Soft Skills, Emotional and Social Intelligence, and Resilience

This chapter examines the importance of skills, such as emotional and social intelligence, and resilience in the professional development of healthcare workers (HCW), and how these skills are crucial for maintaining medical competence and professionalism when facing a health crisis. The COVID-19 pandemic generated rapid change, uncertainty, and ambiguity like no other health crisis has done previously. The SBH Health System has experienced the stress and burden of illness and death during the months of March to June 2020, which characterized the first surge in New York, but was especially prevalent in this socioeconomically more deprived borough where the hospital is located - the Bronx. As the crisis unfolded, so too did multiple fears and concerns within the SHB Health System such as lack of adequate PPE and a high volume of deaths, and each HCW had to rely on their own reserves of resilience and coping skills to overcome personal barriers for the benefit of their patients. In examining these important skills through the surge of the crisis, this chapter also provides practical suggestions and advice on the interventions implemented at the SBH Health System to care for the healthcare worker's mental health, alleviate stress, and promote a healthy and supportive environment. © SBH Health System 2022.

Recovery From Crisis

Whilst there is no universally agreed definition of ‘recovery' in the context of a healthcare system post-crisis, for the purpose of this chapter, recovery is defined as the change to functioning and operations in acute care hospitals from crisis state to non-crisis state. This chapter will present a summary of some of the experiences of healthcare systems worldwide to the COVID-19 pandemic including the successes and shortcomings from all levels within the system. We will present the impact of the pandemic on the building blocks of the healthcare system and outline considerations for its recovery as the early pandemic surge subsides. We will then present a case study of the recovery process from the perspective of SBH Health System in Bronx, USA, following the first surge of COVID-19 in March 2020. Within this, we intend to highlight specific areas for improvement that were indicated by our healthcare system during the crisis and use these lessons learned to implement a plan for recovery of hospital services, continued improvements in-patient care and preparedness for future crises. © SBH Health System 2022.

COVID-19 Crisis Timeline: The Warning and the Surge

After an initial warning, an infectious health crisis, especially a viral one, can surge rapidly from a small outbreak to an overwhelming epidemic or even a pandemic. A surge usually consists of a rapid escalation phase, a peak phase, and a slow de-escalation phase. A surge may include an increase of all categories of patients, emergency room visits, in-patient admissions, and critically ill patients with multi-organ failure requiring ventilation, hemodialysis, and other intensive care measures. There is an accumulative effect of the rapid successive waves of patients admitted into the hospital, with a severe strain on the human and material resources of the hospital. In many health crises, as with the COVID-19 pandemic, the majority of the patients are hospitalized for a long time. Such a long hospitalization slows down the recovery from the crisis significantly. There is a disruptive effect of a health crisis on regular hospital functions and services, such as elective surgery, ambulatory clinics, and care and follow-up of patients with diseases other than the cause of the infectious crisis. This disruption may result in worsening of chronic diseases, such as diabetes, asthma, mental illnesses, and others. It may also result in delay in diagnosis and treatment of various types of cancers and later presentation of cancers at higher stages. Consequently, the disruption places special requirements for resumption of regular services after the crisis and an additional substantial burden on hospital capabilities. This chapter describes the initial COVID-19 crisis at SBH Health System in the Bronx, New York, USA, and shows its unfolding surge over time alongside an overview of the response. While the COVID-19 crisis has unique characteristics, many lessons learned from this crisis can be applied to other crises, especially infectious pandemics. © SBH Health System 2022.

Dynamic Decision-Making and Effective Communications

The COVID-19 pandemic, and particularly the initial surge, created a steep learning curve for most organizations who saw rapid changes in dynamic decision-making processes and effective communication that were essential to maintain functional healthcare. In this chapter, we discuss the decision-making process at SBH during the crisis, outline the infrastructure and processes developed, and the challenges that we overcame. Two top goals were prioritized at SBH: serving large numbers of severely ill patients and protecting the healthcare workers. This was achieved through a series of strategic decisions for health crisis management in an acute care setting, which we discuss in detail and highlight the lessons learned. We hope lessons from this period will help better prepare us for such health crises in the future and that they will also help influence decision-making at other hospitals and departments. In reflection, we conclude that the hospital must conduct serious crisis preparation of all departments, teams, systems, and processes to best mitigate a pandemic surge, which can happen very quickly with short warning and rapid escalation. © SBH Health System 2022.

Collaborative Culture and Lean Daily Management

Adopting a nonnegotiable focus on "patient interest first” together with a strong collaborative culture, SBH Health System - a safety-net, capital-constrained hospital - was able to successfully manage the huge health crisis surge of COVID-19 in spring 2020. A prerequisite for any acute care hospital during a health crisis is a solid pre-established framework for operations, effective communication processes, and a culture of focus on problem-solving, which is adopted by all ranks. LDM is a structured, daily process of collecting data and evaluating performance metrics and is a recognized method used to drive appropriate behaviors that result in a culture of seeking, along with a desire, to solve the organization's problems. Conceptualized by the Greater Baltimore Medical Center, the essential goal of LDM is to turn an organization's workforce into a group of coordinated and focused problem-solvers, and it is anchored on the quadruple aim: better health outcomes, better care experience, least waste, and most joy for healthcare providers and patients. After a phased introduction to SBH, LDM changed the way healthcare workers perceived their work in multiple beneficial ways and shifted the culture of communication to become more open and structured. Fitting the quadruple aim into crisis planning and preparation may present an opportunity for an enhanced health crisis preparedness and management program. © SBH Health System 2022.