Wellstar Kennestone Hospital

Tony Gallagher

Permit me to start by stating the obvious. Never in my wildest dreams would I have imagined leading I cardiac diagnostic Department of 90+ involved employees through a modern-day pandemic; but that is what we faced. The Wellstar Kennestone Cardiac Diagnostics department consists of an inpatient non invasive cardiology lab as well as five outpatient cardiac diagnostics centers and two cardiac rehabilitation centers.

As a leader through this event, there is a two fold approach that you must prepare for. The first is that you must manage your team leaders and keep them prepared so that they can get through each day. The second is to continually round on the front-line staff to make sure that they are comfortable in their current work environment and that their needs are met. When facing a situation like this, it is difficult to make any long-range plans. Therefore, short-term becomes the priority. Initially, you plan to get through to the end of the day. Then you try to set weekly goals. In the early stages of pandemic, we learned very quickly that there is absolutely no sense to make plans much longer than that.

A recurring hurdle is trying to maintain enough staffing to stay operational. Even though we are all health care workers, that does not mean that your employees do not have fears for themselves and their families. These fears must be acknowledged, and your employees must be heard. If taking care of your staff is the number one role of a leader during a pandemic, maintaining operations so that you can continue to provide quality patient care is second. That may sound backwards because the goal is always patient care first; but if you do not take care of your staff, you cannot take care of your patients.

"To maintain operations and keep procedures available to your patients, personal protective equipment (PPE) needs to be kept available"

To maintain operations and keep procedures available to your patients, personal protective equipment (PPE) needs to be kept available. During the COVID-19 event, PPE became scarce. Clinical areas had to be prioritized for who would receive which level of protection. Direct COVID patient exposure had the highest priority. Even outpatient diagnostic procedures had to be prioritized; stress testing, can cause the disease to become more aerosolized.Therefore, staff members performing these procedures receive a higher level of PPE than someone performing a Nuclear Stress Test.

This creates another communication hurdle. Since not all procedures have the same exposure, not all staff members get the same level of protection from the PPE. Although this seems practical and expedient, explaining to a single parent with two children at home why they do not receive the same level of protection as the next staff member tends to erase logic. Clear explanations and communication are extremely important. That communication must be consistent from upper levels of administration to direct supervisors.

Significant loss of volume was our next surprising turn of events. Although, there are generally no shortage of cardiac patients, during a pandemic people are afraid to go visit their physician or get their testing performed.Procedure volumes dropped to as low as 20% of their normal volume. This created the need for a balancing act between how many staff are required to maintain operations, or how many needed to be flexed off or redeployed. This is where a teamwork approach Is extremely beneficial. We held routine meetings with our staff to discuss our lack of volumes and therefore, the lack of ‘regular’ work. We would explain our volume and staffing issues and ask them if they were able to be flexed off. If so, did they want to use their paid time off (PTO), or did they want to go without pay. If they did not have PTO, or did not want to be flexed off, we tried to redeploy them into other areas.

There were certain nursing units that throughout the pandemic were always in need of extra help. This extra help did not necessarily need to be skilled nurses, but rather people who were able to lend what we called Helping Hands. These helping hands quickly became the backbone of the pandemic. They were runners, who could go anywhere in the hospital for supplies or to move patients. They assisted with patient care by turning patients, taking vital signs, or just moving equipment in the room to help the primary care nurses. And in some cases, they did things as simple as bring lunch to the staff or the patients.

After any event you always want to re-assess to see what you did right and wrong. Although there are many lessons to learn from this event, there is a definite number one lesson that we learned: Communication is Key.