Leadership in a Time of Crisis

Matthew has a discussion with Dr Garry Brydges.  He is the Chief Nurse Anesthetist at MD Anderson Cancer Center in Houston Texas.  They discuss how his institution is responding  to the current pandemic and how they are planning for a possible resurgence of the coronavirus in the future.  They go over different aspects of leadership and how it can be challenged during a national and institutional crisis. 

Be sure to read and download the transcripts to this episode. Click on the tab above.

Check back often for more episodes pertaining to health and wellness and issues concerning the COVID-19 pandemic.

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Website:  https://goingviral.buzzsprout.com/

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Transcript

spk_1:   0:05
Hello and welcome to the going viral podcast. I'm Matthew Zinder, a certified registered nurse anaesthetist. I'm in advance practice Nurse that specializes in the practice of anesthesia. Scope of this podcast will explore health and wellness from the broad to the specific. My aim is to educate while offering a unique perspective. Thank you for joining me today and let's get right to the show today. I talked with Dr Gary Bridges. He's a chief nurse anaesthetist at a large institution in Texas, and we discuss the concept of leadership during a time of crisis. We will go over many different aspects of how his institution is dealing with the current cove in 19 Pandemic and how he is dealing with it personally. So I hope you'll enjoy our discussion. Aziz. Usual police. Stay tuned. Check back often to see if some new episodes have been uploaded. I've got some interesting ones coming up, one of which I've already recorded. The topic is preparedness for a crisis. And I have a very interesting discussion with a gentleman who owns a wilderness survival school s O. That one is coming up next and then also we will, as promised to get into the stress management topics This week, I'm actually interviewing a hypnotherapist and a hypnotherapy instructor who is a retired CR and A, and he will discuss with me different techniques for stress management. So finally, as promised, I will be getting those episodes uploaded as well. Aziz usual also, thank you very much to those who have given me comments and feedback and suggestions for anyone who is interested. Please check the website going viral dot buzz sprout dot com, where you can find all of the previous episodes and a player if you wish to use on, listen that way and then also, if you have any constructive feedback or questions, you can email me at going viral podcast at gmail dot com. So again, without further delay, here is my discussion with Dr Gary Bridges. All right, well, Gary, thank you very much for joining me today. I know that you are incredibly busy, so I really appreciate this time that you're that you're giving me. Ah, and usually what I do when we start off is ask people to give a bit of a background on themselves, and then we can kind of get right into the discussion?

spk_0:   2:39
Sure. Uh, say, my name is Gary Bridges. I am the chief nurse. Anaesthetist that M. D. Anderson Cancer Center in Houston, the Texas Medical Center. I'm adjunct faculty over Baylor College of Medicine Nurse Anesthesia Program, as well as the University of Texas Nurse Anesthesia Program. I am the immediate past president of the American Association of Nurse Anesthetists. Um, and then I guess it's a hobby. I do. Ah, lot of education. So, uh, I am rounding out my fifth graduate degree of PhD and in healthcare economics through nursing. Ah, doctorate of nursing practice that's focused in cardiac and, uh, um, re synchronization therapy with pacemakers and a nurse practitioner degree in addition to a nurse anaesthetist.

spk_1:   3:34
That's quite the list. Uh, we have discussed this many times in the past, and I'm sure I've mentioned this in the intro, but Gary and I are friends. We speak together on the lecture circuit, so I have always been very impressed by the list of credentials that you have. You have lots of letters behind your name, but now how many Sierra days were you in charge of the your institution?

spk_0:   3:56
Yeah, we have. Ah, 110 serenades that currently work for So it's ah and its constantly expanding. So, um, you know, I think within the next year, year and 1/2 will be somewhere up words around about 150 nurse anaesthetist in our practice. So it's constant

spk_1:   4:15
constantly, you know, that's that makes sense, especially in today's day and age. But obviously, with what we're going through right now with the pandemic, how has that affected your workforce?

