Hi, it's good to have you. He's a doctor. He has been shown. Hello, and welcome to the monthly HCC Intelligence webinar and virtual office hours. Today's webinar is entitled Leading Teams During the Crisis, COVID-19 and Beyond. My name is Danielle Feinberg, HCCI's coordinator, education and research. I will be your moderator for this event. Before we begin, I would like to cover just a few housekeeping items with you. All participants are muted, but please use the chat or the questions box located on your screen to submit comments and questions. Questions that are submitted will be answered when we transition into the virtual office hours portion of the webinar. The recording of the webinar, slide presentation and transcribed Q&A will be made available on the HCC Intelligence page within several days following the webinar. Today, we are joined by Cheryl Fetebene, Family Nurse Practitioner, La Comunidad de España, Clinical and Practice Management Liaison, National Nurse Practitioner Entrepreneur Network. Cheryl has been a family nurse practitioner and nursing leader for 30 years and has experience in a variety of healthcare leadership and clinical roles. She has been part of numerous national nursing initiatives including the Nurses On Board Coalition and the National Forum of State Nursing Workforce. She has worked on initiatives including value-based care and payment models for NPs and is a national presenter on the topic of provider burnout. She currently works for NPEN as a clinical and practice management liaison and for La Comunidad de España as a family nurse practitioner in Kennett Square, Pennsylvania. Our objectives for today's webinar are to assess your current practice and team members by using a joy and work framework to measure burnout, describe how to develop and utilize a team-based care approach during a crisis and explore ways to move beyond crisis. What do you keep? What do you discard? I now turn it over to Cheryl. Well, thank you so much and good afternoon, everybody. This is Cheryl Fatebeni and it's my pleasure to talk to you today about this topic. So I wanted to start off with talking, we had mentioned joy and work and just the whole concept of joy and work seems to be at least these days somewhat of an oxymoron. Next slide, please. So in 2017, the Institute for Healthcare Improvement developed a curricula around this concept of joy and work and some of you may be familiar with it already. As healthcare professionals, it may seem like joy and work is an oxymoron. How can I have joy in a stressful work environment when I barely have enough time to take a break or regroup? This curricula was a response to the increasing number of suicides and workplace violence that's been experienced in the past. Next slide, please. So this is part of what the framework includes for that joy and work. And there's a couple of steps and I'm gonna lay them out here for you and then we're gonna go into more detail about this framework and these individual steps. So the first part is identifying your team. So you need to know who is on that team. You need to be clear about what aims and goals are for that team, measures that you wanna use to help you identify your team. What goals that you wanna use to track changes over time. And then what changes would you like to see? We will be talking about the use of PDSA cycles, which people may be familiar with, as well as implementation of those PDSA cycles and how you can do that. Next slide. So for those of you that have seen this before, this may be a review, PDSA is the Plan, Do, Study, Act, which is really the cornerstone for the work of the healthcare improvement group that put this together. So you're picking something that's of interest, you're identifying that together and then you put that through the plan and then you do it, you see what happens, you study and then you make changes based on that. Next slide. So the first thing you have to do is think about an organizational assessment. So who is on your team? So that may seem like an elementary step, but it's a very important step to really lay that out, maybe jot that down and figure out who that team is. Next slide. So again, going back to the IHI framework for this, you also need to think, particularly in the environment that we're in right now, what about the safety situation of your location? As we all know, we have been dealing with COVID-19 since March of this year and for some of you may be longer than that. So this is kind of the new normal for us, thinking about, do you have enough personal protective equipment? What about reusing them? Some of you may be experiencing loss of staff also due to illness or burnout or just general fear of coming to work. And then what about the infrastructure and the support that you have currently? Next slide. So what about burnout during the crisis? Next slide. So the whole concept of burnout has been one that we've been following and tracking in healthcare for quite some time. And it's particularly timely now and kind of accelerated in the world that we're living in. So when someone is in the throes of a full-fledged burnout, it makes it very difficult to function effectively on a personal but also on a professional level. Burnout usually doesn't happen suddenly. You don't just wake up one morning and all of a sudden feel burned out. It's something that is insidious and creeps up on us like a slow leak and makes it much harder to recognize over time. Our bodies may give us warnings. We may be getting warnings from all around us, but sometimes we don't hear it very well. Next slide. So a little bit about the background of this concept of burnout, which was really very much in the news before COVID-19. And there was already mounting evidence that physician burnout in particular, which has been pretty well studied, affects the quality of care. And findings show high prevalence of this systematic problem threatens the