| Dave Kaufman – host: | When faced with immense challenges, strong leadership is crucial. The COVID-19 pandemic put a strain on all facets of society and put strong and effective leadership to the test. Our healthcare systems faced massive disruptions to the norm, the likes that nobody had ever encountered. On today’s episode, we’ll go behind the scenes at a Canadian hospital to see how they reacted to the pandemic and how leadership lessons learned in the classroom allowed for displays of strength and a steady hand when it was needed the absolute most. |
| Dave Kaufman – host: | Welcome to the second season of The New Normal, the podcast exploring management research brought to you by Delve the official thought leadership platform of McGill University’s Desautels Faculty of Management. I’m your host, Dave Kaufman. On this episode of The New Normal, we will be discuss how management in healthcare responded to the COVID-19 pandemic, look back at the lessons learned and carried forward from the first wave of COVID in March and April of 2020, and examine the importance of maintaining a steady hand in the face of wide scale change. |
| Dave Kaufman – host: | Joining me for this episode is Dr. Lynn Mikula, the Vice President, Chief of Staff and Chief Medical Executive of the Peterborough Regional Health Centre in Peterborough, Ontario. She is a graduate of McGill University’s medical school. And in 2021, Dr. Mikula earned an international masters for health leadership from the Desautels Faculty of Management at McGill. I spoke with Dr. Mikula on the two year anniversary of when North America came to the realization that COVID was going to be a major event. I asked her to take me back to the moment she realized that the world was about to shift. |
| Dr. Lynn Mikula: | I don’t remember the exact date, but the first meeting of our incident management structure, we were all crowded into the boardroom together in person. And we were looking down through the windows on the cafeteria of the hospital and the cafeteria was full of people coming, having coffee, meeting with their family members, leaving, coming for an appointment. And I was standing next to one of my colleagues looking down at this and he said to me, “This is all about to change.” And we had this moment of, “Wow,” the penny dropped. This is going to be so different for all of us. And inside of a week, the world had turned on its head. But we knew that we had to still be here and we had to keep coming to work. And we had to make it possible for all of the people in our organization to keep coming to work. And it was in that moment, we made a commitment to that. We said, “We’re going to make it safe for people to keep doing their jobs because that’s what we’re here for.” That is the most fundamental role that we play. |
| Dave Kaufman – host: | In August of 2021, Dr. Mikula published her master’s thesis on lessons learned from the pandemic, including team empowerment and psychological safety in the healthcare hierarchy. I wondered what she observed at the Peterborough Regional Health Center that led her to write this thesis. |
| Dr. Lynn Mikula: | I think the pandemic was an upheaval, of course, for all of us and I had the good fortune of going through the degree program at McGill in the midst of it. And what I started to observe were all the changes in the way that my hospital was running as a result of the pandemic and I was able to reflect on them through the lens of what we were discussing at McGill in the management course and in the coursework around that. And what I started to observe was this tremendous crisis and this tremendous upheaval brought with it actually a great deal of positivity in the hospital, at the same time that people were afraid of what was coming in the very early days of wave one and afraid of what was going to transpire in subsequent waves. There was also a lot of goodwill and energy and desire to do the right thing. And it brought a vigour to the hospital that I hadn’t seen previously, and a singularity of focus. And I thought that that was really worth exploring. |
| Dave Kaufman – host: | It became apparent very quickly that the arrival of COVID was a crisis unlike any other. I wondered how do healthcare organizations normally adapt to a crisis? |
| Dr. Lynn Mikula: | It depends on the crisis. Healthcare workers really love to say that they’re great at a crisis, they do crisis all day long. And on a certain level, that’s true. The sort of small-scale crisis, the person who comes in having a healthcare crisis, the number of victims from a car crash, for instance, the things that are part of healthcare worker’s daily lives, we do really, really well. This crisis of the pandemic was of a completely different nature. It was societal, it was certainly across the entire organization. It was sustained. It was nothing like anyone had ever seen before. And that kind of crisis, and large bureaucratic organizations like hospitals are not necessarily very good at, there’s no policy for that. There’s no process for that. Other than every hospital has an incident management response policy, which is the very basics of how you get started. |
