Leadership During the Covid-19 Pandemic

A Survey of your Experiences as a Leader during the Covid-19 Pandemic

Dear Colleague,

We invite you to participate in a research study about leadership in healthcare during the covid-19 pandemic, by answering a survey. This survey is only for those with a formal leadership role in healthcare, so please answer these questions only if you have a job title that includes words such as 'director' or 'manager' or 'chief' or 'head' or 'supervisor' or other similar leadership term. This study has been approved by the Institutional Review Board of Baylor College of Medicine, Houston, TX.

Answering this survey should only take about twelve minutes of your time. By answering this survey, you are giving consent to participate in this research. Participation in this survey is purely voluntary. If you do not wish to participate you can ignore this invitation. We do not foresee any risks in participation. Responding to this survey will not affect your job performance. All individual responses in this survey will be anonymous, and data will only be reported in aggregate. Through this survey we are trying to identify the challenges and barriers leaders such as you experienced during the pandemic, the personal effects you experienced, and the methods you used to face the challenges and perform self-care. We are also trying to identify important lessons of leadership, especially crisis leadership, learned by you during the pandemic. Your answers will generate knowledge that will help educate leaders, and help them be prepared for future crises, or for a worsening of the current pandemic.

The results of this survey will be published in a peer-reviewed medical journal. We are also happy to directly send you the results prior to publication, if you provide your email. If you have questions about this research, please contact Dr. K. S. Gautham at gksuresh@bcm.edu.

We thank you for sparing your valuable time if you do decide to participate in this survey.

To start answering this survey, please proceed to the first question below.

Sincerely,

K. S. Gautham, MD

Professor of Pediatrics and Chief of Neonatology

Baylor College of Medicine, Houston, TX

Lakshmi Katakam, MD

Associate Professor of Pediatrics, Baylor College of Medicine

NICU Medical Director, Texas Childrens Hospital, Houston, TX

Ryan McAdams, MD

Chief of Neonatology, Department of Pediatrics

University of Wisconsin School of Medicine and Public Health

Madison, WI

Question Title

* 1. Please indicate which of the following challenges you personally encountered as a leader during the covid-19 pandemic, or witnessed other leader colleagues encounter. Select all that apply:

Rapidly learning emerging new information about covid-19

Creating new guidelines or policies for care of suspected or confirmed covid-19 patients

Educating and updating unit staff about the new guidelines or policies, and revisions

Updating the new guidelines, protocols or policies as new information emerged, and educating staff about these updates

Implementing new policies for laboratory testing for suspected covid-19, or performing surveillance lab testing

Implementing new policies about universal mask wearing in the unit

Implementing new question-based and temperature-based screening at entry to hospital or building

Reconciling unit-specific policies with policies developed in the department, hospital, or health system

Finding locations in which to place patients with suspected or confirmed covid-19 infection

Ensuring adequate supply of personal protective equipment for unit personnel

Reorganizing patient care rounds to prevent crowding and ensure social distancing

Reorganizing other team activities such as hand-offs, huddles and morning report

Reorganizing teaching conferences

Shutting down research activities

Ensuring that unit personnel were taking all precautions to avoid getting infected with covid-19

Ensuring that unit personnel at high-risk of morbidity and mortality from covid-19 infection received special precautions

Providing psychosocial support to unit personnel to address their fear, anxiety and distress

Ensuring that unit staffing by physicians, RNs, RTs and other disciplines would be adequate if there were absences due to quarantine or illness

Ensuring that unit personnel felt socially connected in spite of social (physical) distancing

Ensuring that faculty and fellows were academically productive (with research, publications, teaching and other scholarly activity) when not providing clinical care

Implementing new policies about family visitation

Responding to the distress and displeasure of family members about new visitation policies

Managing exposure of unit personnel are exposed to a person with confirmed covid-19 infection

Managing exposure of patient or the patient's family member to a person with confirmed covid-19 infection

Communicating with the media or the public

Deploying unit personnel to other units (such as an adult intensive care unit)

Creating new work schedules to minimize covid-19 exposure risks and still meet workload demands

Educating unit or department personnel to use video conferencing platforms for meetings and educational purposes

Implementing and adapting telemedicine for conducting unit or department rounds

Other (please specify)

Question Title

* 2. Please indicate the specific barriers that you personally encountered as a leader, or witnessed other leader colleagues encounter during the covid-19 pandemic. Select all that apply:

Inability to obtain covid-19 testing for unit or department personnel even when required

Poor communication from leaders of the department or hospital or institution

Hospital policies created by Infection Control or hospital/institutional leaders not considering the special needs of the patients or setting or physical layout of your unit

Incident command center members imposing 'top-down' policies across entire institution in an authoritarian manner

Inability to get necessary unit personnel fit-tested for N95 masks

Lack of information about exact quantities of PPE available in hospital and how long these supplies would last