spk_0:   4:24
Yeah, so that's interesting. It's it's really certainly move the pendulum. You know, we have to look at roles outside of the operating room, which I think is critical. Yes, the volumes, like every other facility, you know, within the state of Texas as well as across the country, scheduled cases are cancelled and it's typically relegated to emergency. Now, the interesting thing working for a cancer facility, Uncle logic care is a little bit different, And so when you have life threatening cancers, um, those need to be addressed, whether that be surgically or chemotherapy or radiation. So in that light it does give us a little bit more volume, if you will, by comparison to the outside. So there's a little bit of protection there. But with that, because we have an immune compromised patient population. Our vigilance with personal protection, not only for ourselves but our patients is, um is extremely number one priority within our facility. So our volumes, yes, have gone down. But, you know, we've We've relegated the Sierra neighs, Teoh, other advanced practice roles. And, um, no, they're they're making significant inroads to make sure that the facility is able to meet the needs of our patient population here.

spk_1:   5:49
Well, there's That brings up two topics that we could also that we could definitely talk about so we can start with. How is your PPE? Since that is a nationwide problem?

spk_0:   5:58
Yeah. So our given us being a, um, uncle logic facility. We don't see the numbers like you would see and place like we're witnessing in New York City, which is just tragic, um, even within the Houston or the Texas Medical Center. While we are the highest concentration in the state of Texas of covert positive patients, our facility, um, you know, doesn't see too many of of positives there. You know, we obviously have a heightened level of surveillance as individuals come through the door and I will tell you our president of our organization, Dr Peter Pissed er's was way ahead of the curve, I think before many and was, you know, abating a lot of our travel. Well, before even orders were coming across the state of the nation. So that insight was was spectacular. And I think part of that enabled our facility to really navigate the supply chain early, which was good. And so in our facility, um, the the appropriate numbers of PPE are are there, they're available, They're not in abundant amounts. And so we certainly, like everybody else, look at strategies in order to preserve our PPG. So that's using UV lights, the strobe lights. And, you know, we have a system in place in order to do five treatments of that, and then we recycle new masts into the end of the practice. We also utilize, um, those of us whether that be the anesthesiologist, whether that be the nurse anaesthetist. We use the papper hoods in our practice because of the immediate proximity to, um, you know any patient that has aerosolized procedures, anything that we would be concerned about respiratory droplets.

spk_1:   8:03
Okay, very good. So that sounds like you're a little bit better prepared than your average institution. Especially if you're size. So that's Ah, that's a good thing. Have any of the provider's been infected at all? As far as you know,

spk_0:   8:18
as far as I know, no, Certainly within the Sierra nays. Um, there has been zero. And and I think that's attributed to the fact of not just with the in our department, our our chairman. Our division had have been way ahead of the curve also. And I think that leadership, through our organization all the way through to the president, has really helped keep us ahead of the curve and and certainly, you know, I mean, you see it across the country. The tension of health care providers of literally going into the trenches and caring for these very ill patients that turn very quickly, um, is concerning not only for the patient's health but also for your personal health. And that was the number one priority in our facility is to make sure that our employees across the entire organization that they were protected number one priority, which then, you know, it allows them to function too higher capacities. And then I would say somebody that we've heard stories of people going in without any protective equipment, which is just, um I can't even imagine on and certainly, you know, and has been said many times that you know, whether that be a nurse, the nurse, the nested is nurse practitioner on the front line. I mean, these are the warriors that really, you know, hats off. You know, it's hard to not even get choked up a little bit about it because of, uh, you know what they go through Certainly in the New York area as well as other epicenters like New Orleans, you know, and we all choose this profession those of us that deliver health care to help people and and sometimes, you know, the tough times there, just like this one with the cove in 19 Pandemic. You know, prior to that was Ebola, and then we had MERS. I mean, it's stars and, um, you know, and I think that's when our our teams shine in health care delivery and people get a reminder of what we go into as far as the battle on the front lines, and you know what that being said. You know, I called friends across the country up in the New York area and listen to some of the stories and horrific, um, conditions that they had to endure. You know, it's and we're thinking about them because, you know, there are some areas that were hard hit and they were limited on PP, which was unfortunate.

spk_1:   10:51
Yeah, that's you're absolutely right. In fact, that's what gets me to is, uh, you say you can get a little choked up from looking at it. The one that always gets me is the pictures of the facial bruising of some of these and 95. But then also seeing the news stories of the's providers wearing hefty bags or garbage bags over themselves and and even looking at some of the the PPE that might be considered appropriate but really isn't like, you know, the face shields. They're really not appropriate. You're supposed to be wearing goggles where no virus can get into your eyes because that's another form of transmission. So it's such a difficult situation. It really is Now. How so? How many Covad patients or Pako vid positive patients do you have in this institution.

