Leading through crisis: COVID-19 and beyond

Alexa B. Kimball, MD, MPH, the president and CEO of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, takes us behind the scenes in the early days and months of the pandemic.

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Now that highly effective COVID-19 vaccines are helping to rein in surging illnesses and deaths, many people in the US and a number of other countries are tiptoeing toward a new-normal world. Yet the pandemic isn’t over. In the US, it continues to upend lives and livelihoods, and disrupt the health sectorin a range of ways. As health care practitioners and industry leaders draw a collective breath, it’s essential to reflect back on the earliest days of the scramble to manage the fast-moving crises unleashed by SARS-CoV2 and consider key lessons learned.

Alexa B. Kimball, MD, MPH, is the president and CEO of Harvard Medical Faculty Physicians, a large group practice at Beth Israel Deaconess Medical Center in Boston. A professor of dermatology at Harvard Medical School, she sits on the board of trustees for Beth Israel Lahey Health. Her responses to the questions below are excerpted from the Executive Education at HMS webinar “Health Care Leadership During COVID-19.”

Edited and condensed for clarity

Starting from the early days of the pandemic, how did you balance the short-term needs of an unprecedented clinical crisis with longer-term imperatives — your institution’s financial stability and its teaching and research missions, for example?

We have close to 2,000 providers who are providing care both at Beth Israel Deaconess Medical Center and across Massachusetts at the hospitals run by Beth Israel Lahey Health. We needed to take care of all the patients we would normally see in ambulatory settings. We needed to get our physicians organized to manage the surge and we needed to deal with incredible uncertainty.

Very early on, I began keeping a brief, almost telegraphed record of the main things I was thinking about each day. March 11, 2020, says “Telehealth.” That was the day I sat my team down and said, “We’re going to have to convert rapidly to telehealth. And by rapidly” — this was a Wednesday — “I mean next Monday.” It wasn’t clear how we’d get reimbursed, but we needed to double down and get that done so we could serve our patients. That Friday, the governor of Massachusetts announced that all elective surgeries and elective medical care was halted. By Monday, he had already established parity for telehealth and we actually had set up our first rudimentary systems.

Right away I was talking about PPE, innovation, how we could get the supplies and expertise we needed, and communications — what to share and when. The hospital had done a lot of our communications, so our capabilities were fledgling at best. We needed to know what we were allowed to do and what we were not. How are we going to get reimbursement? How are we going to manage supply chains? What were the feds doing? And so, immediately, we shifted to a crisis communication structure, which was daily huddles to regroup on the information coming in. At the beginning, we really just needed all hands on deck to bring information in as fast as we possibly could, then turn it out the other way.

How did you and your team adapt to rapidly changing conditions as the pandemic evolved?

We were having so much thrown at us from a regulatory perspective and a constantly-evolving, dynamic situation, it was so hard to keep up. We really had to think differently about how we communicated and wrestled down information to make it actionable. Some of it wasn’t ready for prime time, but we needed to figure out how to manage it. Once we realized what the threads were, we could break it apart again into more discrete responsibilities.

As we evolved, I shifted to assigning people to particular topics: my chief legal officer would handle legislative issues, my chief financial officer would look at fiscal aspects. We created town halls for our faculty and daily newsletters for a period of time. These emergency command structures were never designed for chronic emergencies, which is really what this became at the end of the day. We now meet a little more frequently than we did pre-pandemic, but have shorter meetings than during the pandemic. We’ve reduced the town halls and newsletters in frequency as the pandemic has eased here. But those were really important and popular during the most intense moments of the crisis.

One of the things we did well is thinking beyond the particular issues of today. Part of this required making sure there was enough bandwidth in my vision to say, “Okay, what’s going to happen two weeks from now that I need to think about?” I think where we’ve seen leadership in the pandemic fall short a bit has been stuff that’s reasonably easy to anticipate. For example, vaccine distribution. It feels like everyone says they’ll vaccinate group 1 and then group 2 and then group 3. It seemed obvious to me that you’d want to overlap these. You don’t have to get to the very end before you start the next thing. You need to be looking ahead. That’s a really strong lesson. And so today I’m thinking about how do we bring our remote workforce back into the office in the fall? What’s going to happen in the next three weeks, and then three months, and then six months and then a year?

What lessons have you learned about yourself and your leadership style?

There is certainly a literature about crisis management and how leaders should adapt to it. I had been involved in managing some crises before. We had the Boston Marathon bombing. We had the 2015 season of incredible snow where we shut down for days on end — we had people who needed to get into the hospital, people who couldn’t leave the hospital. Even some little crises: when the water main broke and there was no water, how do you run a hospital with bottled water?

I tend to have a coaching style where I bring my team together, we shoot through the problems, I help remove barriers, refine the plan and keep it all oriented to the mission. I had to adapt, instantaneously, to a very different style: “This is the information, we need to make plans and implement.” You can lose important elements of what’s not going well that people may not be bringing to you. You have to be sure you have your feelers and your environmental scan out. But you also have to make rapid decisions and recognize that you’re not going to make all of them right. We’re a pretty lean management organization, so that helped a lot in terms of being able to execute on decision-making quickly.

One of the most encouraging and fabulous things about crises like these is you can elevate junior people to levels of responsibility you wouldn’t normally greenlight, or that might take them a long time to grow into, because you just need talent in lots of places. And they shine — that’s uniformly been my experience.

My management style had to ramp up and ramp back down as we moved out of urgent crisis. Now I can be the coach again. Once you’ve come out of a crisis, I think it’s time to re-evaluate how you want to think about your management approach and style.

— Francesca Coltrera

View the full webinar, “Health Care Leadership During COVID-19,” which delves more deeply into this topic.

Continue the conversation on Twitter by connecting with us @HMS_ExecEd or with Dr. Kimball @AlexaBKimball.