| Dr. Lynn Mikula: | That’s what hospitals rely on. That’s what hospitals relied on in the early of days of the pandemic, but to sustain crisis mode for a really long time, that’s not something that hospitals are good at. It’s not something people are good at. It’s not something that we as a species can do particularly well. |
| Dave Kaufman – host: | Did management have a kind of rule book that could be looked towards as an example of how to handle COVID versus anything that they had handled in the past? |
| Dr. Lynn Mikula: | Yes and no. Every hospital has a policy that tells them what to do when the unforeseeable happens, when there are a large number of trauma victims in the emerg(ency), when there’s a major infrastructure failure, when there’s a cyber attack. And that policy basically is, “Here are the first few things that you do. Here’s who you call. Here’s who your early decision makers will be. Here’s how you need to set up communications.” So for a short term unanticipated event, yes, hospitals have something to rely on. For something like this, no, this was not anything that we were prepared for. So what we did rely on was that how do you respond to a short term crisis? And then we had to learn from that and adapt it as the pandemic continued to go on and on and on. |
| Dave Kaufman – host: | Did earlier seismic events, such as Ebola or C. difficile give any type of lessons on how to prepare for this crisis? |
| Dr. Lynn Mikula: | Interestingly, yes. There were some infection control policies that said, “This is how you deal with the patients.” What there wasn’t was a policy that said, “This is how you deal with the global supply chain for masks collapsing. This is how you deal with the fact that you’ll have to isolate far more people than you could ever imagine. This is how you deal with healthcare worker burnout. This is how deal with all of your nurses’ kids having to be home from school for months on end.” So yes, but it was far too simplistic to adapt to what we ended up facing. |
| Dave Kaufman – host: | Let’s talk about PPE. We heard horror stories about the shortages of masks, gowns, gloves. What kind of shortages were there and how did the hospital adapt to these problems? |
| Dr. Lynn Mikula: | I do have to say that my hospital was luckier than most because we had a very robust pandemic supply. We actually had a warehouse that was well stocked with PPE. So we didn’t find ourselves caught out the way a number of other organizations did. But certainly in those early days, when we started to just see a tremendous run on PPE, everyone was using it, they were using it because we were telling them they had to. They were using it appropriately. But we also saw some very new things happening. We had people stealing PPE right out of the hospital. |
| Dr. Lynn Mikula: | We had some drive by thefts of masks. We had a lot of stuff going walking that we needed to not go walking. So it was scary. Everyone was worried about running out. And that was one of the things that really contributed to fear and anxiety in the organization is, will there be the equipment necessary to stay safe at work? And everyone was watching Lombardi and everyone was watching New York and everyone was watching people having to bake their N95 masks in their ovens and going, “Oh, good Lord. How am I going to be safe at work?” So it wasn’t only a logistics and a practical problem, it was an emotional problem as well that we had to manage. |
| Dave Kaufman – host: | Of course, managing people, colleagues, patients, managing the risk that everyone is taking. These are some of the major challenges. In that situation, you want to know that management has your back. |
| Dr. Lynn Mikula: | And at the same time we were being put in a position with policies coming down from the ministry of health saying, you need to restrict. You can’t just give out as many N 95 masks as you want. You need to ask people to use fewer. We were asking people to step away from best practices and to do it without a safety net. And that was very uncomfortable. Those first few weeks, almost everything that we talked about ended up being PPE and supply chain. I learned a lot more about supply chain than I ever wanted to. |
| Dave Kaufman – host: | Dr. Mikula says that she never thought for a second that she would face PPE shortages in her hospital. |
| Dr. Lynn Mikula: | Both as a working doctor and then in my early days as a manager and a leader, the supply chain was not something that we worried about. And my eyes have been opened. We’re continuing to see impacts of supply chain shortages today. Now we’ve learned to look for it. And now we’ve integrated supply chain into clinical decision making in a way that didn’t exist before. |