spk_0:   11:37
So, you know, we're a 6 600 bed facility. It would jump anywhere from 8 to 10 so we were good at keeping it minimized, you know, again, it goes into the surveillance program, and and we had checkpoints throughout the entire facility. We shut down parts of the facility to make sure that it was a coordinated effort. Um, that as access points, we even put our Sierra neighs at the access points to help in that surveillance to make sure that we identified any of the symptoms that were consistent with potentially Kobe positive. And then we would do rigorous testing on the patients. And, you know, we've had none in the operating room setting, Um, and the ones that did have symptoms, We identified them quickly, and, um, nobody was refused care. They were triaged to an area of heightened surveillance. And so, you know, and I think it's just prudent for any facility. You know, if you're not dealing with them, you know, large amounts in the emergency department, Um, that you have these sort of strategies put in place ahead of time to be able to manage. You know, even if they're under surveillance. And so we would have both P Y units as well as a positive unit. And so we would make sure that that Sepp degree of separation was was clearly delineated so that we could focus our attentions and strategies on whether you were positive or under surveillance.

spk_1:   13:14
This kind of could lead us into you know what the general topic is, and that is leadership in a time of crisis. So how would you say that your leadership styles and those of of your superiors might have changed in light of what is going on? Because this is such uncharted territory, right? So how can you even adapt to something like this when we're learning as we go along?

spk_0:   13:40
Yeah. You know, I think these air one of the critical moments in time that test leadership, right? And, you know, I think one of the keys is is is leaning on leadership experiences. It's the same as with the nurse anaesthetist, right? All right. I may not be delivering an anesthetic in the O. R. But I can transfer my skill sets and adapt to a new environment that I'm unfamiliar with. I just have to fall back on my experience, my education and my skill sets and the same thing goes with leadership, you know? And I think one of the first things is to really communicate what your staff as as to the unknowns and it's okay to not know everything. And I think it's very important to acknowledge the fact that you don't know everything and there's going to be a lot of unknowns. What? We're going to make it through this together. And I think that level of authenticity bills, you know, through honesty, a lot of trust, Um, for your employees, the other is, is you're gonna make mistakes. And I think it's important to when you identify that is that you admit those mistakes and their corrections that you're gonna make very quickly. Um, the other pieces is every time that and as we've seen with Cove, it you know changes occur every 30 minutes and and that at Adaptation, um is going to create some frustrations. And and, you know, I think that in part is paramount, where leaders need to be more than just transparent, but messaging consistently and constantly over and over and over, and with the caveat that you're looking after your people and that you're going to protect them at all cost. The other is knowing what? The landscape trying to stay proactive and ahead of the issues, you know, And I will tell you that the minute this was happening and we started seeing the orders come out of, you know, reduced surgery schedules. But then we had executive orders, you know, from, um, State governors and those opened up and reduced a lot of the barriers that we confront on a day to day basis. And, you know, I think the power and that that were able to mobilize people in different environments at a moments notice. And I think coming out of this one of the greatest successes is all of those leaders that were instrumental in that, you know? And I mean, my hat's off to CMS. Director Verma, H. H s director, A czar. You look it. The state governors, I mean, 12 states, you know, induced executive orders to get rid of a lot of the barriers and patients over paperwork. And, you know, I think everybody can attest to the fact that the paper burden that we have to confront on a day to day basis, which unfortunately keeps a lot of us in administration busy on a day to day. You remove that and you're allowed to be able to put your people into highly effective patient care environments. And that was one of the things that we did here was, um, you know, I was one of the first ones with the first team was to get emergency privileges in order to be able to function in the Covad units. And so we put a C or in a team up there to function with the physicians. And how we set that up was we would have a seer in a or nurse practitioner or P A and physician diets. So they functioned in unison and then collaborated with the nurses, the respiratory therapists. Um, and I would tell you going up in those covert units was extremely inspire because you had a group of people that volunteered to be up there. The collaboration. It has been some of the best that I've ever seen, and I think that those credence to the leadership teams not only within certainly our facility to our governor to agent just as well a CMS. If it wasn't for those executive orders, we would have been hamstrung. And we're seeing that in places in New York. We look at Sierra is flying in into New York City constantly to try to help the covert crisis. Um, and it's it's inspiring. Um, and I think those successes and and acknowledging the courage that these people are willing to go into and take care of these patients because they're going into the unknown, the abyss of health care delivery. And we've never seen anything like this in modern times. And so, you know, I think the last time the crisis was that bad was the Spanish flu. You know, we're still not out of the woods yet. We may see this come back whether that be the fall in heaven forbid, if that gets overlapped on the on A on a flu epidemic or a pandemic, um, this could quite feasibly get a lot worse in 6 to 8 months time. And so this is not a time to let her guard down. And and I think from a leadership perspective, and certainly my viewpoint is I don't look at what tomorrow is going to bring. I'm looking at what is October, December, January, April next year and quite feasibly another year after that. And what are those tracks that we have to put in place to safeguard? Not only are resources but our people and make sure that we've learned from these opportunities. And, you know, I think you know, leaders that are good and that have developed a skill set. They excel in these times, right? You know, and you pull the skill set through and you leverage meant a different way. But it certainly, you know, experience. Um, like anything else is is an imperative, I think, in leadership to be able to navigate.

