“Adversity doesn't build character, it reveals it.” James Lane Allen
The COVID-19 pandemic is a crisis unlike any we have faced before. Unlike a fire, a flood, or a shooting, the coronavirus we face is invisible and insidious. In most disasters, people come together and lean on one another for strength and support. In this crisis, we are told to do the exact opposite; we are physically distanced and vulnerable to remaining out of touch with our colleagues, friends, families, and communities, both literally and figuratively. As leaders, it is our job to direct our departments through these troubling and unpredictable times. Yet most of us have never experienced a crisis of this magnitude. By studying this crisis and the world around me, I have come to appreciate more than ever the importance of effective leadership. There are many facets to a strong leader—decisive action, steadiness amidst chaos, adaptability and resilience, logistical and tactical expertise, creativity, clear communication, teamwork, strategic thinking, and reflective learning—and the phases of this pandemic have called upon all of them.
Decisive Action
Very early on, this pandemic was a crisis occurring on lands far away from home. It affected many in the department merely in the form of inconveniences associated with cancelled international meetings, concerns over reimbursement for hotels and airline tickets, and worries about whether academic productivity for canceled events would still be recognized at year-end evaluations.
Everything changed, however, as the viral pandemic reached the United States and our hospitals. Suddenly the number of cases was growing uncontrollably. One of the first steps in my department was to create a COVID leadership team to meet virtually on a daily basis to direct departmental functioning. This team consisted of key department leaders, including physician, technical, and administrative leadership. All department decisions were funneled through this leadership team, and additional teams were created to handle specific tasks.
We decided quickly to close the reading rooms to non-departmental staff. We sent medical students and reading room assistants home. Electronic communications and signage directed referring clinicians to phone for virtual consults, and technologists were asked to call the reading rooms for discussions with the radiologists rather than coming in person. Despite fears that other departments would resist these changes, there was little reaction outside the Radiology department. These early measures were swift and effective.
Steadiness Amidst Chaos
On the ground, in an effort to provide social distancing, we deployed many of the radiologists to isolated workstations and facilities previously used only occasionally. In addition, we purchased several home workstations and moved reading room workstations into physician offices. Some radiologists in the department nevertheless expressed considerable concerns for their health and exposure and worried that sharing workstations was unsafe. The panic was real, and a few faculty members initiated discussions on developing living wills and trusts. Others dismissed these concerns, citing the numbers of physicians involved in direct care of COVID-19 patients. Due to the large number of radiologists and limited IT resources, it was not possible to designate individual workstations to all radiologists. But it is important to remember that everyone views the crisis through a different lens. Recognizing and respecting the fears of concerned faculty and mitigating those concerns, where possible, went a long way toward eventual comfort with our working conditions—in particular, listening with empathy, sharing genuine concern, and emphasizing our loyalty and commitment to one another. Calm, reasonable, and repeated reassurance was more important than antibacterial wipes in setting the tone of these discussions. In time, this urgent phase passed, a new workflow was established, and concerns eased.
Adaptability and Logistical Expertise
The next big task of the pandemic crisis involved canceling a large number of nonurgent medical imaging studies based upon Centers for Disease Control and Prevention, American College of Radiology guidelines and orders from the Governor of the State of Ohio. Creating concrete plans was challenging due to the lack of complete information. How strictly do we enforce this mandate and for how long? We were tackling a problem without full grasp of its magnitude or duration. Leadership adaptability and logistical expertise were important as we developed processes and procedures. We divided faculty and trainees into rotating teams of clinical and stay-at-home duties. An arbitrary reentry date of May 4 was chosen, and section chiefs tasked their teams with reviewing scheduled cases and prioritizing them as urgent or deferrable. This work required investigating the electronic health record for adequate information, speaking with the referring physicians and patients, creating templates to document the information, writing scripts to place communications in the medical record, and developing spreadsheets to capture the enormous amount of information collected.
Compared to coordinating the clinical efforts, managing the research efforts of the department was only a minor leadership challenge. The College of Medicine and Clinical Trials office suspended all research early on and we focused primarily on keeping our research staff employed and productive. Fortunately, many researchers were able to continue work from home, albeit not without some early IT challenges.
