Lessons Learned

Hi everyone,

We’re weeks into the pandemic now, so let’s pause briefly to consider our performance. We should be proud. We’re not perfect—far from it—but we’ve gotten a lot right. We’ve learned a lot, both from our mistakes and our successes. Introspection is the key to growth.

In no special order, here’s what we’ve learned:

• Morale: Morale means everything. We need spirit, energy, commitment, and enthusiasm to defeat the virus. We need to nourish morale, especially by recognizing the efforts of our colleagues on the front-lines and their enormous impact on patients’ lives.
• Transparency: Tell the truth. Show the dashboards. Armed with facts, we’ll rise to the occasion. How many cases do we have? What kinds of equipment shortages do we face? What’s the status of testing? What is leadership discussing at their meetings? Transparency promotes engagement and trust.
• Communication: Make it timely, concise, honest, consistent, accessible, and useful. Let’s be sure everyone is up to date, following the same policies, and working with the same facts.
• Planning: You can’t “over-plan.” Anticipation is key. Thankfully, we’ve re-deployed staff, created new ICUs, developed triage protocols, re-designed team structures, and procured medication and equipment ahead of schedule.
• Cohesion: One team, one mission, one fight. It doesn’t matter if we work for the hospital or the school. It doesn’t matter which department or section we’re in. It doesn’t matter what degrees we list after our names, or if we list any at all. We rise together.
• Patience: We all make mistakes and nothing happens as quickly as we would like. Everyone’s working 24/7. Give everyone some slack.
• Leadership: School, department, hospital. Leadership with a vision. Leadership that cares. Leadership that follows through on commitments. Leadership that recognizes hard work and looks out for the well-being of our staff. How lucky are we?
• Science: Crisis breeds opportunity. Novel therapies, tests, protocols, and equipment. Collaborating across sections and departments, across the country and internationally. No time to wait.
• Safety: Ensuring everyone can protect themselves. We wouldn’t ask firefighters to enter burning buildings without protective gear, and we should never ask clinicians to expose themselves to a lethal pathogen without PPE. We need to enforce masking, social distancing, and clean workspaces. We can’t fight the virus without a healthy workforce.
• Listening: Hear the messages from the front-lines. What are they saying at the bedside? What works? What doesn’t? Listen to the real experts.
• Values: Patients first. Treat them like family. Contagion creates challenges, but it doesn’t override our duty to communicate, to care, and to comfort.
• Skepticism: Don’t abandon treatments that work just because someone wrote an editorial or tweeted an anecdote. Time-honored treatments—like low tidal volume ventilation—are time-honored for a reason. Read widely but think critically, especially now.
• Flexibility: New teams, new places, new teammates, new structures, new ways of teaching, new equipment, new ideas. How exciting! Go for it!
• Advocacy: When something isn’t right, speak up. Healthy organizations like ours embrace honest, thoughtful, constructive feedback. We share a common goal, but we can only fix problems we know about. Come forward, please.
• Vulnerability: Now more than ever we need to ramp up our responsibility to the poor and the marginalized. Not everyone can work remotely. Not everyone can socially distance. Not everyone has a mask. Not everyone has a home. We have neighbors being forced to choose between their health and a paycheck. The rate of infection in New Haven is much higher than in the surrounding towns. The vulnerable are suffering higher rates of severe illness, complications, and mortality. When the epidemic ends, let’s redouble our commitment to social justice, because that’s the only way to improve the health of the people we serve.
• Professionalism: We place the needs of our patients and community ahead of our own. We show up. We do what we’re asked to do, and then we do more. We’re proud to be called heroes, but deep down, we know this is our job. Our calling. Our life’s work.
• Compassion: Let’s look out for everyone who is struggling. Sometimes it’s obvious, but sometimes it’s invisible. Some people show it, but some people hide it. Either way, let’s care for one another.

So much has happened since the pandemic began. We’ve learned many essential lessons, and with each passing day, we’re getting more and more right. We deserve to be proud.

And now it’s time to get out into the sunshine. Tomorrow morning, I’m starting a week on NP15, in the COVID-ICU.

Mark