spk_1:   19:43
Now, when? And I also agree with you and what you're saying when it comes to planning, thinking ahead, thinking of six months down the road or next year, what have you or what is your thought process for six months or a year down the road? And have you implemented anything yet?

spk_0:   20:00
Yeah, so So one of the things our planning from from an organizational standpoint, is going to be a slow upward trajectory, but, um, one of the things that it's going into this, you know, learning from from the past. So one of the things that we're doing right now is is training more serenades and the covert unit, Um, so that let's just say this happens again in the fall or or next winter, um, that we now have, ah, cohort that is able to just walk in and be able to provide that level of care. What we've also done is in that resource manual is started to build the strategies that worked where at least appeared toe work based on the limited evidence that we have, um, we've created videos for just simple things, like paper training exceptions, so that when we have to move quickly the next time, we've already got memory there, and and so, um, we've built that into the practice. And so we're going through simulations on a daily basis with our current staff. We've also from the nursing side have applied for state licenses for reciprocity. If a disaster was toe happen, or if this starts to mount again, let's just say in the summer time that if we have to mobilize our staff to go and help in another state, we've proactively started to move in that direction also, you know, I think it's important that, you know, we've never seen the removal of barriers like we've seen in this scenario Katrina, where, you know, we had limitations in in nurse practitioners in Sierra Neighs that couldn't go to another state and helping in New Orleans during Katrina because of licensure and practice. And, you know, which is just absurd when you've got that level of crisis, you know, 75 miles away. Your knowledge base doesn't change, right? Um, and so we've started to look at that and started to pay those pathways so that if we have to execute again, we can do it very quickly because we've already done at once and also, you know, again learning from your past mistakes. And so we look at our opportunities and we tried to, you know, re carve out strategies for that. And then when it comes to resources, obviously, you know, there's a lot of innovation right now that's going into personal protective equipment. And I'll tell you, you know, you can scour anywhere on the Internet and and look for peopIe. It's it's all over the place, right? And certainly You know, we see a lot of three D printing a lot of innovators, and there's some good ideas out there. There's not so good ideas out there. And so, um, I think one of the things that you know, we leverage our, um our service lines are supply chains to make sure that we've got supply. And certainly I think the learning opportunity here from a supply chain perspective is, is to make sure that, you know, we used to function with just in time or jit ordering right. And that doesn't work in this scenario. Ah, and so there needs to be, ah, supply. The other thing that we looked at was, you know, can you re engineer anesthesia machines going and taking care of whether be a covert patient or whether it be a mechanically ventilated I see you patient and so brushing up on skill sets with mechanical ventilation in the covert patient, you know, and so there's been a lot of postulates shins there. There's a lot of papers coming out ahead of publication on what's the best motive? Ventilation? And, you know, I think it's now turning out to be high flow oxygen therapy which is by nasal cannula and trying to avoid intubation at all costs. But when you do go into intubation, it's a little bit, but not quite the, you know, acute respiratory distress syndrome or ARDS management's. It appears that the lungs air not reacting the same way. And you know, yes, prone ing does work. Um, but the diffuse nous of of this disease And you know, there's University of Washington cardiac surgeon Did some three D modeling of a patient Rakove it that they scan, which is actually on the Internet. And it's interesting to see the patchy nous of how the virus actually infiltrates lunch. But learning from all of that and trying to retool our management skills moving forward. And so, you know, I think that that helps us be a little bit more prepared, moving forward. Should we confront this? The other thing that we have to think about is this is one dimension, right? This is one incident, one crises. We're getting ready to go in to the peak of the hurricane season. So what happens if we get a flood in a hurricane? How are we going to adapt to that in the midst of this crisis also. And so, um, you know, those were kind of tough questions to answer, because that's something we definitely have not gone through. And so, you know, trying to take some innovative thoughts. We certainly you know, I think back to the leadership stuff is engaging the people that you're leading in the discussion and not mandating, you know, orders to them, making sure that the part of the conversation And I'll tell you our organization is very, very good to create conduits and keep a pulse on on our staff as faras, you know, how are they feeling? Any thoughts they have that could maybe change things, make things better? Did we slip somewhere? Is there an opportunity to improve one on an area? And we take that information to as we move forward? Because, I'll tell you, your front line workers air going tohave the best information on helping you navigate not only current times but moving forward into the future. And I would say the other important piece of that, too, is, is your face time as a leader. It is imperative that you're in the trenches with your people and you know I was like I said, I was one of the first ones also to get emergency privileges to function in the I. C. U. So that if I needed to get mobilized in there, that I would be able to do it. And the fact that it's not just my people, I'm there with them in the trenches, you know? And I think this is one instance where social distancing, you know, for lack of a better word or term doesn't apply. Your warriors are courageous, and you need to lead your warriors on the front lines in crisis, like so why we went into health care delivery. Yeah, it's unnerve ing. It's unsettling. A times it can be scary, But the bravery that I've witnessed serenades nurses, physicians across the entire health care continue is just astronomical. Nothing like I've ever seen in my lifetime. It's been incredible.