Creativity
Fulfilling the education mission of the department required a great amount of leadership oversight. To continue educating medical students remotely, we developed an entirely new curriculum that could be delivered online. So too, residents in teams rotated between in-house clinical work and online learning. Organizing conferences virtually was relatively easy as most radiologists are comfortable with electronic lectures. In fact, a silver lining in this crisis has been the creativity born of necessity. To keep the formats interesting, connected, and dynamic, several faculty members created unique and innovative training modules such as “scavenger hunts” with daily clues sent to residents. Some faculty and residents struggled with the demands of online learning and questioned its value, but the quality of these programs and innovation of our faculty continues to impress me.
Clear Communication
Most of us do not have experience leading in a crisis of this magnitude, and it is difficult to chart the right course in such unpredictable conditions. But perhaps more than ever, frequent, meaningful communication is essential to maintaining a sense of community and purpose. In our department, I send a daily email with updates and minutes from the daily leadership COVID Call and hold virtual faculty meetings every 2 weeks. I also send a weekly wrap-up email to the department every Friday. Of course, there is a fine line between too many and too few communications and meetings. Finding that balance offers a chance to distill and concentrate the quality of communications, and to acknowledge the all-too-frequent repetitiveness that inflates our inboxes.
Likewise, for meetings, it is important to schedule only those that are focused, purposeful, and organized. In a climate of rapid change, it is more vital than ever to keep participants from talking over one another or drifting from the daily tasks at hand, especially when there is emotional turmoil. Good leaders provide enough information to keep faculty informed and grounded, while importantly guiding the dialogue from discussing the crisis itself to discussing how to handle the crisis.
Teamwork
Eventually, we ended up with over 30,000 deferred cases that needed to be rescheduled and fit into already overbooked imaging schedules throughout the health system. Again, we formed small teams of physicians, technologists, schedulers, and administrators to review the schedules, prioritize cases, and communicate plans to re-open our imaging centers and schedule patients. We ensured that reentry would be safe through COVID checks at facility entry points, social distancing in radiology common areas, and equipment and facility cleaning. Coordinating these efforts required identifying those most equipped to carry out each task and empowering everyone to contribute as a team.
Strategic Thinking and Reflective Learning
Having responded in all of these ways to the short-term challenges, today we find ourselves considering the road ahead and reimagining the future state of our department. It is clear that many of our policies and procedures will need to evolve as we come through the COVID-19 pandemic, but it is less clear how that will take place. With concerns over a second surge this fall, we must ensure that our departments are prepared.
This work requires a shift from defense to offense, from reactivity to proactivity. We already have new priorities and soon will have new habits. When the crisis recedes and we look back, we must examine what we see. It would be a wasted opportunity to revert to previous operations unreflectively. Rather, we need innovative ways to conduct our work more effectively.
For example, my department has slowly come to recognize the value of working from home. Many faculty members express renewed interest and even more emphasis on at-work childcare solutions. The issues of well-being and emotional balance have risen to the forefront of many discussions in the department. I also believe we need to re-examine the need for so many meetings in the future. Certainly, the value of face-to-face meetings is well established; decisions get made faster and issues are better resolved when we are all at the same table. But more often than not, meetings are held only because they are routinely scheduled, and not because there are specific tasks that need to be tackled.
Finally, although social distancing has proven challenging, it has also demonstrated to me the value of solitude and the opportunity to think quietly, something that we often miss amidst the bustle of our busy days. The work of managing a large, productive academic department during such upheaval is demanding and exhausting, and yet amidst occasional pauses I have found the work equally empowering due to clarified purpose.
The pandemic is certainly not over and the challenges of leading a department in the post-COVID era have just begun. We have substantial financial burdens, and faculty are being asked to work harder even as they are being informed of decreased salaries. But as we recoup, it is more important than ever to set the tone of steadfastness and to practice mindful and reflective leadership. As we navigate the recovery and reentry process, my department will review what worked and what did not. I hope to create an environment in which we will continue to be resilient, creative, strategic, and reflective. Because ultimately, the qualities of good leaders are both revealed and built during adversity, and I am hopeful that the adversity we face together will make us, together, stronger.