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‘It Mattered That I Was There’

A healthcare leader's lessons from COVID-19’s front lines
July 2021

When we spoke early in 2021 with Laureen Hill, M.D., who, as group senior vice president and chief operating officer, leads day-to-day hospital operations at New York-Presbyterian/Columbia University Irving Medical Center (NYP/Columbia), she and her team were managing yet another unique inflection point in the coronavirus pandemic. As cases of COVID-19 once again were spiking in the New York region and the country, the academic medical center was beginning its herculean efforts to vaccinate the population against the virus.

More than a year into the pandemic, Dr. Hill was still leaning on lessons she and her team learned during the initial shutdown in March 2020: the importance of communication and connection and the rewarding feeling of having a sense of purpose in what you do. Going into the hospital every day and speaking with staff in person whenever possible, she continued to seek an environment where teams aligned with their sense of purpose as they work on the front lines of an unprecedented crisis.

“I’m trying to tap into something deeper and to create something more sustainable: that we find purpose and meaning in our work,” Hill said. “I tell them: ‘Wouldn’t it be wonderful if, when you go home at the end of a really difficult day, you say, "Wow, that was a tough day, but it was a great day, and it mattered that I was there"?'"

Several themes resonated throughout our conversation with Dr. Hill, issues that, while in many ways unique to her hospital experience during COVID-19, will resonate for other leaders in healthcare and beyond as they seek to lead during challenging times.

Health systems go through constant preparations for emergencies and worst-case scenarios, and that work was crucial in early efforts to fight COVID-19. At the same time, it was impossible to fully prepare for exactly what this pandemic presented: a confounding, highly contagious and deadly respiratory disease, a fractured government response, and an economic shutdown and corresponding crisis.

Dr. Hill said that situational awareness — based on skills learned earlier in her career in high-stakes, fast-paced clinical settings — helped prepare her to lead a team as the virus shut down New York City, and front-line workers faced a nearly relentless, moment-to-moment fight against COVID-19. And this situational awareness helped Dr. Hill and her team with developing critical innovations in real-time.

I was struck by how much people see. It’s not only what you say, it’s what you do. People see it.

For example, as the hospital faced critical shortages of personal protective equipment (PPE), providers were having to change PPE every time a medication had to be reprogrammed in the patient's room. In reimagining the process to maximize their resources, the teams added extension tubing that placed the pumps in the hallways, allowing medication to be changed without requiring new PPE.

“In the operating room and the intensive care unit, and all of my years training in simulators and learning crisis resource management — you learn that you have to understand your environment and what resources you have,” Dr. Hill said.

A setting of effective innovation, however, required Dr. Hill and her teams to find pockets of quiet for reflection, especially in the midst of the crisis. Dr. Hill told us it was critical for her team to find time to pause, ponder the issues and seek creative solutions quickly — putting aside the feeling of hyper-connectedness that can dominate and create burnout during extremely stressful events.

“It is all about creating the time and space for people to think, and continuing to practice that so that we can remain effective and nimble and agile,” Dr. Hill said.

Every day for 15 weeks, Dr. Hill came into the hospital as she and her staff battled the COVID-19 crisis. Her presence, she said, was critical for her understanding of the highly fluid situation on the ground and the need to develop solutions for issues as they arose.

I’m trying to tap into something deeper and to create something more sustainable: that we find purpose and meaning in our work.

She also learned quickly that her presence as a hospital leader on site in the midst of a pandemic was noticed by clinical and non-clinical essential workers who kept the hospital running through the first months of the pandemic.

“I was able to see the effect my presence had on the teams,” Dr. Hill said. “For example, the security guards, so many of them came to me last summer and thanked me. It was frightening for people, especially those without a lot of medical knowledge or background. And one of them said, ‘You know, Doc, we came in because we knew you were here.’ I was struck by how much people see. It’s not only what you say, it’s what you do. People see it. That really made an impression on me.”

To call New York City’s COVID-19 crisis an “all-hands-on-deck experience” for healthcare organizations like NYP/Columbia is an understatement. To shore up their approach, Dr. Hill and her leadership team had to identify talent well beyond existing team structures to ensure that they could manage the pandemic.

Dr. Hill looked to a wide-ranging, talented pool of people and then reoriented how they were assembled into teams. Dr. Hill also adjusted her management style to ensure they met fast-arriving challenges. Leadership met daily and everyone was empowered to share thoughts and opinions and have a hand in decision-making. This helped create a sense of buy-in — everyone was involved in critical decisions — and also helped expedite the process.

In the end, she had a team that was able to adjust as the COVID-19 crisis evolved, with new advances in treatment, new surges in the fall and winter, and the rollout of the vaccine to hospital staff at the end of 2020 and to patients at the start of 2021.

“The goal was understanding all of the resources available to me and assembling teams in new ways with new inputs, new insights, different talent sets and different interests,” she said. “Then it was framing the questions and creating guardrails for the team. We have created a safe space where we can throw out ideas, and we can reject ideas, with no offense taken. This talented pool of people can solve problems in unique ways…and it is a team I will want to carry with me, well after the crisis is over.”

If there was one lesson Dr. Hill learned about leading through the COVID-19 crisis, then and now, it was about communication. “When you feel like you’ve communicated effectively, communicate some more, because there can never be too much. Maybe you figured out the great solution to a complex problem, but that is only good when the people around you understand it and can help you execute on it.”

We have created a safe space where we can throw out ideas, and we can reject ideas, with no offense taken.

The pandemic created unique barriers to communication. While emails and videos were important tools, they were no substitute for in-person communication. Dr. Hill and her teams sought ways to convene whenever possible, even amid social distancing protocols, to communicate important information beyond email.

She also used team meetings to allow people to get together and form connections. “In these meetings, I deliver some information, but I really allow the time for dialogue and connecting with the team,” she said. “I have found that to be the most effective way to communicate about those things that really matter.”

Myriad challenges remain: the continued COVID-19 infections and variants, the financial fallout for hospitals and health systems, the continued vaccination deployment, and the overall emotional toll.

As a physician, the goal is to deliver safe and effective care for patients. Now a healthcare leader who no longer works at the bedside, Dr. Hill says that the best way she can help meet that goal is to create a joyful work environment for the people who work for and with her.

Ultimately, Dr. Hill said, she wants to make sure her employees can link to the purpose behind their work. She aims to connect with every team member as often as possible, having authentic conversations based on commitment and concern. She is also doing resilience training and hosting these workshops with her own leadership team, with the goal of creating and sustaining a high-functioning, resilient team

“To speak quite frankly, people are tired, exhausted and burnt out,” Dr. Hill said. “We cannot always control our circumstances, but how we perceive and respond to our circumstances is within our control. It really is around educating and training the team about how to tap into that awareness, especially during moments that feel so overwhelming.”