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  • Leadership in Times of Crisis

    Author: David J. Langer, MD

    In March of 2020, the world changed as the coronavirus descended upon New York City. As the effects of the pandemic escalated, we were confronted with a world that felt like a military battle, yet with the goal to save not kill. Initially as a neurosurgeon, I felt impotent, without a role or a clear way to contribute. We had created an incredible neurosurgical group over the prior years. A group talented and ambitious, but also collaborative and empathetic. As I witnessed the change of landscape of New York City, I was deeply affected by what was being lost; fear for my family, our department, my income and my career. However as the days passed, I realized that while the world had changed nearly overnight, I hadn’t. I had trained tirelessly, helped to create a wonderful collaborative department culture, yet felt lost without clarity and purpose. As we prepared for the onslaught of our unseen enemy, we furloughed our department. Within days the hallways had emptied, our cases cancelled and I was alone with my thoughts.

    David Brooks wrote an op-ed piece for the April 16, 2020 edition of the New York Times that deeply resonated with me as I thought about what we had accomplished during this difficult time. His essay entitled “The Age of Coddling Is Over,” lamented the loss of rigor and hardship in most of academia and how it has impacted a generation of our youth. However, he points out that unlike the arts, scientific rigor has been maintained and he reflected upon the intrinsic “hardness” of medical school. He goes on to write how the maxim of excellence is not action, it’s a habit. “Tenacity is not a spontaneous flowering of good character. It’s what you are trained to do. It manifests not in those whose training spared them hardship but in those whose training embraced hardship and taught students to deal with it.” Thinking back to our response, I realized it was this essential element of training that drove my decision-making. Our training gave us a role to play, though we had to identify what that role was in a world of chaos.

    Leadership is both a noun and a verb. One must first identify the noun part in oneself by realizing they have it and then work to affect the people around them to make the whole better. The chaos of the hospital was rapidly escalating. Our group had little if any role in the conflict as we were told to stay home, avoid getting infected, and wait to be “redeployed.” Chaos is in the eyes of the beholder, however, and where there is chaos there is opportunity. A crisis affords the leader a clean slate to reimagine him or herself, innovate and take risks to impact the greater good. Action, when planned and thought through, is far greater than reaction. Identifying ways for our team to contribute became a new focus.

    I began to create a plan in my mind that would allow our team to accomplish two things—one immediate and one more long term. I recognized there were going to be two distinct components to our role leading not only in the immediate crisis but also leading long-term change. Chaos required calmness, self-awareness and empathy for the fears and anxiety our team was experiencing. Change required creativity, vision and risk taking. I realized that the world would not be the same for some time. Effectively influencing behavior in this chaos required leading by example; an early self-deployment onto the units treating COVID patients would allow our faculty to get directly involved in the medical care and find ways to make ourselves useful, use our training and find a role long before we were called upon to do so. Initially, I felt contributing at the point of care would be a valuable way to learn about the disease to prepare for possible deployment as intensivists while finding a way to assist our medical partners as the hospital became overwhelmed with sick patients. Ultimately, we made ourselves useful before anyone else could determine it for us, while securing our roles in areas where we could learn and assist our hospital colleagues. We had developed a culture in the department over the years of mutual trust and collaboration. This was essential during this turbulent time. The team needed not just guidance but trust that this was a credible strategy—putting ourselves in harm’s way and finding a role in the chaos. 

    In the long term, it became evident the pandemic also presented a unique opportunity to change the paradigm of how care and communication of care has historically been delivered, leveraging some of the newly acquired technology tools at the point of care and in the office. We found opportunities to assist our ICU teams while initiating utilization of both enterprise and local software focusing on collaboration, education, patient care and community service. We focused at the point of care on communication.  We rounded in the morning with the ICU group, learning to treat Covid patients and then, using mobile asynchronous and synchronous communication, we kept in touch with the families remotely. This allowed us to expand upon our understanding of the disease, and support our hospital partners all while experimenting with a new mobile communication platform. Our patient communication strategy was adopted by our nursing and patient experience teams, facilitating collaboration across care team members. Our reach and impact extended outside of our hospital’s boundaries, contributing to our system’s initiative with the US Military at the Jacob Javits Convention Center field hospital. Lastly, we were positioned to be on the forefront of advancing clinical trials for the health system, having long-lasting and translational impact on the future of care. In retrospect, these decisions were hugely impactful in ways wholly unpredictable to both myself and our team. The efforts we made continue to pay dividends and are likely to radically change the way we treat and communicate with each other and with our patients. While it took a pandemic to force sorely needed change, the mistake would have been not to put our training to use and adapt to the opportunity amid chaos.

    The initial idea to act and assume new roles allowed our team to contribute in unexpected ways, and personally has become one of the most impactful events of my career. Finding a role in the chaos of the hospital gave us focus and calmness as we identified new short-term goals to which we could contribute.  Simultaneously our workflows contributed to our ability to be impactful in the subsequent stages of both COVID and post COVID, prepared for what was visibly in front of us while preparing for what could not be seen.

    Chaos is primarily an emotional reaction to lack of clarity, loss of structure with ill-defined boundaries and diffuse and often-dissonant communication.  Leadership shines greatest in these moments and is perhaps the ideal environment in which a leader is tested. It is difficult however to simply turn on during these moments. Leaders must prepare for times like these by ensuring a culture of trust and altruism is a core element in the group they are leading. Leaders must support their teams without consideration of their own careers. Without an earned trust during normal times, it becomes more difficult to set an example and lead during chaotic ones and nearly impossible to engender change. While a modicum of normalcy has resumed, prepare now for what is to come. Be empathetic, give up ground, surround yourself with strength, be unselfish. The hardship of our training has prepared us for what is now and what is to come. Chaos will rear up once again someday.

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