spk_1:   27:30
It's amazing to watch, and I had actually mentioned this before, probably in one of my first broadcasts, and that is yes, we go into a profession to help, but we were not prepared to go into a profession to put our lives on the lines like fire and police officers and military, and this is a totally different paradigm for us. But But we're still seeing people jump in with both feet almost without thought, and it's very inspiring. It's amazing to watch. We did if you did bring up two things that I wanna go over and they're two totally separate tangents, so we'll go one at a time. And that is back to the concept of I see you and being in there in the trenches with with your people. Um, the concept of even using different pieces of equipment to fill in the gaps, like the's engineered homemade, almost ventilators or an anesthesia machine with the ventilator or the I C u Ventilator 3 to 3 totally different things, especially when you're dealing with what one weight might consider, of course, sick lungs that look like a R. D s or some other acute respiratory illness. How is it working when you don't have that? That I see you ventilator with all the different settings that you can go to to tweak what's happening like, and I I use old machines. I work in ambulatory surgery centers that are owned by the physicians. They're not going to buy a $60,000 robot brand new computer anesthesia machine. They're gonna throw in a a 1990 draeger with one event setting and volume control. So that's what I'm used to. And but that's not gonna work with what we're talking about. So what options do you have? And what have you been using so far?

spk_0:   29:23
Yeah, So, I mean, that's a great question. And and I think it's not an easy answer. And And I think you know, this requires a lot of thought, you know, Certainly when our students come into the O. R. One of the first things that we say is you never do general applications on the entire patient population. You must individualize the care to that individual. And so with that, there was a team of us. Um, first of all, we figured out how maney ventilators do we have? How many anesthesia machines do we have during the surge? What could we ventilate feasibly and then started looking at and teasing out? So which patients get which type of modality and it was decided, um, through a number of of experts in the I C. U as well as in our department that our anesthesia machines would not go on Kobe patients. They would Guan the typical, whether it be a medical, I see you patient or somebody that's maybe requiring a little bit more ventilation after surgery. And those anesthesia machines would be managed by, um, the nurse anaesthetist as well as anesthesiologists. The sophisticated modes of ventilation on on our ventilators would then go to the Kobe patients and way I had, uh, excellent supply in our facility of both anesthesia machines as well as mechanical ventilators. So there wasn't too much concern based on what we were seeing, but we're still prepping for it. Um, and you know, we've been fortunate where we've only had at any given time to patients on mechanical ventilation that were positive. And I think the success story there is nobody in our practice has died from Cove. It are mechanical ventilation. Those patients again, we're balancing cancer with cancer treatment with, you know, this novel Corona virus, and just trying to think back to the numbers. I mean, we've essentially everybody has been weaned off mechanical ventilation, and now we've implemented the high flow, uh, nasal cannula, and, um, it's been 100 100% success in our facility. So, you know, hats off to, uh, the physicians, the the nurse anesthetists, the nurse practitioners, the P A's and the nurses as well as respiratory therapists. I mean, the collaboration, as I said earlier, was extremely, extremely tight in that unit, and everybody functions in in a well executed and coordinated unit. And so those patients, you know, they got the fancy machines when they were needed, and I think there was an aggressive management that was tailored to each one of those patients. But we had never considered putting an anesthesia machine on a covert patient to mechanically event unless they were in the O. R. For for an emergency, which that was another preparation workflow that we've worked on. We put in place negative pressure rooms, etcetera, Um, and they were there ready to take care of covert positive patient. Thankfully, so far, we have not had to do that.

