insights in isolation from others.
That’s why managing our fears and listening is fundamental—why it’s key to refining our understanding in service of doing well by our patients and our hospital systems. The ability to say, “I don’t know” and ask, “What do you think?” are the ultimate indicators of a fearless leader.
- Don’t make it worse: We can’t be afraid of those questions and activities that take us outside our comfort zones—especially if we don’t want to make it worse. So while management by walking around isn’t an original concept, I began visiting patient floors with the San Antonio University Health System’s CMO and the vice dean for graduate medical education—even though we knew the sight of an approaching swarm of physician leaders was certain to fill even stalwart hearts with dread.
Surprisingly, however, we found that the more frequently we were seen on the floors, especially where COVID-19 patients were being cared for, the less our presence was met with apprehension. In fact, I found that simply asking "How are you really doing?" and "Are you okay?" eventually led to more engaged and helpful relationships.
When we first started doing these rounds together, our motto, "Just don’t make it worse," was a joke. But it became a guiding mantra that led to more thoughtful, less reactive decisions and responses. Our walks and talks allowed us to engage with people working in an extraordinarily stressful environment, and see them as people doing their best to deliver great care. They, in turn, found comfort in our efforts to build connection. I'm confident these efforts helped deliver better outcomes—some unexpectedly positive—and ensured myself and my colleagues didn’t make it worse.
- Be aggressive early: To those who will face the next inevitable health care challenge, heed this warning: If you fail to take quick, decisive action, you’ll pay the price for your hesitancy. From the start of the COVID-19 pandemic, myself and my colleagues at University Health Systems realized we needed to act quickly and be very strategic and aggressive about resourcing our laboratory to support the community effort for testing.
Fortunately, others in the community realized this as well. Dawn M. Emerick, EdD, director of the San Antonio Metropolitan Health District (Metro Health), wasted no time organizing a coalition of individuals, including myself, from laboratories and hospital systems in the area. The coalition focused on making sure the proper equipment and safe and accurate testing were available, and our efforts saved lives.
- Learn another language: Pathologists can better serve their hospital systems if they deliver messages lay administrators can understand without the use of Google Translate. In fact, by learning to speak "administration," pathologists can serve as a bridge between laboratories and medical technologists on the frontline with administrators in hospital finance, operations, and procurement; in this role, pathologists can support efforts to make sure the right resources and equipment from various vendors end up in the right hands at the right time.
In a previous role as a system laboratory medical director, I was summoned to the CMO’s office on my first day of work to talk about how to make blood delivery and transfusions safer. By partnering with laboratory leaders, lay administrators, chief operating officers, nursing and physician leaders, and other stakeholders, we made sure no one was left "lost in translation"; instead, the team developed a system approach that ensured safe transfusions for patients.
- Honor your significance: I sincerely hope pathologists will come to embrace the power of their unique perspective and clinical expertise in order to leverage their significance. We pathologists are really agile in flipping between the big picture and minutiae—we shift from the 10,000-foot level to the microscopic level day in and day out, which gives us a special insight into the impact of small changes in workflow to the overall clinical outcomes of an organization.
Furthermore, and perhaps most importantly, I hope all pathologists will reject their stereotypical categorization as geeks hunched over microscopes in hospital basements next to a stack of slides. Each one of those slides represents a person. Each slide means we’ve touched a person’s life and made important, clinically impactful, potentially life-changing diagnoses. While it’s true most pathologists never receive calls from patients thanking them for the sodium result or the cancer diagnosis, I hope no one will forget the significance of our work: how it informs the decisions health care executives make and guides the care delivered at patients’ bedsides.
Emily E. Volk, MD, FCAP, is president of the College of American Pathologists and chief medical officer at Baptist Health Floyd, New Albany, Indiana. She is also an associate professor of pathology at the University of Louisville.