foundation of our U.S. healthcare system. We've seen increasing rates of alcoholism, broken relationships. But what's particularly troubling is the last bullet here, which is the suicide rate, particularly in male physicians, is much higher than the general population. And also troubling is that for female physicians, that the suicide rate has really been going up over time, hitting an all-time high for our healthcare providers. Next slide. So while we think we may know and understand what the signs and symptoms of burnout are, I just wanted to walk through it with you to really look at it at a step-by-step in a sequential way. Because as I said before, it really is something that kind of creeps up on you over time. So I think we all know about the physical part, you know, whether it's at work or at home, just that physical and emotional exhaustion, maybe having trouble sleeping, eating, maybe quick to anger. Next. Also feeling a sense of cynicism, maybe detached from work, from joy, things that made you feel good before are not feeling so great right now. And then just generally feeling ineffective, feeling a degree of apathy and maybe irritability. And it's at this point when burnout is pretty full well underway, and you begin to see changes in performance. And this is often the first time that we really stop and think about what's going on for us. Next slide. So when you add COVID-19 to an already difficult situation of burnout in this country with, you know, short staffing and long hours, high turnover, really looking at a pretty explosive situation for so many healthcare institutions, organizations, and teams. So not only do we already have the long hours and the high turnover, now we have concerns about safety. So maybe your personal safety, you may have safety concerns from your families worried about you going into work. I know that that's something that I've been dealing with many months. And if there were cracks in your infrastructure before, this is when they really start to come through and you start to see more clearly where the problems may be within your clinical setting. Next slide. So again, a little bit more about burnout and COVID-19. So we have the beginnings here with that physical and emotional exhaustion, depersonalization. So maybe even feeling as if patients or those around us would feel a little disconnected from what we're doing. There's also an increase in medical errors when this happens. And this has been found over time that once we're feeling disconnected, we just begin to see those medical errors. It could be problems with documentation, treatment. All of that can also lead to patient dissatisfaction where the patients can feel that we're not connected to what we're doing. You may also see that in terms of changes in stats and the practice of patient satisfaction scores. And then all of that ultimately leads into a personal effect for all providers. And that's where you may see the fatigue, anxiety, depression, much of which we carry back into our homes. High satisfaction scores for both physician groups and patients were consistently associated with a higher percentage of patients experiencing the continuity of care, lower no-show rates, and more effective use of ancillary staff. So we want to do our best at work, but when we're facing a situation But when we're facing this, both burnout and now COVID-19, we can really get ourselves into some trouble. Next slide. So when considering the mounting evidence about burnout for all providers and knowing that it adversely affects the quality of care, these findings suggest that this highly prevalent and systematic problem, which was already there before COVID-19, is really beginning to crack the foundation of our US healthcare system. So one thing we've noticed, particularly around burnout in clinicians, and this has been shown statistically that there's actually higher prescription rates. So giving out more prescriptions, standard of care may not be met as it should be. There may be irritability, medical errors, quality of care issues, and a feeling of overwork, and even providers moving to alcohol as a way of being able to cope. Next slide. And then as we know, we had kind of that powder keg already there before COVID-19, and now we have the additional factors of the anxiety of what's going on. You may have experienced layoffs or know of others that have or have to be laid off because of childcare concerns. And again, that safety concern, which I think all of us deal with in healthcare, but particularly now from those that we love in our homes about bringing something home, which we don't want to do, and we don't want to bring something home to our families. There can be financial implications, again, loss of job, and also dealing with the very real factor that we are dealing in some cases for some of us in life and death situations, and maybe seeing some co-workers, friends, and patients who have COVID-19 and die from that. So it's a particularly troubling and difficult situation for all of us. Next slide. Some of the new concerns are things around, again, PPE. We're talking about N95 masks. I think it's a household word now. Nobody knew what they were. I remember being issued an N95, not really having to ever use it. Now we're counting our N95 masks. There's always enhanced cleaning protocols, and they may not have come on board right away. In those early months, these concerns of how to provide care, many offices shut down or did offsite testing. We provided care in the parking lot in a tent. And just trying to figure out the new normal is also putting on an additional level of anxiety for all staff in this situation. Next slide. So there are some things that can help us get through these crises, and this model of team-based care was here well before COVID, but it fits perfectly as another framework for what we were talking about and how to get through these troubling times together. So