spk_1:   32:59
How are the CR days advance practice nurses and such being utilized in their non typical roles? Like I see you, Are you seeing a return to bedside nursing? Or are they acting Maura's intensive ists? How are you utilizing them

spk_0:   33:18
Sierra neighs specifically as well as the nurse practitioners because there at least in our facility, they are trier ice, you nurses. And so you know this is where you know the skills come out. And Syrian A's nurse practitioners add that added level of expertise from their prior critical care experiences. And so now you can function. Um, not only is as helping and augmenting the nursing care and I'll tell you, I've got serenades. They don't sit, Um, they'll go in with the nurses and they'll help with the nurses and whatever care that's needed, whatever procedures air needed. The benefit of the Sierra Nasar nurse anesthetists in the nurse practitioners is they are able to bridge a lot of those those immediate needs where typically we would have to make a phone call to a physician, right. And in our practice, we would have positions here in a physician nurse practitioner di ads. And so there was that level and bridging between the physician all the way to the nurse at the bedside, and and so we leverage those capacities to the hilt. So it was everything from ordering to doing procedures. Um, you know, if there was an intubation this year. UNAIDS would be in there if they weren't performing the intubation. You know, there's that that skill set a handzus. Okay, this is what you need next. The one thing that you don't want to be doing is taking time and fussing around with an intubation with a covert positive patient. And you're trying to minimize their civilization of respiratory droplets And so, you know, mitigating all of that. It needs to be more than just one skill set of hands, whether it be intensive ists, whether that be a nurse, anesthetists, nurse practitioner, Anesthesiologists are up there helping out too, you know, And again, it comes back to that collaboration, um, was just astronomical watching and participating in in some of that with the our team. You know, I will say, there's, you know, not to get into politics, but you see, when these executive orders come out, um and all they really did was remove paper barriers, right? The bureaucracy of the system, um, you know, and I hear about people allow its independent practice. There's no independent practice because, um, everybody functions in collaboration. There's no vacuum. And in fact, if I witnessed anything with these executive orders on I certainly encourage whether that be governors or the president or CMS or HHS is to continue with this because what it did was is it brought everybody at the table and we actually enhanced collaboration and communication. It didn't it didn't create wedges or separations or anybody running off rogue, which I think sometimes is. That is the perception that is completely not what happens. They actually collaborate, even Mawr, and everybody learns a lot more from one another. It's just been awesome to witness, I would tell you,

spk_1:   36:37
and it delivers a more effective health care system to the patient, which is all that matters. And it is another good study when we all come out the other end of this. Hopefully there are some people that are really keeping track of the outcomes and show it for maybe how we change healthcare for the better. And that is, as you say, how we collaborate with our peers. Hopefully it is Ah, hopefully it is continued and it's a good outcome, you know, shown. So now, off to the other area that I mentioned was you had kind of touched on this. But how are you as a leader at the institution, addressing the inevitable stress and anxiety around what is going on? Because I you did kind of allude to the fact that one of the things is obviously and this is how I try to to run my practice. My little tiny corner of the world is I just want constant communication being put out both to my facilities and to my providers. And I want toe have an open door to any feedback or questions that they have and that you kind of did allude to that is having good communication. And you also kind of touched on giving some of the control back, which is obviously a great thing when you are addressing stress and anxiety, and one of the things that causes that stress and anxiety is a lack of control. So if you can find a place to have some control back, that obviously helps with that. So how are you specifically addressing it?