| Dave Kaufman – host: | Once the problem was established, certain guidelines were put into place. Dr. Mikula says that going local to source PPE has been a huge help. |
| Dr. Lynn Mikula: | Definitely. We made partnerships with a lot of local businesses to produce PPE, hand sanitizer, all sorts of things. We, even, in the very early days, asked our community to start making cloth masks for the hospital and set up a process where they could drop them off and handed out instructions about how to do them and just launched this 1,000 mask challenge. Other hospitals did that as well. And we still have some of them and we still use them, not for patient care, obviously, but we do still give them out. |
| Dave Kaufman – host: | Despite challenges faced in the first wave of the pandemic, it was essential that Dr. Mikula and her colleagues at the hospital showed a steady hand on the wheel. How did she maintain her confidence and assure staff that they could trust management’s decision making? |
| Dr. Lynn Mikula: | That was a big part of what we talked about as a leadership team, what I reflected on. I was the chair for the incident management response table, and that was a big table and it was a table that crossed all the levels of the hierarchy and the organization. We had frontline people, we had the CEO and everything in between, and there was a lot of emotion around that table. And it was the most difficult chairing job I think I’ve ever faced. I knew that I had to project calmness and confidence and focus when I wasn’t feeling any of those things myself. I was scared for me and my family and my kids and my friends and colleagues. We talked a lot about that. We talked a lot about how we were going to keep our feet on the ground and move forward into what felt like a huge, vast, scary, unknown, and lead the organization forward. And the way we did that was we just amped up our communication to an unbelievable degree and got very comfortable with saying, “I don’t know. I don’t know, but we’re going to figure it out.” |
| Dave Kaufman – host: | “I don’t know,” was not something that Dr. Mikula was used to saying. |
| Dr. Lynn Mikula: | No, not in hospital leadership. You’re sort of used to saying other things, but not, “I don’t know.” And certainly not, “I don’t know, but let’s figure it out together.” And it was an incredibly empowering thing for us to learn how to say. |
| Dave Kaufman: | I find that fascinating. Personally, I took great comfort over the last two years when people in positions of power said the words, “I don’t know.” And I still really question when people speak confidently about COVID because we don’t know what’s around the corner. Dr. Mikula says that if management is going to say that they don’t know, exuding confidence that that won’t always be the case is crucial. |
| Dr. Lynn Mikula: | I think there were moments when we may have gone a little bit too far with the, “We don’t know what’s coming.” I did learn that you have to strike a balance in terms of acknowledging uncertainty. You have to have that underlay of, “We will figure it out.” So that’s why those two statements being paired together are critically important. Just saying, “I don’t know and I’m as freaked out as you,” doesn’t really help when you’re in a leadership position. But, “I don’t know and I can see my way to finding the solution. And here’s how you can be involved in it. And here’s how I’d like to bring you in to finding the solution.” That is where you get to a place of safety and trust. |
| Dave Kaufman – host: | So much of today’s episode and The New Normal series is about change. Changes thrust upon us, changes that are coming in the future and how thought leaders see and adapt to that change. Healthcare is a great example. Change is necessary, yet, established norms are what allow for healthcare to be safe and trustworthy. I wondered how do healthcare organizations deal with such a paradoxical relationship? |
| Dr. Lynn Mikula: | Well, because we have an imperative for change. Healthcare science is always changing and improving and new things coming down the pipe, but healthcare also has a mandate to be safe. And that’s why healthcare is so tightly regulated. You don’t really want hospitals, for instance, to be the hot bed of innovation when that innovation is happening on your family member. So at the same time, as we need to keep up with medical advancement, we also need to be safe. And that’s why healthcare organizations have this structure and this hierarchy and this bureaucracy and all of these rules, but taken to an extreme, they stifle change. |
| Dr. Lynn Mikula: | So you often see this statistic where it says it takes 10 years for a development in medical science to make it from the bench to the bedside. And that’s why that innovation, that development has to navigate regulations and approvals. And then you have to convince all the frontline clinicians to adopt it. They have to buy into it. So you’ve got this imperative for change that is science driven, but then you have this resistance to change that is rooted in people and practice and pairing those two and creating space for both, because they’re both important is a real paradox. |
