Medical leadership applied as an ICU Doctor during Covid-19
Guest blog by Dr Hanieh Asadi
COVID-19
May 17, 2021

The global disruption caused by the Covid-19 pandemic has revealed the effects of the increasing demand on healthcare systems as well as highlighting both abilities and areas requiring additional coordination and development. As seen in the media, the pandemic has unveiled the central role of healthcare systems and how it makes a difference in human lives. However, more importantly, during these times it is the leadership skills, adaptability and resilience of the healthcare professionals and hospital board members that have a central role in leading successful and safe working environments.

 

I believe that the pandemic has underlined the importance of the combined knowledge and expertise of healthcare professionals from different professional backgrounds, to support a working environment that many of us never experienced before. The pandemic itself is incredibly stressful for healthcare professionals as we have had to distance ourselves from our families to keep them safe as well as fearing for our safety by looking after patients infected with the Covid-19 virus. Going to work at the hospital also means following certain routines such as having a temperature check, only entering the hospital via certain entrances and wearing face masks at all times. It also means that we have a larger number of patients in the intensive care unit (ICU) and working with new team members.

 

The pandemic has brought together teams, changed hospital infrastructure around patient care pathways and our routine working patterns. At one of the intensive care units (ICU) I have been working in during the pandemic, our morning handover has changed the structure to include the team of ICU doctors, anaesthetists, surgeons, ward managers and matrons and medical students who have graduated sooner to provide extra help on the ICU. The on-call ICU consultant for the day starts the meeting by ensuring all team members are present with allocated roles, clarifying the number of occupied ICU beds, specifying the number of patients on the wards with the potential requirement for ICU admission and the night doctors highlighting any patients at risk of deterioration. Any issues, be it patient-related or logistical, are addressed as well. At the end of the meeting, the team leaders for the different groups are given walkie-talkies to facilitate communication between different teams. At the end of the meeting, the team leaders meet in individual groups to discuss the plan for the day and task allocations within their teams. This change in working pattern has been facilitated by non-urgent operations being cancelled, which freed up both surgeons and anaesthetists to work with new teams and in other areas of the hospital. The structure in the hospital wards have also changed, the healthcare professionals are no longer only looking after patients within their speciality but allocated towards according to the greatest patient care needs. This also means that they have had to familiarise themselves with new equipment and work within new teams.

 

The necessity of the combined strength of multidisciplinary teams has been underlined further and reflects how healthcare professionals from different specialities and backgrounds are vital for a well-functioning organisation, which influences and optimises patient care. However, to lead or be part of a well-run organisation there are essential skills required, which doctors are not taught during their medical training. Leadership is in everything we do as healthcare professionals and is not only about clinical decision-making but also a way of thinking in broader and more inclusive ways. Leadership is in a range of activities that we undertake regularly in the clinical setting, such as; communicating with colleagues, leading multidisciplinary team meetings, conducting difficult conversations with relatives and patients, supporting team members and knowing how to facilitate the development of their best qualities.

         1. Open and honest communication

As an employee, I value open, inclusive and honest communication. This is not only to reassure staff during times of uncertainty but also makes employees feel heard and included. The capability of leaders to adapt to the demands of staff that are overstretched in their roles is key as well as dealing with psychological stressors which will be detrimental to their motivation and morale. 

 

         2. Practice active listening

I learnt that listening and observing provides valuable information about team members as well as helping to maximise the capabilities of each individual. Having a network of teams that are connected from the front line to the management team will optimise the communication pathways and lead to tactical decision-making. Local teams are the best in making decisions based on the perception and their judgment of the situation around them. The responsibilities can also be distributed as well as creating an opportunity for team members to share their experience. This will not only make them feel valued but also provide new knowledge that could help create new strategies and work policies.

         3. Lead by example 

One of the greatest learning points for me has been realising the importance of leading by example. A skilful leader can stimulate and extracting the best qualities in the team members whilst facilitating an environment of safety. I do appreciate the urgency of decision making during a crisis, but with this pandemic uprooting our normal working patterns, we have to think about long-term planning as much as short-term crisis management.

 

         4. Utilise different decision-making styles 

The integrative decision-making style is useful early on during the restructuring phase of the hospital to the increasing demands of the crisis. This involves the inclusivity of many teams where the options of multiple courses of action can be derived from. In addition, a decisive approach to the more task orientated assignments such as creating new policies and care pathways are useful. 

 

         5. Empower people

By empowering staff members they will feel valued and committed to their job as well as experiencing a positive impact on their personal development and growth. This can be done by leading, managing and coaching; the three main tasks for team leaders as per West in Effective Teamwork [1]. Leaders should also be self-reflective about their ways and ask for feedback from team members. A top-down model of managers dictating various tasks to the team members might result in feelings of anxiety and undermining of the abilities of the staff.

 

I believe that in the healthcare sector there is an unspoken rule about the nature of our job role that drives us to adhere to our duties beyond expectations. The pandemic does not only mean that we are working in a challenging environment with an increased workload but involves fears and concerns around our welfare by being part of a professional group that is on the frontline of a health crisis. In addition to the negative impact of this on the mental wellbeing of healthcare workers, the restrictions in meeting with families and friends will exacerbate this further. I have come to understand that during times of a crisis it is skilful, empathetic leaders who encourage camaraderie in an environment of flattened authority that will increase productivity and boost morale amongst staff.

 

The medical leadership training that I undertook meant that I became more confident in my role as a physician by understanding leadership in greater detail, my awareness around leadership styles improved and I was also able to easier identify the transferable skills that I utilised to co-found Generation Leader. This made me realise the need for making training in management and leadership available for all healthcare professionals and students in a more flexible way, adapted to their clinical and academic commitments to fit their skills gaps and interests.

Dr Hanieh Asadi,

ICU Doctor and Co- founder of Generation Leader 

www.generationleader.co.uk

 

References

1. Michael A West. Effective Teamwork, p.76. Wiley-Blackwell 2012.  ISBN:  

  9781119966005

About Generation Leader

The Medical Leader Programme is an online management and leadership programme made specifically for healthcare professionals. The programme has been created by medical doctors who know how the healthcare sector works from years of experience. The programme is applicable, relatable and impactful and helps all learners succeed in gaining essential skills to excel in day-to-day work activities, such as; communicating with colleagues and patients, conducting difficult conversations, knowing how to lead and motivate teams and problem solving. The content is curated according to the management and leadership requirements of the U.K. medical Royal Colleges and the courses are CPD accredited.

Article by
Dr Hanieh Asadi

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