spk_0:   38:10
Yeah, so there's there is that's a whole other arm of how we've managed and obviously not just myself. It takes an entire team to look after our people and I'll start with it started with our president, Dr Peter Pissed Er's um, whom made the statement. Our number one priority is our people and their safety. And that's not just from covert virus. That's mental health. And we have an entire cascade of services that is available and made available and actively engaged. Our employees toe offer them if they felt there was in need to access, you know, employee health. We have a number of experts that are willing to sit down and help navigates our employees through any with that, be emotional or psychological or even stress just between the balance between the workplace as well as at home or the fear of of which I have to give credit again to this organization that nobody's lost their job. This organization has gone above and beyond. And and I'll tell you, this is probably unheard of our human resources department at our facility, you know, there were a couple of executive orders that had come out. Um, I believe was for teachers, which we didn't didn't apply to us, but not just personal time was made available, but, um, extended illness bank, which is actually preserved after you so many hours of vacation time, etcetera, That was all opened up, toe all employees. And so there was no barrier there. There was some additional recognition time that was made available to every single employee in this institution. And so what did that do? Um, if there was a concern where an individual just felt, you know, I didn't want to take this home to my family. I don't have anywhere else to go. I would like to use personal time. So that was made available so they could take from one of three different banks personal time, extended illness. And if a person exhausted all of those, this institution provided one week off disaster pays What we what? We define it as I mean, that is unheard off. And so it's It's a credence to our president, really, as well as our human resources department really looking out for people. And so that helped us navigate on the front line. Um, and again, this this sort of goes in parallel where you need to kind of keep your finger on the pulse with your with your staff and gauging how they're feeling. And as house home going you know, your kids at home who is taking care of your kids and in times of stay in place. Um, and that was palpable with with some of our staff. And we made the arrangements to make sure that they're able to spend the time that they needed with their family. The other is, is Well, you know, if I'm taking care of Kobe patients, um, I don't want to bring it home. And so, um, you know, and we've seen this. Now, the hotel industry has made available hotel rooms for first responders healthcare providers to be able to get through this crisis. And so, you know, again, this was something that our organization made available and work the inroads. And so I think that takes the initial fear and anxieties down a little bit, but not completely. I think the other piece in this, in parallel is is partly leadership approach. Um, and it speaks to being in the front lines with your staff. It's not face time on WebEx. It's not face time on Skype or zoom right. It's face time in person. Um, and listening to what their concerns are. And, you know, I made sure my door is open at all, given times, so that and I can tell you that. You know, I had people first thing in the morning. And make sure I'm the 1st 1 here. Doors wide open. Coffee's there. They come and sit in, and they share their concerns, and we work on it real time. Um, do you need to go home? Do I need to step in for you? And, you know, what are some of the concerns? You know, Is there something different that you would engaging them in the decision making on the front lines gave them a sense of control over, you know, reinforcing also, You know, when I would either send an email out to the entire group is that number one priority is you. And that goes through the entire organization and its coordinated, um, all the way through to our president, that of anything helped with, um, the majority of the anxiety. Now, obviously, there are people with, you know, unique situations, and we address those on a 1 to 1 basis, which I think those took a little bit more time. But I think it's important that they're given the appropriate amount of time on reinforcement and made sure that they were well taken care of. And I will tell you that the litmus test there is the amount of people that would come back and say thank you. Um, that's all you need, right? Is to say I was so scared. But your management team and the strength you guys being here in the front with us and helping us move through these times is witnessed looking out for our needs. I can't 110. 50% of thumb have come if they haven't emailed me coming said in person that you know, the management team. The leadership has really settled a lot of their anxieties. And so we do take surveys. And, you know, I think people see surveys. They roll their eyes. But one of those is how are we doing? Um and are we taking care of your mental health needs? And, um, you know, not that explicit, but essentially, the stems of questions are really to get that. You know, do you feel like you have the resources that you need? Is your leadership team meeting your needs? Um, and it's asked over and over because the message, like I said earlier, needs to be repeated many times and eventually, you know, this is all predicated on trust. And do I trust my leader and I've I've I've witnessed some profound transformations in individuals that I would have never expected in a lifetime. And, um, I will tell you that it's a testament to this organization that we work for. Um, it's a testament to, ah, the leaders that report to me, and their unwavering stability for the group has just been like no other I've ever witnessed. And it's it's inspiring.