| Dave Kaufman – host: | One example of change in adaptation in the midst of a crisis was how lives were saved in the second wave of COVID, after healthcare professionals realized that instead of leaving patients in the ICU on their backs, turning patients onto their stomach was actually making a huge difference for their breathing and for their survival rates. |
| Dr. Lynn Mikula: | Yes, we saw a lot of bedside adaptation actually, when we learned that there’s a right time to put someone on a ventilator, that exactly putting patients on their stomach, there’s a right way to manage their intravenous fluids. And now we have a bunch of medications, tools that we didn’t have in the first waves. And we’ve had to learn how to prescribe those. There’s also the adaptation that comes from how you do things, not necessarily what you do. So for instance, how you care for a patient who’s in isolation? How do you bring their family members in to see them safely? How do you do that when their family members are contacts of them and the patient themselves has COVID? |
| Dr. Lynn Mikula: | How do you do that and keep everyone safe? And how do you make everyone comfortable with that decision and understand that that decision is important? And then all the way to big organizational adaptation, how do you set up COVID assessment centres and testing centres that we never had to do before? Where do you put those in the org chart when you don’t even know how long they’re going to be around for? We adapted on every single level. It was a lot. |
| Dave Kaufman – host: | As I mentioned earlier, Dr. Mikula published her thesis in August, 2021 on lessons learned in the pandemic. I asked her if she could take us through some of the main discoveries. |
| Dr. Lynn Mikula: | We had to innovate a lot and we had to innovate very quickly. We discovered that the best way to do that was with what we called working groups. What, in my thesis, I called teams and they truly were teams. They were groups that developed to meet a specific need, a specific question. They were usually across disciplines. Frankly, it was whoever was available at the time. So we ended up with people with a great variety of expertise coming together on these working groups or these teams to produce a solution. And we had not had that in the hospital before. And it was so wildly effective that we are able to really produce solutions at a dizzying pace and then work them through an iterative process of, “Is it working?” “No, actually it’s not working. Let’s change it.” This working group structure, it’s a very interesting thing to situate in a large organizational hierarchy. |
| Dr. Lynn Mikula: | No one really owns them. They don’t belong to a particular portfolio. They cross all kinds of organizational silos and they’re wonderful. So the main thing I think that we learned is that if you can create a space for those teams, if you can arm them with the resources to be effective and if you can make sure that people come to those teams knowing that they will have trust and psychological safety and that they’re empowered to make some decisions, boy, there’s a lot that you can do. And how do you keep that going now alongside the hierarchy? How do you make space for that in the hierarchy? So that was the main lesson from the thesis. And frankly, the main lesson that we’re still trying to implement in the hospital |
| Dave Kaufman – host: | Was psychological safety something that was not considered before, or at least not to the same extent? |
| Dr. Lynn Mikula: | Nowhere near as openly. Things weren’t as scary. It was really when things became so scary and when we were looking at other hospitals and other parts of the world being under such tremendous strain, people couldn’t contain their fear and anxiety anymore. It had to go somewhere. So we tried to set up ways for it to come out in a safe and a productive way. And that’s when we started talking about trust and psychological safety and how to build that environment and how to make that environment really thrive and be sustained. |
| Dave Kaufman – host: | I asked Dr. Mikula, if she would say that overall her and her colleagues were successful in building that safe and trusting environment. |
| Dr. Lynn Mikula: | I would say the jury’s still out. In the early waves, we were very successful and people felt good, but this has gone on for a long time now. The workforce is exhausted, burnt out in every sense of the word. It’s increasingly difficult for people to feel safe at work when they are just so tired. Everyone’s tired. Society is tired. But healthcare workers in particular, not only have to deal with the societal exhaustion, but also the ongoing problem of COVID at work because it hasn’t left the hospitals, it’s still here. So I don’t know. I think the proof will be in the pudding in a year or two hopefully, when we’re finally through this. Ask me again then, and I’ll let you know. |
