Finding silver linings during the pandemic: An interview with Dr. Christopher Dale of Swedish Health System.

“As the Chief Medical Officer for a five-hospital system, I spend a lot of time thinking about how groups of people can collaborate better to deliver better care to patients and do so in a more efficient and effective way. And so, there are a lot of silver linings for us in terms of COVID, in terms of organizationally how we come together.” — Dr. Christopher Dale

Labcorp’s Dr. Brian Caveney conducted a fireside chat with Dr. Christopher Dale of Swedish Health System.

Dr. Brian Caveney (left) and Dr. Christopher Dale (right)

Question

Dr. Caveney: In the early days, we had a pretty significant global shortage of personal protective equipment to protect your frontline healthcare staff. How did you make those decisions about how to protect your clinical staff?

Answer

Dr. Dale:  There was a lot of ambiguity around what personal protective equipment was needed. We tried to listen to the CDC and the World Health Organization. Swedish is part of the Providence family of organizations, and so we were learning a lot from Providence. We were really trying to be accepting of the ambiguity and, at the same time, to be a source of authority and good decisions. The availability of things obviously was quite a challenge at the beginning. It’s like the run on toilet paper that we all remember from the grocery store. Same thing happened with gowns and N95s and surgical masks.

We were fortunate to come into this with a robust supply chain, but [we] definitely went through a period of time where supplies were tight. I remember being outside one of our EDs when a local Chinese benevolent organization came and donated a bunch of masks. I remember going out in the rain one day to get boxes of masks out of the back of somebody’s car. I was just so impressed with the generosity of our community as people came out of the woodwork to offer what they had so that we all could get through these difficult times together.

Question 

Dr. Caveney: I’m sure communication was critical as people on your team were learning things, as doctors were finding out things about patients. How did you communicate and make decisions on the fly?

Answer

Dr. Dale: It’s interesting to reflect on the silver linings of COVID and some of the lessons learned. One of them was about bi-directional communication. If you’re going to operate a large organization successfully, you have to understand what’s actually going on with the front line and what people are going through, and, at the same time, help get information out to the front line so that people know what we’re doing in terms of the plan.

We employed a tiered huddle structure at each campus. At each one of our hospitals, there’s a daily huddle, and that’s where, starting at the unit level, we’re able to understand what’s going on. That filters up to department levels, that filters up to the hospital and then ultimately up to the system. Then we’re able to make decisions rapidly together as a system and then push some of those things back out again.

Question

Dr. Caveney: One potential silver lining, based on the perhaps hundreds of conversations I had with physicians across America—who probably hadn’t used the words ‘sensitivity and specificity’ since the medical school test—gave us an opportunity to explain that no test is perfect. No test is 100%. You have to put it in the context of the rest of the clinical information and you don’t treat the number, you treat the patient using the data that you got from the workup that you did.

We’re happy to contribute to the incredible work that doctors, nurses and others have done across the country, throughout the pandemic. Are there other lessons that you would share with our audience from the pandemic?

Answer

Dr. Dale: As the Chief Medical Officer for a five-hospital system, I spend a lot of time thinking about how groups of people can collaborate better to deliver better care to patients and do so in a more efficient and effective way. And so, there are a lot of silver linings for us in terms of COVID, in terms of organizationally how we come together.

We’ve kept the tiered huddles structure going that I mentioned before and coupled that with a management system that really works on closing the loop with frontline caregivers. You hear about burnout, particularly in healthcare, and one of the ways to fight burnout is to look at those things that are difficult in people’s daily journeys and figure out how we can improve the lives of folks who are trying to improve the lives of others.

For me, that’s one of the tremendous lessons to come out of this—the focus on provider and caregiver wellbeing. And what are the things that organizations can do to progressively make the delivery of care more efficient, more effective and ultimately easier for caregivers and providers. If we can make ordering the right lab easier or interpreting the results of the lab better and more reliable in the context of the patient, I think those are areas where Labcorp and delivery systems like Swedish can partner so that we can continue to improve the care that we deliver to our patients.

Question

Dr. Caveney: There was incredible collaboration among the different commercial laboratories to figure out what platforms to bring up, what the global supply chain looked like and how we could improve the science and, eventually, turnaround times. How did you make decisions around bringing up some testing capacity locally on site versus needing to use excess capacity for maybe less acute patients and outpatients at a partner like Labcorp?

Answer

Dr. Dale: We rely pretty much exclusively in terms of our inpatient footprint on Labcorp for testing. We had a series of discussions around which machines would be available, and then reagent availability was a big issue. We really tried to answer the question: what’s the best way to provide the quickest turnaround time for people who need it the most?

It’s interesting to hear you talk about the commercial testing labs coming together across America. Maybe we don’t talk enough about the number of different parts of America that had to come together in order to fight the global pandemic, right? There’s so much interdependency in this very complicated system. As a healthcare delivery system in Seattle, we’re not experts in lab testing. We’re experts in patients and in diagnosis and in treating people and in having relationships and in our local communities, but we need to have partners who have deep expertise in their areas of expertise, so that we can all come together to improve the health of our communities and keep people safe. We saw areas here where people rose to the challenge again and again.

Question

Dr. Caveney:  Do you think that there are some potential lessons learned from what we’ve all gone through so laboratories and the clinical and administrative staff can work together in the future to drive better care outcomes because of a more cohesive and collaborative clinical environment that we all want to see?

Answer

Dr. Dale: Unquestionably so. I’m a pulmonary critical care doctor, so I’m an internist, and you can’t practice internal medicine without good laboratory data. It really is being able to take the measurements of blood or serum or whatever it is and put them into the context of the patient. Then form a diagnosis that we can act on. If you couple that with therapies and treating patients, then you have what medicine is from a scientific perspective. Doing what’s humanistically right for patients is the art of medicine. I think that we can continue to partner more and really collaborate to provide better services for patients.

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