In this three-minute video, LDI Senior Fellows and Wharton School management research experts Ingrid Nembhard and Lawton Burns comment on their COVID action checklist for managers in health care organizations.

Although news coverage has overwhelmingly focused on COVID-19’s death toll and catastrophic economic impact, the pandemic is also a management problem of a magnitude and complexity beyond anything previously faced by American health care executives. That aspect of the pandemic has been of great interest to the experts at the University of Pennsylvania’s Wharton School who study managerial processes in corporate and institutional organizations.

Two of those top Wharton experts — LDI Senior Fellows Ingrid Nembhard, PhD, MS, and Lawton Burns, PhD, MBA, teamed with University of California Berkeley Professor Stephen Shortell, PhD, MPH, MBA — to search the scientific literature to identify evidence-based practices and principles that have previously been found most useful to leaders and managers navigating past disasters and crises.

The reality is that COVID-19 is not just a public health and epidemiological issue, it’s clearly a management issue as well.

Ingrid Nembhard

Five actions

Writing in the New England Journal of Medicine Catalyst platform’s Innovations in Care Delivery, the authors presented a list and explanations of five actions that should govern the strategic thinking and daily management practices of health care leaders in institutions now enveloped by COVID-19. Simply stated they are:

Put people first
Manage operations creatively
Attend to teamwork and communication
Create outside partnerships
Embrace clear and humble leadership

“The reality is that COVID-19 is not just a public health and epidemiological issue,” said lead author Nembhard, the Fishman Family President’s Distinguished Associate Professor of Health Care Management at Wharton. “It is clearly a management issue as well. Look at some of the COVID-related questions we’re struggling with: How do you deal with supply chain management? How do you create capacity for testing and treatment amid uncertainty and resource constraints? How do you enable positive team functioning among people with no or limited history of working together? How do you deal with emotions in the workplace?”

‘Extreme state of VUCA’

In their Catalyst piece, entitled “Responding to COVID-19: Lessons from Management Research,” Nembhard and her co-authors characterize the current situation in and around the national health care industry as “an extreme state of VUCA” — the U.S. military’s acronym for wartime situations that are simultaneously volatile, uncertain, complex and ambiguous.

There hasn’t been a single health care class in the country that has discussed the supply chain for PPEs but when COVID hit, we didn’t have any and suddenly the supply chain issue was crucially important, but a discussion no one was prepared for.

Lawton Burns

Although the Catalyst article was only seven pages long, Nembhard and Burns said the response from across health care surprised them.

“I don’t think anything I’ve written in my career has received as much attention as this piece,” said Nembhard. “We’ve seen it circulated by the National Cancer Institute and the American College of Healthcare Executives, and health systems have been reaching out.”

“It’s also one of the least ‘scholarly’ things we’ve done,” added co-author Burns, Professor and Director of the Wharton Center for Health Management and Economics. “There’s not a single statistic, number, model, or theory in the article, yet it’s become our most widely disseminated thing out there. I think Ingrid, Steve, and I hit a nerve and that managers are hungry for practical information about how to deal with this crisis.”

‘Unprecedented how-to challenges’

The Catalyst article notes that managers at every level and in all sectors of health care face “unprecedented how-to challenges” beyond anything they or their organization have ever experienced.

“Health systems have always prepared for disaster response, like hurricanes,” said Nembhard. “But the COVID disaster is very different in a number of ways. The disasters we’re used to are usually regional in scope, so you can rely on assistance and supplies coming in from surrounding regions. If you were a health system in a devastated area needing personal protective gear that you didn’t have, you’d call another hospital two or three counties — or two or three states — over to send some. But now, every organization has been hit and is in the same dire situation. The magnitude of COVID is such that I don’t think anybody could have been prepared for this.”

As a result, previously obscure hospital logistical systems have been pushed to center stage for managers.

“Take the supply chain issue,” said Burns. “In the past we focused on high end things like defibrillators, pacemakers, stents and other jazzy ‘physician preference’ items (PPIs). But, this time around we’re talking about personal protective equipment — PPEs. I can guarantee you there hasn’t been a single health care class in the country that has discussed the supply chain for PPEs because they’re low cost, generic items. But when COVID hit, we didn’t have any of them and suddenly the supply chain issue was suddenly crucially important, but a discussion no one was prepared for.”

Creative managerial strategies

The authors also point to some organizations that deployed creative managerial strategies very early as the pandemic evolved.

“Within two weeks, Stanford Healthcare scaled up and combined telemedicine triage of COVID patients with drive-through testing” said Nembhard. “There are been a number of organizations that have done miraculous things. That was one of the first ones published, so we know about it. Drive-through testing spread throughout the country after that.”

Another example of creative response the article cites is the Cleveland Clinic’s “Code Lavender” program that has existed for some years but is particularly relevant to one of the pandemic’s most discussed problems — the emotional trauma and physical stress experienced by hospital clinicians struggling in overloaded, under-resourced settings to deal with a deadly new disease for which there is no known treatment.

Code Lavender

Cleveland’s Code Lavender can be called by hospital staffers in times of severe emotional stress. The difference is that instead of a “crash cart” team that administers to a patient, this code team delivers evidence-based psychological first aid measures to doctors, nurses and staffers.

Another example is Intermountain Health Care’ huddle system that starts with 15-minute gatherings of care teams on the floor to discuss the real conditions and problems of the right now — information that quickly gets passed up into subsequent huddles of top managers who can implement rapid systemic changes.

“I have been impressed by organizations with cultures that are able to cultivate positive emotions — whether they’re playing “Don’t stop believing” every time a patient is released or has a positive turn, or organizations where you see the staffers together doing Tik-Tok dances,” said Nembhard. “That is something you never would have seen in health care before. And those organizations are dealing with the same sort of devastation as everyone else but they’re finding a way to lift each other up in the midst of that and I think that’s actually really important.”

“One thing I think we’ve all learned from this,” said Burns, “is how much we’ve come to rely on the health care system to get us through this. It’s not just the public health system and Dr. Fauci and everybody at CDC and NIH and the vaccine researchers. For the last three months I haven’t heard a single person say ‘our health care system is broken’. In fact what I’ve heard people say is how much they appreciate the fact that we have a health care system that can do what it’s now doing.”