| Dave Kaufman – host: | I look forward to that day when we’re finally through this. But as she says, it’s still here. There are however other factors that were unforeseen even at the start of the pandemic. I asked Dr. Mikula how her and her team dealt with a very vocal and sometimes violent anti-vaccine movement and their potential for verbal and physical assault. |
| Dr. Lynn Mikula: | We held very true to our beliefs and our principles. And it was difficult. We had some people working at the hospital who subscribe to that movement. Hospitals in Ontario anyway, had to make a choice about whether they were going to implement a mandatory vaccination policy. We chose to. That was not easy, but it was, we believed the right thing to do. We continue to see people come into the hospital who are angry about seeing masks everywhere, who are difficult with our staff. And we just adopt a policy of, “We’ll care for you. We’re here to care for you, but we don’t accept that behaviour.” So that was really just getting back to our core beliefs and our core principles. And that I would say was, in fact, one of the easier decisions of the whole thing. |
| Dave Kaufman – host: | What about how to support the staff dealing with anti-vaccine protests at, or near the hospital? |
| Dr. Lynn Mikula: | A lot of it is just making sure that they can be heard and supported, the people who are facing that, frankly, abusive behaviour, making sure that their manager, the person who they’re most in contact with has resources to offer them, giving them time off if and when it’s needed. We’ve increased security in the building tremendously. For a while, every Wednesday at lunchtime, there was a protest of anti-vaxxers outside the hospital. So we would send an internal message saying, “We know it’s happening. Please just don’t react. Just continue doing your job.” But at the end of the day, difficult behaviour in healthcare is a thing that you face even outside of a pandemic. And it’s tough. It’s tough. You need to have a lot of really good supports for people in place and you need to keep developing them and we are. |
| Dave Kaufman – host: | So much of what a hospital is based upon is stability, trust and established practices, the stability of standard practices that produce results, the stability afforded when management and staff work in concert in a trusting and established environment. Yet, the response to a crisis brings an opportunity for wide scale change. As the healthcare sector moves forward, is there room to project stability in the midst of such massive change? |
| Dr. Lynn Mikula: | You know, the strategic planning approach is not really up to the task at hand. There are a lot of different ways that, just as a leader, I try to stay on top of what’s coming. We’re fortunate that in Canada and that we have some Sentinel countries that we can look to because there always seem to be a few months ahead of us on the COVID curve. But it’s more than just COVID. We have experienced giant leaps in digital care as a result of the pandemic. |
| Dr. Lynn Mikula: | Our human resources crisis in healthcare has now been exacerbated by the pandemic. Our infection control precautions are never going back to what they were before. Every facet of the organization now needs to look at where we are today and try to imagine where we want to be in the future, and then figure out how to bridge that gap, understanding that that imagination of the future might be very different from what actually comes to pass. It makes people very uncomfortable. I think you need to acknowledge that. And I think you need to say, “It’s okay, we’re going to do our best. We’re going to plan within the limits and the constraints that we have. And if we get it wrong, that’s okay. That’s okay. We’ll change. Let’s try and we’ll adapt.” |
| Dave Kaufman – host: | Will healthcare practices continue to be able to keep pace with massive change while projecting the stability necessary to maintain the trust of both staff and patients? And will lessons learn from the COVID-19 pandemic create new opportunities for management to better learn and adapt to a changing world? Will the importance of psychological safety continue to be valued after this crisis subsides? The answers to these questions, which we will only know over time will determine how we respond to the next seismic event, whenever that day comes. Stay tuned as we navigate this new normal together. |
| Dave Kaufman – host: | The New Normal is brought to you by Delve, the official thought leadership platform of McGill University’s Desautels Faculty of Management. I’m your host, Dave Kaufman. Producers of today’s episode, Dave Kaufman, Robyn Fadden, and David Rawalia. The technical producer of The New Normal is David Rawalia. |
