Think about the greatest challenge you’ve had to overcome in your life. What made it the most difficult? What emotions come to mind when you reflect on it? How did you keep going?
In February 2020, the Lexington VA Health Care System (LVAHCS) assembled our Incident Command for the first time in response to the COVID-19 Pandemic. Two years later, we are still meeting to ensure things are running smoothly. I cannot articulate clearly enough the strain that has on a system or organization, especially a health care system. I could write thousands of words on any one topic: resource management, supply chain, contingency planning, infrastructure, process changes and flow, telehealth, access to care, leadership, surge plans, communication (and lack thereof). There have been hundreds of worthwhile articles written by folks on all these topics over the last two years and while I don’t consider myself an expert, I’d like to share my experience.
In March 2020, the CEO of our health care system (HCS) asked me to lead an offset of Incident Command in response to the COVID-19 Pandemic. The mission was clear, “to ensure that we maintain outpatient operations throughout the pandemic.” To put this in perspective, our HCS has over 750,000 outpatient encounters per fiscal year. It was all I could do to keep my breakfast down despite my 15 years of experience in healthcare at my organization. Even with a clear mission, the goal was overwhelming.
Organizing my team
I quickly assembled a team of leaders in our organization. Some had official leadership titles, but others did not. I was intentional in selecting those in our organization who I knew and that I could trust. From clinical service chiefs, and administrative leaders, to receptionist in the clinics. Each were a subject matter expert in their role within the facility and each had the ability to influence others.
Understanding why we were there
Despite what was happening around us, our facility has a clear governing mission – we Improve the lives of veterans.
Coronavirus was unknown; however, we also knew that heart attacks, strokes, etc. are still going to happen. We needed to find a way to meet our governing mission while dealing with these added challenges.
Getting to work was our next step
We knew our emergency and in-patient resources could quickly become strained, so we got to work prioritizing preventative care at every opportunity. Our job quickly became keeping veterans out of inpatient status and the emergency department. We also made plans to maintain outpatient care with the resources we had for as long as we could; however, we also built tiered plans based on our community prevalence/needs. Hope for the best; plan for the worst.
Over the course of the two years, outpatient operations had hundreds of plan-do-study-act (PDSA) cycles. Tackling new issues each week, we implemented our tiered level plans and converted face-to-face care to telehealth and then back to 100% face-to-face. We were one of the first sites in our national HCS to implement COVID-19 testing and provided testing for other sites. We were also one of the first sites in our national HCS to implement COVID-19 vaccinations and saw patients from over 15 states travel to us to be vaccinated.
But most importantly, we met our mission. When our sister facilities curtailed services, we didn’t. When their acute care resources were exhausted, ours weren’t. After the surges we didn’t have thousands of backlogged outpatient appointments. We persevered because our focus was our governing mission.
We were successful because of our team and our focus on the mission.
The main point that I want to convey is that “I” didn’t do anything alone. It sounds cliché, but the successes we had were because of the people that I am fortunate to work with every day. We are all bought in to our mission. The best advice that I can ever provide is that you need people in your life, both professionally and personally. The time you invest in building relationships with people will have a ten-fold return every time.
We are still not out of this pandemic and no one can predict the future. However, I find solace in the fact that I have wonderful people at my side. There isn’t any challenge that we can’t meet together.
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By: Phil Branham, director, clinical operations, Lexington VA Health Care System