next slide. So we all have our role to play here, whether it's at work or at home. When we work together as a team, and I think we know this both personally and professionally, not only do we get more out of work, but we feel better about the work that we're doing. Next slide. So why do we need high-performing teams? Well, we need them now than we needed them ever before. So we're going to talk a little bit more about what makes a high-performing team, how are they different than others, what differentiates these teams in both how they meet their goals and those that do not meet those goals. And what about a team-based care approach or the lack of a team-based care approach that can actually make your day-to-day work much more difficult? Next slide. So we know from the literature in looking at sports teams and other types of teams what it takes to work together and work well and become a championship team. So there are a number of different models for this, but I think what's important to look at here, and these are the six Cs of a championship team, that I think starting off with a common goal and hopefully a vision and mission of the organization that you're working for is very important. Everyone needs to have a commitment to that. Everybody needs to be clear about what their goals are. We all know that we experience conflict at work. We need to find ways to work through that and in the end pull together for that common goal. Next slide. So we know going back as far as 2003 when the Institute of Medicine put out its work around the core principles of successful care coordination, even back then, teamwork and collaboration were already an integral part of what makes a successful team, as well as quality improvement. And these were the recommendations and they still hold true today. Next slide. So we know that for a culture of teamwork, we need to have that team working together and we see how those intersecting circles, you need to agree or believe in the culture of the work where you live and work, as well as quality outcomes, because we know that the work that we do is always driven in many ways by quality outcomes, both for incentives, but also for the bottom line of taking care of our patients as best we can to give them the highest quality work that we can and our highest quality performance. Next slide. So much of what I'm gonna be talking about in the next few slides may seem to you as if it's very elementary and everyone should know this, but I think when you go and talk about this with leadership or even think this through, this is not always as straightforward as it may seem. So we know that it's really important to have a team, but in order for a team to work well together, everybody needs to know what everybody else does. And again, like I said, I'll make the analogy here of a baseball team. The pitcher needs to know what their role is in terms of throwing that ball, how they pitch, where they pitch. If you follow sports, you know that there's a lot of communication that goes on between professional sports teams in order for them to be successful. So again, knowing and understanding each role and then how you fit into that role. And the last piece about mediated conflict is something I think we don't address often enough in healthcare. Problems often tend to accelerate over time and we're not really watching what's going on and they may grow too big or feel too big for us to be able to address, but really need to tackle those as soon as we see that there's a problem. Next slide. So a study was done. I digress a little bit away from healthcare and talking about social supports. But again, this is the area of psychology and a study was done in 2008 with the volunteers and had them stand at the base of a hill to look at the climb, how far, how high that would be. They then used a metric to measure how steep the climb looked. When that person stood alone at the bottom of that hill, the climb looked much steeper than when they stood there with a team member or another colleague. So we know that teamwork matters and we don't want you to be standing alone. Next slide. So the next step is about team redesign and optimization. We know we can't redo everything. We're in a time with limited resources in some cases, but I think many of you have probably had changes to your team over the last couple of months as we've worked through these challenges. So we're gonna talk a little bit about that and how you can optimize or possibly even redesign the group that you already have to work more effectively together. Next slide. So again, we're starting simple and then moving to more complex in this idea. So we all know that before you start any work, it's really important to look, understand and analyze the problem or what the situation is. And in this case, we'll call it just the demand for healthcare. So before embarking on trying to change your team, you need to understand your team. So again, you start with the team composition, some very elementary points, who's on there, some basic stuff, how is visit scheduling done, how do workflows work, who works with whom, what are the different roles? So just making sure you know and understand kind of the building blocks of your practice. Next slide. So again, in considering team redesign, before you can redesign something, you have to make sure you understand what you currently have. So again, as we talked about looking at your demand, you also need to think about separately, is everyone working to the highest level of their expertise? Is everyone working at the highest level of their licensure? And this is particularly important in cases of advanced practice providers, nurse practitioners, PAs, even medical assistants. Is everybody doing what it is that they were trained to do? And then you look at your team composition based on a number of different factors, but these are just some. Often team has a lot to do with the