My Covid-19 Experience as an Intensive Care Doctor
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 to 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 has 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, in order 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 in order to keep them safe as well as fearing for our own 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 facemasks 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 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 start 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 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 specialty but allocated to wards 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 specialties and backgrounds are vital for a well functioning organisation, which influences and optimises patient care. However, in order 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 on a regular basis 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.
My personal experience and journey in learning about leadership has been very educational. I have utilised skills I have acquired from a medical leadership programme in leading and participating in adapting one of my workplaces to the Covid-19 pandemic as well as responding to the national need of ICU doctors by working across different hospitals and teams. These are the learning points that I gained from my experience as a doctor during this time:
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. By having a network of teams that are connected all the way 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 be helpful in creating 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 has the ability of stimulating 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 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 . 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 own 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 my 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
1 . Michael A West. Effective Teamwork, p.76. Wiley-Blackwell 2012. ISBN:
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