Leading through transitions: COVID-19 and medical practices

For healthcare leaders, cutting through all the news about COVID-19 leads to numerous considerations to navigate the pandemic:

• The public health aspect, particularly direct patient care
• The economic aspect, the staffing question and the financial survival of your medical practice
• Uncertainty on how long this will last, significantly different than other disasters you may have faced
• What will happen when this is over and what kind of transition will be required to get back to normal.

 
In these unprecedented times, consider that we need to transition to a new way of doing things. In his book Managing Transitions: Making the Most of Change, author William Bridges suggests that transitions have three phases that must be managed to successfully move forward: It starts with an end, moves through a neutral zone and ends with a beginning.
 
The end is where you “take leave” of the old situation. One of the key differences when making a transition is that, this change is situational; for example, changing to an electronic medical record from paper charts. Transition is letting go of the old “reality” — psychologically, it will never be the same again. It is important to recognize and accept this.
 
The neutral zone is “no man’s land,” a sense of limbo filled with uncertainty. It is important not to rush through this phase — accept it as real but not necessarily the new reality. This can be a scary time, but it’s where creativity occurs. Think of it as spring, when seeds take root and grow into the plant you desired. Yesterday no longer exists, and something new and exciting can emerge — it’s a time to engage with your colleagues. They may share similar fears, but their ideas and willingness to help and buy into new processes will assist in achieving growth.
 
The beginning will occur only after the neutral zone is complete — here we find renewal. There are barriers, of course — it was easier or better doing it the way it was. A new way of doing things may feel risky, and there is always a temptation to go back to the way we’ve always done it.
 
To stay the course, remind yourself and your colleagues of four P’s: 

1. What is your purpose — a clear perspective of what you are and what you want your organization to become?
2. Create a picture of what you hope it will be — a clear image, communicated to all, which represents to them a secure, comfortable image of what will be.
3. Develop and follow a plan designed to be personal, not organizational; one that follows a series of steps, with the focus on the process, not the outcome.
4. Make sure everyone has a part to play. All must recognize the problem and feel they can contribute. Prioritize open communication and others’ feelings and recognize everyone’s contributions.

 
It is important to be consistent through the phases, to seek win-win situations to reinforce the transition, to create a new identity and to celebrate success once achieved.

Applying these lessons to COVID-19

The response to COVID-19 means an end to some of the ways we have done things. First, there’s an “initial phase” of dealing with the virus and its associated illness. Communication with patients, staff, suppliers, payers and many others has changed. Triage of patients via phone, in their cars and before entering the office has changed. Caring for COVID-19 patients as well as “normal” patients has changed. The list of changes goes on: Canceled elective procedures or wellness visits, staff reductions, risks of taking care of patients with limited personal protective equipment (PPE), as well as loss of revenue despite continued expenses.
 
Think of the many emotions that arise during this phase. Stress bears down on everyone: owners, employees, patients, suppliers, payers and countless others within the healthcare system.
 
Next, the neutral zone is the “management phase” in which the daily routine has changed and requires a new set of policies and procedures. In other words: Let’s get through the day with as little risk as possible. Let’s see what the federal and state government programs mean in terms of restrictions and possible financial support. This is a good time to review how, what, when, why and where things were done in the past. What are the barriers to success, what gaps occurred, what sources of waste can be identified, perhaps using flow charts?
 
During this time, there may be opportunities to meet and talk since patient volume will be lower. Ask employees what changes they would like to see in their job. Accept that things will never be the same.
 
Finally, the beginning has two phases in dealing with COVID-19. We’ll call the first one “recovery,” when practices are clear to look at resuming elective procedures and routine visits that were rescheduled. Which employees are needed in the office, and which ones can continue to work from home? A review of the financial picture finds the revenue stream fairly clean and significantly reduced. The level of new patients and ongoing revenue streams have created significant cash flow problems, not only now but for the short-term future. Many questions can and will be answered about patient flow, supply availability and changes that will become permanent from CMS and each payer. Constant communication — not necessarily talking but listening, reading and gaining a clear understanding from employees regarding internal issues and doing the same with suppliers, payers and competitors in the marketplace regarding external issues.
 
The second phase of the beginning is the “new normal.” Here is where implementation occurs. Telemedicine and new applications, such as artificial intelligence (A.I.), must be worked into the daily routine. Chronic care management programs will continue. Elective surgeries will now be managed with little or no wait time. Payment models will become more risk based and shift away from fee for service. The budget process will be adjusted to allow for more flexibility. Cash reserves will be maintained. Teleworking will be included in staffing models and all positions will be focused on a newly identified purpose. Patient wait times will shorten as barriers and gaps in the patient flow process are removed, making each patient’s experience much more pleasant. The overall culture will be patient centered, a group-first dynamic, with effective, transparent communication, and recognition and acceptance that each member of the team will play a key role in helping to achieve the organization’s purpose.
 
COVID-19 has caused a great deal of concern, frustration, fear and anxiety. However, it will give us time to reflect on what is and what can be. Be cautious and measured in your approach while also being open to new and better ways of achieving your personal and organizational purposes.