local population. You may be bringing people in that speak particular languages, location is key. It may have a lot to do with budget, what you can afford. Always keep in the back of your mind how you might utilize cross-training. How could cross-training help you if you have particularly limited staff or funds to be able to do the work? Next slide. So these are just some simple suggestions about how to do a team redesign. And you can certainly use these or others. We know, I think in healthcare, that the role of the registered nurse has changed over time. I think the piece that may be missing for some practices is they may not be maximizing the billable hours that an RN can actually bring to the practice in terms of health promotion. And there's coding specific for that, but that tends to be underutilized. Medical assistants also, as we all know, we've seen them work in a variety of different ways within the practice, but again, just making sure that they are working to the top of their level of training with oversight and look at what the needs are within the practice and how you might be able to expand that role some. Behavioral health is another important one. When I was first doing this work, we had talked about virtual as something to aspire to in healthcare. And I think if there's one silver lining we may have had from everything going on right now is an acceleration of virtual visits. And we'll see how that all plays out in the long run, but has become the new norm of healthcare. Next slide. And then we want to look at outcomes for role clarity and also optimization. So it's all well and good to talk about, looking at who's doing what, but you also need to measure that. And these are just some possibilities of some practice outcomes and things that you might want to use, standing orders, you probably already have some satisfaction survey, or even, I would say, particularly now in practice, one of the things we're looking at is turnover rates. You can also look at billable visits. You know, what are your collectibles? Could you do better on that waiting time? There's a lot of different ways, but think about how you can marry that up with the practice outcome that you're looking for and the one that you'd like to measure. Next slide. So tracking and measuring, and how do we do that in order to identify changes? Next slide. So this is something that we tend to think about last rather than thinking about first, but in order to make effective change, to bring that change and show changes in whatever the metric is you choose to leadership, you really need to be tracking, identify, track, and one of the ways that you can do that is to lay out your SMART goals. So you need to think about what it is in the practice that works, what is not working, maybe pick one achievable goal, and again, something that matches your patient population, think about all the stakeholders, and then think about data you're already collecting rather than if you're gonna do a small PDSA cycle, so a Plan, Do, Study, Act, use data that you already have, try to make it as easy as possible. Little wins go a long way in getting the support of both leadership and administration in making changes. Next slide. So you may have heard about SMART goals. The reason I have two columns here is that one of the ways I use SMART goals in doing the work, this work, is goal one is often an organizational goal, and goal two is a personal goal. So as we know, we can make changes within our organizations, but if we ourselves are not doing a self-assessment and also thinking about how we might be able to make changes, it's going to be difficult to carry that back and implement it into the places we work if we're not also working on ourselves. So our goal is specific, and they need to be something very specific, and these are just some ways that you can figure that out. How are you gonna measure it? Is it really something that you can get done? Sometimes we reach a little too far, but make sure it's, as I like to say, it's low-hanging fruit, something either that's easy to change, easy to measure with data that you already collected. And is it realistic? Is it something, you know, the practice would feel is a realistic goal for you to study within a short period of time? And then when do you expect to meet that goal? So again, just a way to kind of carry you through that process and keep you on track. Next slide. And this is just a sample for a run chart. So this is something that you would be working, hopefully, with your quality improvement team, or maybe there's not a team, maybe it's one or two people, and find out a little bit more about how quality improvement is done within your practice. So what's important about any work that you do is that you do have to track it over time. And this is just something called a run chart, and you can find other examples online, but this is a nice way for you, without getting too complex, to set a goal, to track that goal, to look at it over a period of time, and we have the number of weeks here, and then just identify key times when certain things happened, and then look to see where you are over time. And this is a very simple, straightforward way to be able to track a goal, and also to share with others, because that's the thing is you're gonna need to articulate why it's important, what happened, what worked, or maybe what didn't. And this is just one way to be able to do that. Next slide. So next we're gonna talk a little bit about how you take care of yourself, and also of your staff. And I think we all know and appreciate that this really has felt like unprecedented times, both for ourselves personally, throughout our country, and even throughout the whole world. This is a time unlike any others, at least for me, I know it is in my career. Next slide. So one very important thing about dealing with a crisis, and imagine something that truly is a crisis, and think about