Leadership Reflections from the Pandemic
The federal government and the Centers for Disease Control and Prevention had officially declared the virus a pandemic. Businesses were shutting down. Stay-at-home orders had been issued for Los Angeles County, and there was a run on groceries and household items. The next day, I met with my management team to lay the groundwork for what would be our virtual HIMS department (vHIMS).
With little time to execute in a complex environment, and very little information, we developed a three-phase plan to address the concurrent, mid-term, and long-term requirements that the organization was considering.
By March 20, we had developed the CoVid-19 Interventions & Logistics Plan for HIMS. With safety as the primary principle, we reassigned staff to work remotely, secured and distributed PPE, and physically distanced staff on-site. The plan included a detailed organization of our teams’ potential for remote work, and essential and prioritized services. We have been successful in meeting organizational service requirements and adjusting our services over the past year by integrating three key components: safety, communication, and collaboration.
In May 2020, we finalized our vHIMS Integration Plan, and I am excited that we are now executing the final stages of our work plan. What has emerged is a keen understanding of what our teams need to be successful and what I can do to support that effort.
There are ground rules, articulated in a telework policy that every staff member must sign, that includes being productive and engaged through communication with colleagues and managers. There are also schedules to ensure equity across teams for on-site work, because despite the level of electronic capabilities afforded to us, we still have work that must be completed on-site.
One example of a ground rule is the need to ensure that our patients can reach us by telephone, and we are converting our patient-facing customer service office to an on-site call center. This new call center will integrate new technologies that allow for more agents, remote answering, and a new website for integrated release requests, which will increase timely communication for our patients and third-party requests.
I’ve been reflecting on this past year a great deal, and part of my reflection includes my performance, communications, and humanity. When directors were asked to move their teams remote, most were already working in that capacity, so the transition was not as challenging. However, I had to consider how to move 97 staff and equipment to remote environments.
I knew it was going to be a heavy lift for my team, so I began the only way I knew how, by asking “What can I do to serve my team?” In other words, what do they need from me right now, tomorrow, and in the coming months? As the person to whom they turn for information and leadership during a time of uncertainty, what can I do to make the changes in their work life make sense?
Listen. I do a lot of listening. My team would say I do a lot of talking, too, and that’s fair because I do tend to think out loud. However, listening is also about creating space and opportunity for others to exchange ideas. We leveraged communication tools such as Microsoft Teams and Zoom to schedule routine huddles and check-ins with the managers and staff. In the beginning, we just talked about what we were going through, and that was enough. Then, I began to introduce one or two items per week to help drive our virtual services plan forward.
Influence. My organization, like many others, has seen a surge in the utilization of telehealth. This increase has led to opportunities to rethink the way we do things and has opened wider the view of the work my team does in the organization. For example, questions about the appropriateness of electronic signatures and which modality to use required productive influence and collaboration to help the organization identify new solutions. My influence is demonstrated by being seen—by being on-site just as staff are required to be on-site. I enjoy working remotely as much as anyone, but I believe that leadership is action, so ensuring equity for on-site time means that I also participate. A leaders’ influence is not just felt, it’s also seen in context.
Communicate. This is potentially the most critical component of good leadership, and an expectation of mine for those with whom I work. I have the advantage of working in an organization that is often at the forefront of cutting edge and community practice, so I shared bulletins and updates regularly with staff. We scheduled quick updates each month for several months to ensure that staff understood the mandates for PPE and physical distancing. I recall advising staff during a huddle to be mindful of getting their information from trusted sources. I think about that now and realize there was so much we didn’t know. As a leader, that’s part of the communication challenge during uncertain times: to share accurate (as much as possible), timely information and, most importantly, to explain the information in a way that makes sense and link the information to organization or department requirements.
Grow. Over the summer, we began to settle into new routines. While the pace of work and projects seemed to increase, my teams’ ability to come together and address issues more acutely was impressive. I want to recognize that, despite the pandemic, people grow and want to find their way through challenges, and that is how I see my role: equal parts navigator, challenger, and builder. I did more navigating in the beginning of the pandemic and see myself building more now, which is in my wheelhouse because I enjoy strategy and change. Challenging convention and disrupting thoughtfully is necessary, and I think these features are integrated in my professional practice.
When I think about this past year, I consider the hundreds of stories that I could tell of resilience, loss, and gratitude. When I asked for a small photo of the staff’s at-home work space (to ensure safety of PHI, etc.), I received pictures of the many simple ways they created to ensure they would be successful, such as using card tables and drapes as partitions. Staff sent me notes of gratitude, and I was surprised because I was the one who was truly grateful that they would go to those lengths and work so hard despite the challenges all around them. As if the pandemic weren’t enough, in June, a beloved staff member passed away. A kind and loving human being, he was a CCS professional who worked tirelessly to improve processes and encourage his team.
This was a hard time for my staff, and I couldn’t imagine what to say or how to comfort them, so we took some time to grieve together. I also can’t forget the unsung heroes of our department, our concurrent scanning team, whose job it is to round the units of both hospitals and scan documents seven days a week. They see and hear what many of us only imagine, and I appreciate them every day.
I have been asked what stands out the most about leading during the pandemic, and what comes to mind is being okay with ambiguity. Every day of the past ten months have had a fair share of uncertainty and ambiguity, and I have learned to accept that and do my best to plan, be available to listen, and make time to reflect and grow. All the skills that inform my leadership practice have been tested, and each day I am grateful to have the opportunity to serve others in this profession.
Maria Caban Alizondo (mcalizondo@mednet.ucla.edu) is the director of health information management services for UCLA Health System in Los Angeles.