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  • Gigi Fergus, MBA, BSN, RN, Kim Brown Sims, MBA, RN

Top 6 Things Learned From Setting Up a COVID-19 Field Facility

Kim Brown Sims MBA, RN, FACHE, NEA-BC, Randal Christensen MD, MPH, and myself co-authored this article to share some of our takeaways from the experience of creating a COVID Field Facility. We discovered several leadership pearls we'd like to pass on. #COVID19 #leadership

In early April, the decision was made to open additional healthcare facilities to manage anticipated surges in COVID-19 patients requiring medical treatment in California. After 2 weeks of construction and facilities management in a closed arena, our hospital executive team was brought in to operationalize the plan. The objective was simply stated: be prepared to accept patients on April 20th. We had seven days.

As experienced executives, we knew that it was difficult to pull off such a feat with people we knew and had worked with let alone with an executive team and 300+ healthcare professionals that had never even met. Daunting? Yes. Impossible? No.

We accomplished our task despite multiple scope changes and operational issues. In fact, within 2 weeks, we had received our first patient, created 60+ standard operating procedures and policies, and created an entire document cache for patient medical records. During this endeavor, there were many learnings. Here are our top 6:

  1. Empowered and valued staff can move mountains. Most of the standards of operating were created by front-line staff. They used their experience and knowledge of what needed to be done and developed the process to achieve the desired objectives. People tend to support what they create, so even after creating and operationalizing a plan when issues arose, the team did not see this as a setback but rather as an opportunity to tweak, refine and continuously improve the practice -- without much management oversight. Take care of the front-line experts, they in turn will take care of everything else. Value individuals’ strengths and align their tasks and objectives with their skill set. Then get out of their way.

  2. Maintain a laser focus on the objective. Our main objective was to be operationally ready to take patients on the seventh day. This forces you to re-think: what exactly must I have versus what do I want in order to take care of patients. We asked staff to bucket their want list into three buckets: must haves, needs, and would be nice to have. We focused on the must haves -- we reviewed each must have under one microscope: was it absolutely necessary in order to take care of patients. For example, it might be nice to have an electronic vital signs machine (one that takes automatic blood pressure and pulse), but that device isn’t a must have requirement for care of the patient. What is a must have is a means of taking blood pressure, which includes a manual cuff. The difference in cost is roughly $1500. The lack of electrical outlets combined with the high cost of repairing broken medical technology only punctuated the need to keep things simple including the equipment. We consistently redirected staff away from high-end items and directed them to minimum requirements in order to stay true to our mission of taking care of patients in a field hospital.

  3. Establish standard work from the outset. As Standard Operating Procedures (SOP’s) were established, expectations for care were punctuated at the same time. These standards were reviewed, put through practice drills, and documented through competency assessment and evaluation. This process was made much more simple by the fact that the staff had created most of the SOP’s themselves. Again, people tend to support what they create, and they will defend process and adherence to that process. Administratively, we didn’t have to do much policing -- the staff self-policed each other. We merely had to verify and validate. The staff set their expectations early and we reinforced them frequently.

  4. Bring representative stakeholders to the table early, often and each time conflicting direction is received. Working with multiple state agencies created a challenge in that each agency seemed to have a different agenda which created multiple conflicts in direction and scope. With each change in scope and direction came an equivalent change in operations, sometimes on a day to day basis. By creating opportunities for stakeholders to interface regularly and together, we were able to work through the disparities that created havoc in operations. Simply said: Get everyone on the same page quickly whenever vision and direction from your superiors is at conflict with each other.

  5. Document everything. Initially we jotted down simple notes from meetings but we found that our understanding of what was covered in the meetings differed from what other stakeholders understood. Our focuses were different, so our memory of topics and agreements also differed. Once this was acknowledged by our team, going forward with every meeting and conference call, we took copious notes to include who said what and follow up actions. We then followed up major meetings with an email recap of the meeting content which was sent to each attendee. This resolved any discrepancies going forward.

  6. Laugh out loud, a lot. Cut each other some slack. Be open to seeing things through a positivity lens. We knew that this staff had essentially volunteered and their hearts were in the right place. So when a less than exemplary situation presented itself, we took the position administratively of educating and supporting staff rather than creating a hyper-punitive environment. We spoke to what it means to work in a Just Culture and a High Reliability Organization. We educated staff on what those terms mean. We practiced what we preached. And we laughed with each other whenever we could. We learned to roll with the punches and simply chose to take a positive view of the world. Our mission aligned us; our laughter bonded us together.

The dynamics of undertaking the monumental task were -- bar none -- the most interesting encountered by this seasoned healthcare executive team. When working in a highly matrixed organization, miscommunication, opposing directions and competing priorities prevail; this was no exception. Even more interesting was coming into the project late in the game as individual consultants having never worked together before, with a team of 300+ new graduates, retired volunteers and a smattering of active professionals who took on this challenge as a means to fulfill the need to help. Without structure and focus this had a large potential of turning out disastrously. The key to our success was identifying our individual strengths as well as those we served, harnessing those strengths, removing obstacles and getting out of the way. We spoke frequently of the fact that the common goal amongst us all was ultimately the desire to provide high quality safe patient care to those in need. We never lost that desire and the result was truly amazing.

Kim Brown Sims served as Chief Nursing Officer, Randal Christensen, MD, served as Chief Medical Officer, and Gigi Fergus Served as Chief Executive Officer at Sleep Train Arena Alternative Care Facility in Sacramento.

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