a house on fire. So communication during a house on fire is really essential. You're going to be giving people information. You're going to be, you know, giving people information about what to do, what's going on. That's just kind of an extreme case. But think about that when you're thinking about communication. So that it does feel to many of us and to many organizations right now, like it is a house on fire. And don't forget to talk about that. So what's very helpful in times of crisis is to acknowledge crisis. We know that we're all dealing with it, but sometimes it's very helpful to hear that it's just acknowledged for all of us. Maybe what you've gained or lost in your practice. And what about practice updates? At the very least, organizationally, there should be weekly updates. And I know in the beginning of this pandemic, we were getting daily updates, but now it should be at least monthly in some way throughout the team so everybody knows what's going on. Although it's difficult to do, try to focus on what's happening that's positive within the organization, even if it's just the fact that you're all showing up for work. So find something that's positive. Staff meetings are still important. I know a lot of us have moved to Zoom. And again, communication is very important, and I think it's important to see each other. So Zoom is really a great way to do that. And I think we've all gotten a little bit better at Zoom over the last six months. Another thing is the use of PTO. Healthcare providers are notorious about not taking or using all of their PTO. So this is also a time to encourage the use of PTO or think about taking it for yourself. Adjusted hours and even check-ins, like open office hours with leadership can really help, especially for people that have specific concerns about what's going on. So again, communication is a key point during any crisis. Next slide. And in all of this, again, we do tend to forget about ourselves, that we do need to cut ourselves a break. Be compassionate. We spend our days and our lives being compassionate towards others, but it is important to be compassionate to yourself. Think back about why you came to the place that you're working now. Remember why that was important, the mission. And begin, we're all starting to build our resilience. As I said, these are unprecedented times. It's really important to focus on the present. If we go too far into the future, both with ourselves and thinking about where we may be, it can be hard to deal with. Try to remain positive as much as you can. But again, important to practice self-care and find one thing each day that you can be grateful for. Next slide. So as I said before, in talking about teamwork and climbing that hill, teamwork doesn't happen alone. So these are some of the things that I had mentioned before and just different ways that we can take care of ourselves. And it's probably a good time to take a step back, especially if you're feeling exhausted, worried, anxious. None of this is gonna be able to happen when you're in that state of crisis and panic. We're a little bit into a different stage, it feels like for me in our clinical practice, where we're just starting to think about or have the space to begin to think about taking care of ourselves. Next slide. So when I bring you this information, much of it has to do with what your role is within the organization. You may or may not have the ability to make changes. But what I'm hoping that talking about this does is that you take away the pieces that work for you, what makes sense in your role, your role and what you can do organizationally. Just help work through this pandemic and what's going on. So some of the things that are not helpful at all, organizationally, whether we're in a pandemic or not, is blame. Blame doesn't help us, it doesn't move us forward. When we work alone in our work and don't talk to others or network with others and we're siloed, it also makes us feel very much alone and helpless. And poor communication overall, including difficulties with patient flow, systems that don't work. And for those that are running our organizations, all of this can also have loss of income. For a variety of reasons. So, you know, I mentioned the coding issue before, which is incredibly important. And it doesn't, may not feel like the time to be thinking about that. It really is important for each person in the organization to understand what they do and make sure that you're capturing the time that is spent in a way that can help to support the bottom line of the organization. Next slide. So what do you want to keep? What do you want to keep or maybe things that you might want to explore as you're moving beyond this crisis? And, you know, at this point, we don't know when that's going to be. So we're in somewhat of a fluid situation right now. And each one of you will be experiencing this differently. Some parts of it will make sense to you and there'll be some parts where you'll say, there's no way I can do this now. But organizationally, it has been found, and this is before COVID, that there are some things that can help to bring back that joy and work. And again, kind of circling back to the IHI and joy and work framework. And one of the things that was found, and this was research done at IHI, probably about 2009, 10, 11, so well before COVID, was that team-based care is protective in terms of our ability to feel connected to the work that we do every day. So the team-based care model is particularly effective right now as we are going through the crisis of COVID-19 and dealing with this. So if you don't have a team-based care model or you're interested in that, that's something that really could help you moving into the future. And as you're thinking about this, you need to understand how your organization makes change. So you may feel somewhat helpless in doing anything, depending on where you are