COVID‐19: A NYC Department Chair’s Perspective

When I was interviewing for chair positions 3 years ago, a few chair colleagues across the country warned me this job was a lonely one. I understood as a chair you cannot maintain work friendships like those I once cherished, that people see and treat you differently because you are their boss, that due to the importance of privacy conversations are sometimes limited to maintain confidentiality, and that you are ultimately responsible for factors that may be beyond your control. My first 2 years as chair in a new organization, in a new city, were filled with extensive listening, learning, challenges, and accomplishments: starting a new academic department at a renowned institution, hiring 47 new faculty members and 37 administrative staff, adding a fourth clinical site, expanding the educational and research missions. Then, just a few weeks after what then felt like a monumental change, the implementation of a new electronic health record, COVID‐19 emerged.

COVID‐19 has been a crisis like no other, stretching all of us in ways we never before imagined. As an emergency physician for over 20 years, I experienced a new first as I witnessed the heightened level of uncertainty and anxiety which surrounds this illness, much of it due to the many early unknowns of COVID‐19 in its presentation and disease progression. We spent countless hours in discussion and preparation regarding staffing, resources, alternate care areas, and wellness, while guidelines and recommendations concerning personal protective equipment (PPE), testing, and disease management were changing daily, even hourly. The numbers of severely ill patients rose dramatically over a few weeks to our peak of COVID‐19, with over 20 patients being intubated daily at our university site and more end‐of‐life discussions and emergency department deaths than some may see in a career span.

After spending the weekend with my family in mid‐March, a sore throat, myalgias, cough, and shortness of breath led to my self‐quarantine. As a New York City chair in the epicenter of this crisis, I was challenged by the pandemic and the new stresses it created in my role: being able to adequately advocate for resources needed; maintaining the safety and well‐being of our faculty, trainees, and staff; and sustaining the 16‐ to 20‐hour work days that were just not long enough to address everything requiring attention. I was feeling significant guilt of being sick and unable to be present on site, round in the ED, and look into the eyes of our team members to try and assess how they were doing behind their masks and PPE. The proverbial weight of this stress was compounded by the weight of COVID‐19 symptoms I was experiencing. During my brief hospitalization, one of my colleagues texted me (and then my husband) threatening to come take my phone away so that I could take a day off and rest. Despite the frequent vital sign checks, I slept better on the medicine ward than I had in weeks. As I have been reflecting on some of the key leadership skills I have valued during this crisis, like all things, I find they are similar to the ones we rely upon during normal times.

EMPATHIC LISTENING

During this time of incredible uncertainty, we established frequent departmental virtual huddles for two‐way communication providing information while also encouraging feedback and suggestions in a safe environment. As fears increased related to acuity and the projected numbers of intubated patients, we heard from our group that adding the number of available institutional ventilators to our daily e‐mail communications would help to alleviate some anxiety and ambiguity. As we listened to the team’s frustration with their inability to eat and drink due to PPE and infection prevention measures, we converted a conference room into a “clean” lounge stocked with drinks, snacks, and daily donated meals. It was essential to not only think about our patients, but the people who are taking care of them. We brought together the talent of our faculty and administrative teams to provide a supportive environment in which they could continue to thrive and do their amazing work.

TRUST

To be effective, especially during a crisis, leaders need to both trust and be trusted by their team. While building trust may take some time, the inability to trust others as a leader can be paralyzing as no one can do everything on their own. As chair, I had to trust my team to give their best and execute their own action plans. This allowed me to function and have the capacity to guide, to provide reassurance, and to resolve conflicts when they arose.

FLEXIBILITY

In our clinical work fighting COVID‐19 there was a fluidity necessitating frequent change. To innovate, be creative, and consider the situation through a number of mental models, we had to be flexible. Our telehealth team pushed the envelope with limited resources and developed a new nurse‐free model of care using our virtual providers. Our operations team found various alternate care spaces working with hospital facilities’ personnel adding monitoring and oxygen in new environments. We were proactive and willing to invent new solutions for our patients and staff.

COLLABORATION

COVID‐19 fostered working together in an unprecedented fashion and speed with other departments, services, and hospitals. This included creating a greatly needed and utilized ED‐based palliative care service, partnering with our health system’s sister hospitals to develop system‐wide evidence‐based guidelines, and developing a program to safely discharge patients with mild hypoxia. We could not have been as successful without collaboration. We learned that it is more effective to overcollaborate rather than to outcompete when in a crisis.

WELLNESS

I worry for our community. We have been stricken by so much tragedy, anxiety, and trauma. We are all in far greater need of mental health care, support, and wellness resources. We know the dangers of our profession at baseline on our staff, but in times of crisis this is heightened. All of us need to check in with those around us both in our professional and personal lives. The new normal of masks that cover our expressions, social distancing, and video meetings has changed our human interactions. We owe it to each other to ask how our colleagues are coping and processing their own emotions and not become accustomed to our new physically separate world.

As a “lonely” chair in isolation for weeks, I witnessed so many remarkable acts of kindness personally (well wishes and delivery of home‐cooked meals and groceries to my apartment) as well as in general (nightly 7 pm cheering of New Yorkers with cow bells and all, countless donations of food and PPE, a hair stylist’s courage donating his services to allow our physicians to bring their best selves to work, chairs of other departments working 12‐hour shifts in our department to help). There has been a new‐found level of collegiality born from coming together in a time of crisis, working in someone else’s shoes, and rising up to accomplish new things together. I ask and hope that we continue these acts of kindness and collaboration not only during this prolonged crisis, but also after. Continued acts of kindness and empathy will be needed as we enter a new phase of living with the downstream impact of medical and mental health outcomes for both our patients and our colleagues. We will need to be stronger for longer. Our collective strength, collaboration, and kindness unified us through this first phase of COVID‐19 and will undoubtedly allow us to succeed in navigating the phases ahead.

We are changed. COVID‐19 has changed me personally and as a leader. It has pushed emergency medicine to do what we do best, rapidly assessing and responding to crisis. We have learned lessons, demonstrated the tenacity of our specialty, mourned together, collaborated across departments, and showered kindness on one another. The future will require continued navigation of new challenges, and our experiences through this crisis will allow us to prepare for success as we move forward.

AEM Education and Training 2020;4:187–189