Inconsistent recommendations from employee health or occupational health after employee exposure to a person with confirmed covid-19 infection

Adoption of new policies or practices without consulting or informing unit leaders by affiliated specialties such as obstetrics, or Emergency Department, or PICU

Reluctance of staff to work in the unit or department due to concerns about becoming infected with covid-19

Reluctance of staff or faculty to modify their schedules to work in the unit due to other obligations (e.g., research, teaching, vacation)

Uncertainty about whether or not colleagues were utilizing their at-home work time in an productive manner

Other (please specify)

Question Title

* 3. Please indicate some specific methods that you used successfully to handle the challenges and barriers listed above during the covid-19 pandemic, or witnessed other leader colleagues use. Select all that apply:

Periodic phone or video conferencing calls with some or all unit or department personnel

Special education or orientation sessions for unit personnel about new guidelines, protocols, or policies, and about changes to these documents

Periodic email updates to unit personnel about guidelines, protocols or policies, and about changes to these documents

Use of mental health professionals to provide psycho-social support to unit personnel

Periodic group review with unit personnel of emerging data and literature related to covid-19

Individual check-ins with unit personnel by unit or department leaders

Adoption and adaptation of technology for virtual interaction by unit personnel (for teaching, rounds, handoffs and other activities)

Identification and linking to resources for childcare

Web-based easy-to-acesss repository of latest guidelines, protocols and policies

Simulations to identify weaknesses in system of care and to train personnel to be prepared for an encounter with a suspected or confirmed covid-19 patient

Procurement of PPE specifically for unit personnel using funds or leader's personal funds

Acceptance of hand-sewn cloth masks provided by volunteers in community

Modified clinical service pattern or avoidance of clinical service for individuals at high-risk of morbidity and mortality from covid-19 infection

Provision of grocery-shopping services for unit or department personnel

Provision of financial advice or financial assistance for unit personnel

Education sessions for family members of unit personnel

Granting clock extensions for faculty with upcoming promotions

Providing resources to promote wellness and humor to improve morale

Other (please specify)

Question Title

* 4. Please indicate what personal effects you and your leader colleagues experienced during the covid-19 pandemic. Select all that apply:

Sense of being overwhelmed from the demands of leading during the pandemic

Fear of personally getting infected and suffering from serious illness or death

Fear of family members or loved ones getting infected and suffering from serious illness or death

Worry about unit or department personnel getting infected

Worry about unit or department patients getting infected

Physical exhaustion

Sense of inspiration and being called to serve a higher purpose

Sense of feeling energized

Distress from learning from the media or news or social media about the adverse working conditions and hazards healthcare workers in other institutions and countries were suffering through

Frustration from lack of or poor communication from leaders of the hospital or institution (above the level of your unit or department )

Frustration from difficulties with communication with colleagues (e.g., discouragement with email or video conferencing methods)

Sense of being overwhelmed by the volume of email and video conferencing meetings

Frustration with not everyone having a team-player approach

Sense of burden to fill in scheduling needs

Worry about unit or department personnel getting requested to help care for patients outside their comfort zone (e.g., older children or adults)

Sadness or guilt that colleagues in other geographical locations were experiencing surges in covid-19 patients

Gratitude that your colleagues came together as a team

Other (please specify)

Question Title

* 5. Please indicate what methods of self-care you and your leader colleagues used during the covid-19 pandemic, based on your personal experience and that of your leader colleagues. Select all that apply:

Regular physical exercise

Meditation

Journalling or reflective writing or therapeutic writing

Listening to or playing music

Periodic conversations with a mentor or advisor

Periodic discussions with other leaders, either in person or by phone or virtually

Counseling by a mental health professional

Watching movies or streaming shows

Bought or adopted a pet

Baked or made new recipes

Spent time with loved ones

Prayer, either by myself or with others

Participation in discussions or readings with religious groups

Other (please specify)

Question Title

* 6. In your unit, compared to the pre-pandemic period, there was less attention and effort focused on other (non-covid) quality and safety projects during the covid-19 pandemic period. Please agree or disagree:

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Question Title

* 7. Reflecting on your experience with leading during the pandemic, what lessons or principles did you learn, or gain insight into, about successful leadership during a pandemic?

Question Title

* 8. Under the 'new-normal' of work going forward, which of the following areas are you changing significantly in your unit or department? Please select all that apply

Teaching sessions

Morning report

Huddles

Daily patient rounds

Hand-offs

Night rounds

Family meetings

Family centered care/Family visitation

Working from home

Ensuring academic productivity

Personal / family needs

Mental wellness, psychosocial support

Staffing by physicians

Staffing by nurse practitioners

Staffing by nurses

Staffing by respiratory therapists

Staffing by personnel from other disciplines

Continuing precautions to prevent unit or department personnel from getting infected with covid-19 in hospital or outside hospital

Telemedicine

Vacation requests

Travelling to education conferences