organizationally, but think about that. Think about how does your organization get things done. Some, it's directives from the top. Some, it's a groundswell from the bottom. So those are important for you to understand because it helps you understand the culture of your organization. And that will help inform the way that you can bring some of this forward. Also very important to work with management, understand who is working on quality improvement right now, have that conversation, find out about PDSA cycles. Are there any that have been run in the past or changes that have been made within the organization with the QI team? And what have they done? What worked? So again, you have to do a little bit of research on your part, but now more than ever, it's so important to know where the resources are within your organization to help you move beyond this crisis. Next slide. And then personally, I think as healthcare providers, we tend to put ourselves last, and this is a very important time to put ourselves first. So I challenge all of you to think about self-care. And again, this is a personal conversation you'll have with yourself. So what do you do? What do you do for yourself? What do you hope to do? What do you plan? And then do you actually do it? What keeps you grounded at work? Why do you stay where you are? There was something that brought you there, and what is it that connects you to that work? And then spend some time really thinking about it yourself. What would bring the joy to work back for you if you feel that is something that you have lost? Maybe it's more time with patients. Maybe it's working on a project that had gotten sidelined because of COVID. And then think about the leadership team and what's going on, and what do you need? And have you had a conversation with a supervisor or with management about your personal and professional needs? It's really important to advocate for ourselves in order to deal with what we have to deal with at work, at home, but we need to be our best advocates because no one else is gonna do that for us. And that's something that we should really keep as we move beyond the crisis part of what's going on and learn to live with this new normal. Next slide. So roles and responsibilities, and this is just kind of an overview here of things that you might wanna do and just think about is if you didn't know about burnout before, just know that it was there before and it was already making life very difficult for those of us in healthcare. So the scene was already kind of set to make this difficult. And it has diminished income in many ways, both for attrition, poor coding, and a number of other things for our healthcare systems and the systems that we work in. Many people were already feeling exhausted and cynical before we started to deal with COVID. I mean, this is, again, something that's been understudied and something I've talked about in groups for a number of years, so it is not new. And now we have COVID, which has really stretched and stressed our healthcare system in a way I personally have never seen before. And then think about assessing your current work environment using the team approach that I mentioned before about joining work in the framework. And where do you think you and your organization stand right now? Feels a little bit like a loaded question, but it's definitely one worth asking. And then evaluate the practice. Just think about your team, the work that you do every day. Do we already use somewhat of a team-based care approach? And if you do, what works, and if you don't, why not? And are there small changes that could be made, possibly in a practice setting? Maybe a modification of a role, for instance, the role of the RN to do some follow-up phone calls with fragile patients or other things that could help improve this team-based care approach. One of the things that was already well-known before COVID happened was that the team-based model of care was considered a protective factor in fighting burnout. So those who felt or worked in a team-based model of care actually did better with burnout over time. So it's in our best interest to do this. Next slide. Next slide. Sorry about that. I did not quite click fast enough. So thank you so much, Cheryl. That was just an outstanding presentation to really provide guidance on leadership and working as teams during these challenging times. We are going to move into our virtual office hours right now. We're also joined by Dr. Paul Chang, HCCI Senior Medical and Practice Advisor, and Brianna Plensner, HCCI's Manager of Practice Improvement. We have received some excellent questions from our learners, and we're going to address those now. Remember that you can also submit questions via the questions and chat boxes as we proceed through this question and answer portion. Our first question that comes to Cheryl is, how could we attend to the needs of the patient at the same time of being flexible with the safety precautions for staff? That can also go towards Dr. Chang as well. Yeah, that's a great question. And I think that that's been, so I'll speak from my personal experience. I think that's somewhat of a moving target. So in trying to figure out how to work in an environment where we have a pandemic, it really is a new experience, I think, unless you've worked overseas or been through Ebola. What I think about when I think about what we're doing right now, and for those of us that were working back when the H1N1 came out, so we had to ramp up very quickly in a number of ways in order, and at that time, there was no vaccine. We were able to get a vaccine ultimately, but it was the same sort of sense of worry and fear of what's going on right now. So again, if you're not in a good place emotionally, maybe at home, who knows what's going on? We all have our challenges. When you bring that to work, it makes it very difficult to do the best for our patients. And I