If you have heard anything about Yale Internal Medicine’s success combatting COVID-19 in its first wave, you may have wondered who led the department’s staffing plan. Though she would never tell you herself, everyone points to Lynn Tanoue, MD, MBA, vice chair, Clinical Affairs.
“Lynn drove a lot of the big ideas about what we needed to do and how,” said Aldo Peixoto, MD, professor of medicine (nephrology); and vice chair for Quality & Safety. After Yale Internal Medicine recognized the impending threat of COVID-19, watching as it spread in Italy, California, and New York, it was only a matter of weeks before the virus spread to New Haven.
“It was disaster planning,” said Peixoto. Department Chair Gary V. Desir, MD, Paul B. Beeson Professor of Medicine; chief, Internal Medicine; and vice provost for Faculty Development and Diversity; called together a small team, including Tanoue and Peixoto. And from the beginning, Tanoue’s leadership skills stood out.
“She has a unique leadership style,” said Naftali Kaminski, MD, Boehringer Ingelheim Pharmaceuticals, Inc. Professor of Medicine (Pulmonary); section chief, Pulmonary, Critical Care & Sleep Medicine (Yale-PCCSM). “It’s calm but vigilant. Her approach to the pandemic as I know it was, ‘We're going to be ready for the worst case scenario, but we're going make sure that we don't fall apart, that the failures are not the result of our disorganization.’”
And that is exactly what she did. One of the most remarkable changes she implemented was a reconfiguration of faculty personnel to ensure every COVID-19 patient seeking care received it.
“Lynn led the effort of asking other departments, such as anesthesiology and surgery, to lend us physicians,” said Desir. “These were physicians who already have intensive care unit training but are not in Internal Medicine. We re-organized our ICU team structures to allow them to work in the department. This was critical, because at one point we had 110 COVID-19 patients in the ICU. So we had to increase our teams from 6 to 11, and we didn't have all the people within medicine. This was a crucial part of our COVID-19 plan because if the ICU team is unable to provide care for patients requiring advanced care, then the whole system could fall apart, which is what happened in some hospitals.”
Tanoue’s personnel plan not only worked to alleviate the burden on Internal Medicine physicians, but was also a positive experience for visiting physicians from other departments. “We received many grateful emails,” said Kaminski. “Physicians shared that their rounds in the ICU were a very good experience, and that the organization and the support they received was excellent.”
Tanoue emphasized that the COVID response had to be a team effort. Tanoue worked with the Yale New Haven Hospital (YNHH) JDAT team in March 2020 to develop the ICU dashboard, which remains a critical component of the daily coordinated planning for the ICUs across YNHH. She and the MICU leadership team, including Jonathan Siner, MD, clinical chief in Yale-PCCSM; Shyoko Honiden, MD, MS; and Margaret Pisani, MD, MPH; continue to meet at least twice weekly, adjusting resources and planning as the pandemic has evolved over the past 13 months.
Even though the worst may be behind us, Tanoue’s work has not stopped. She has continued planning, first for the second wave of COVID-19, and now for the third. “Preparing for the second wave was more difficult,” said Kaminski. “Although the peak COVID-19 census was lower during the second wave, the total number of patients on the medicine teams was much greater because the wave lasted longer. In addition, we did not reduce non-COVID care during the second wave.”
Desir said that is because Internal Medicine could not delay community care again. So instead, Tanoue and others made contingency plans using only the resources available within Internal Medicine.
“We worked on that all summer,” said Kaminski. “Usually, we have six medical intensive care unit teams. So we made a plan for eight teams, and for 10—how they would be paid, where those physicians would come from. Lynn worked on this tirelessly all summer and even now those plans are changing all the time.”
Desir said that for third wave planning, he, Tom Donohue, MD, chief of the YNHH Medicine service line, and Will Cushing, PA-C, director of the Hospitalist program, Tanoue and others are working to support and increase the hospitalist team, those who work exclusively at YNHH. “We want to increase that number in order to minimize disruptions to our teaching and research programs,” said Desir.
And yet, all who were called into patient care during the first wave of COVID-19 received a new kind of education in watching Tanoue lead by example. “Lynn’s mentorship has had a monumental impact on how I approach my career and on the type of leader I aspire to be,” said Jennifer Possick, MD, associate professor; medical director, Winchester Center for Lung Disease; and director, Post-COVID Recovery Program. “She is the genuine article in all respects—as a physician, a leader, and a human being. As a mentor she has a light touch, allowing those around her to offer a dissenting point of view, try a different solution, or propose a new idea.”
The Department of Internal Medicine at Yale is among the nation's premier departments, bringing together an elite cadre of clinicians, investigators and educators in one of the world's top medical schools. To learn more, visit Internal Medicine.