spk_1:   45:36
Yeah, and there's so there's scores of information and scores of studies that show exactly what you're talking about from a social psychology standpoint, in a a business psychology standpoint that if you have supports in place and you have the communication and you have the different programs in place, you're going to not only have a loyal workforce, you're going to have a more productive workforce because you are showing them that they matter, and it all starts with them. So sounds like that you have, ah, quite a robust support system there, which euro find the have very positive outcomes.

spk_0:   46:15
Yeah, even even on the front line. And this was the decision we made early on was to just you literally obliterate our entire staffing schedule and we cut it right in half a m shift p m shift, Um, and one of the reasons being, because if we did have to endure, you know, a non slot of patients coming in to need to care for I wanted to make sure that every person was fresh and working on the top of their game. So while our employees maybe only worked 5678 hours, But I knew that when they went home that they're gonna be well replenished. Should we need to be ready for a surge. Um, and I think that was important. The other thing that we put Sierra Nasal were specialty teams. Um, we have, ah on Airway Group, which is a physician. Sear in a die ad for the entire institution. A M P M. Shift. We separated out our sierra neighs that worked in the cove. It I see you. And so they don't come back to the operating room for their stent up in the I. C. U. Because we didn't want cross contamination. We also had a number of Sierra neighs and positions that work together to do simulations. And so we took an opportunity to run our people through covert simulations, cove it airway management simulations, malignant hypothermia, cardiac arrest, video tape that we created video so that we could share that with the entire department every opportunity we could to try to get ready, if you will and train our staff. And I think doing those exercises also helped alleviate a little bit of the unknown. So there was some confidence that was built in there every night. Going home. Watching the national news was a reminder how much harder we had to work to make sure that our front line is taking care of, um, you know, began hats go off to every single one of those providers on the front line in New York and in New Orleans and Washington and California. They they took the brunt of it. And, um, you know, bravery is doesn't even define them,

spk_1:   48:38
Agreed. That's it's amazing what we're watching right now. It's It's a surreal odd time, but it is bringing out the best in many people. S O Gary I know that you are incredibly busy. I always ah, want to give who I'm talking to an opportunity for a final thought. So is there anything that you would want to convey or ah, any message that you would want to send?

spk_0:   49:04
Yeah, there's a few. The 1st 1 is, is to every single health care provider out there nurses, Sierra neighs, physicians, pharmacists, respiratory nurse practice. The list is very long. I want to say thank you to every single one of them, from coast to coast for their bravery and their skill sets of sitting in the trenches and doing the work that they do because they are courageous for for, you know, traversing a time and modern health care delivery that's never been experienced. The other is our legislators and administrators, everything from to our governors to our hospital administrators to acknowledging the fact of removing barriers like paperwork to allow individuals providers toe function to the top of their education. It really showed with this crisis that the collaboration actually increases tenfold, maybe even a hundredfold, and those relationships are long lasting and they're very productive. The other is, I think, from a leadership perspective leaders that are looking for What do I do? What are my plans is they need to find a network of leaders that they can sort of bounce ideas off. You know, Social Media, I think, is partly a good platform for that. But I think, um, developing a leadership network. And I think for Sierra in a specifically that means you're not just developing those relationships in the operating room. You're working throughout the entire hospital, whether that be a pharmacist, whether that be a CEO, whether that be the president of your organization, executive leaders, other physicians outside of anesthesia and working with them and in collaborating, it's paramount. The final thought is we've witnessed during times of stress during this pandemic that it can bring out Cem Cem ill behaviors and and they typically come in the form of toxic criticism. And I think you know, if there's anything people should walk away with is to never criticize anybody during times like this crisis that we're experiencing, it's okay to have disagreement. What is imperative that we collaborate as one unit and look after one another, and I think that's the moral of the story of this entire pandemic is that we look after one another and and I'll tell you, America has come out in droves as faras the support. You can't turn to a TV station. You can't turn to a radio station. You can turn to a restaurant that hasn't supported our first responders and her health health care providers. And that's palpable and duly noted. And that's the fabric of America. And it's just been inspiring to be part of it, despite this being a pandemic.

spk_1:   52:07
Well put. Thank you very much, Gary. Again, I really appreciate your time on this. I appreciate your insights and, uh, you know, we will definitely be in touch. Absolutely. All right, so that will do it for this episode. I hope to see you at the next one. This is Matthew's ender and the going viral podcast. Please stay safe and stay well.