don't know that there's any one right answer, but the thing I would encourage you to do is to kind of take a step back and think about what you're doing for yourself. How are you taking care of yourself day to day? And make sure you're actually doing that, because I think we tend to skimp out on caring for ourselves and give so much to our patients. And in doing that and shortcutting that, I think we end up actually giving our patients less because there's not enough to give. You can't give at home, at work, and everywhere else. So take care of yourself. That's what I would say. You know, I absolutely agree with that. This is Paul Chan from Home Center Care Institute. It is so important for the providers to take care of one another, for us to take care of ourselves, because when we don't take care of ourselves, we really are not in a good place to take care of others. But specifically regarding things that we can do to help care for our patients during the pandemic, and also listen to the provider and their concerns. I just want to talk about a couple things real quick. One is to listen to the providers. What are their concerns? What information do they need regarding COVID exposure, trying to decipher the myths from reality? So listen to their concerns. The other is to provide them with some options. By that I mean, are they more comfortable doing a telemedicine visit? Because they're just concerned about possible exposure, or maybe postponing the visit with the patient until a later time. And the final thing is, are these providers going to go in to do a visit and make sure that the office is supplying them with the necessary equipment so that they feel protected and enabled to do great work in a safe fashion? So listen, giving them options, and giving them the necessary PPEs to do their work in the field. Those are some of my comments. Excellent, thank you. Another comment that came in, I'm most interested in guidance that you can provide on how to develop and utilize team-based care approach during the crisis. Sure, so first step is, do you have it? That would be what I would say. And back at the beginning slides, and we don't have to go back to those, but what's important about team-based care is that everybody knows their role. People are working to the top of their license. And there is maybe some crossover even with the work that is being done. I think that's what's important about team-based care. And sometimes you may feel, or your organization may say they're practicing team-based care, but you really need to look at it with a critical eye and say, okay, do I know what Susan does? Do I know what Susan does? So Susan may be my MA, and have I had that conversation? Or is that something, are all the MAs maybe have an enhanced role? So it's important to ask questions. It's important to talk with your team. And it's also important to talk with leadership to see how they view the team, because sometimes the view from the top is very different than the view from on the ground. And that, again, we had talked about communication. It's so important. And to have that communication, and you may be most comfortable doing that one-on-one with your supervisor or manager or someone within the office, or maybe it's something that gets you to make a suggestion to talk about that at a staff meeting. So there'll be different ways of doing it, but I think that the first thing you need to do is kind of do an assessment of your work location and say, does this look like team-based care? Everyone working to the top of their license, people working together on a common goal, people working towards the same mission, is it there or not? And I think sometimes we're surprised when we feel like we're in a team, but we're really working in silos. So know what your team looks like and ask lots of questions. Perfect. Dr. Ting, did you want to add anything to that or? No, those comments are wonderful, terrific. I don't have any additional comments on this particular question. Thank you. No problem. Next question. What tips for leading virtually when you work from home and some of your staff is still in the office, what tips can you provide? Well, the one in the plus column, at least for me, I had been doing work from home for quite a number of years, not seeing patients, but in other ways. So for those that are new to work at home, there's some very important things and there's probably lots of YouTube stuff out there too, but one is having a quiet space. We talked about this as we were preparing for this webinar because we are all doing this from our homes. So you need to have the right technology, you need to have a quiet space in order to work. Working virtually doesn't mean that deadlines change or things change just because you're not with a person. It means probably over-communicating rather than under-communicating because you're not going to run into your colleagues in the lunchroom. So don't assume, be very clear about maybe what you're thinking, what you're doing, or even something that you may want an answer to. Be incredibly polite. I would say go the extra mile to be polite to one another as you're working in a virtual environment. Keep your appointments beyond time, just as you would with anything else. It's even more so when you're working virtually and respect other people's time. I mean, one of my pet peeves in Zoom meetings is people coming late or forgetting to put the mute button on. So there's almost a higher level of caring for one another when you're doing that virtually and you really have to kind of stop and think about everything. So that's what I would say about my personal experience. Yeah, Paul Chang. With my practice, we have had several meetings where some of the providers are away from the office at home and some of the providers are here in the office and together. And trying to get a meeting with all of the providers in a group and also virtually can be a little bit difficult. So I recommend having some flexibility in terms of technology, whether it's having multiple laptops so that the providers here in the office can use individual laptops, or a combination of having a laptop and maybe a cell phone that has another app running that could be a video as well so that the other providers who are off campus away and at home can participate in a meeting if they don't have access to a certain kind of technology. So being flexible. And also, again, just leveraging different kinds of technology that you have in your office and the providers have at home, trying to get that meeting together and I totally agree, having some extra patience for one another because this is difficult times for all of us. None of us have been through this. So, we're in the caring community. I'll start to care by caring for one another. Thank you, Bo. What means do you anticipate for current and future recruitment of staff for in-home care? Similar question for educating public as well as for accepting medical staff into their homes. I'll defer to Dr. Chang on that one because I know the home care field probably a little bit less. So, I don't know. What do you think? So, obviously patients do have concerns about COVID and exposure and so on. So, regarding workflow in our office, when we make appointments with our patients for them to be seen, we do screening regarding whether they have flu-like symptoms or not. And obviously, if they have questions about providers being ill and so forth, we assure them that providers have to go through a screening process before coming to work as well. And if they're not feeling well, they are not expected to come to work or see patients in a face-to-face fashion. So, there's a screening process, both ways, screening the patients and also screening the providers before they can come to the office for care. The other is that when we go into a patient's home, we try to demonstrate that we do take this seriously and that we have a protocol in terms of protecting patients from possible exposure. That may include wearing gloves, face shield or face masks, and demonstrating that we are wiping out instruments before and after visits to give them a sense of that security, that we are taking this seriously and their health is important to us, that we don't want them to be exposed from any illnesses that the provider might be bringing in. So, bringing a degree of confidence and a sense of procedure that you know what you're doing when you come into the patient's home during a pandemic. And I think that can go a long way in providing some reassurance for patients and their families that they are getting great care at home in a safe fashion. And this is for you. Oh, sorry, go ahead, Cheryl. The other thing I was gonna mention, I liked the point about just demonstrating, like changing gloves and all of that. I was thinking of seeing patients today and because of the flow, I am cleaning the stethoscope, the chair, I'm cleaning as people are coming in, in part because it keeps things moving. But I think your point is well taken there, that for people to see you doing that makes people feel better to know that, yes, they actually are cleaning in between every single patient. And it was something that we would usually do and then have the patient come in, but now it's almost better to have them see us do that, to know that their safety and our safety is important. Yeah, I think that's a great point. This is Brianne, I was just gonna add, I think it's really important, just like we wanna show our staff and our team that we're flexible to also make our patients aware of the options that they have to provide care. I agree with what was said about, even if your staff, whoever's calling to confirm the in-home appointments starts the conversation with, I'd like to confirm your appointment, but first I'd like to spend some time speaking with you about the extra safety precautions we have in the home. And also, if you're not comfortable with an in-person appointment, here are the other avenues that we have for you to still receive care. If they're really not comfortable with the provider in the home, if you have a video visit or a virtual visit option or a phone call, I think we need to give our patient options but I also think that there will be a sense of comfort gained if they're kind of given that information and walked through that process right from the start. Great point. Excellent, thank you. So those are, I just wanna verify, do not believe we have any more questions coming in. As we move forward, we've got about four minutes left. I want to remind everybody about the resource center that we have, our hotlines, our webinars, the third Wednesday of every other month as we move forward and our virtual office hours as you saw today, as well as our tools and tip sheets. Our upcoming events, October, in place of our HCC intelligence webinar, we ask you to join us virtually and invite you absolutely to join us for our American Academy of Home Care Medicine pre-conference daily dilemmas and home-based primary care, as well as virtually for the coalition to transform advanced care pre-conference, bridging the gap, enhancing the model for complex illness management. You can always reach out to HCCI through our website, through our phone, through our email. We'd like to thank Cheryl Fetebene for being here with us today. You shared excellent information and it's something that as we move through this time, very, very valuable. Thank you so much as well to Brianna and Dr. Cheng for your insights and your information into the questions that were posed today. We do want everybody to stay safe, stay well, and have a wonderful rest of your day. Thank you so much, everyone.

Leading Teams During the Crisis

COVID-19

team-based care

healthcare professionals

burnout

communication

virtual environment

recruiting and educating staff

self-care