Leading Recovery Whitepaper

From Managing a Crisis to Leading a Recovery

About Alliance

Across 47 states, Alliance works with more than 1,100 hospitals and physician groups to provide industry-leading solutions, partnerships and patient care in the areas of radiology, cancer care and pain management.

Why We’re Sharing

We knew we weren’t alone in the early and chaotic days of COVID-19 as a healthcare organization — but it certainly felt that way. As stay-at-home orders shut down all but essential services across the US, and as cases began to spread across our communities, we launched our crisis response process, led by our Executive Leadership Team.

And then the sprint turned into a marathon, as it became clear that COVID-19 would be with us for the foreseeable future.

We made the decision to document and share more widely our experiences and learnings with other leaders and their teams (which, notably, are ongoing) after being asked by partners to do so. We hope that some of what we’ve learned may help your team continue to not only manage through the pandemic, but lead your team along a recovery path as well.

We made the decision to document and share more widely our experiences and learnings with other leaders and their teams (which, notably, are ongoing) after being asked by partners to do so.

COVID-19 Leadership Response Wheel

We’ve divided up this White Paper into a “Response Wheel” outlining four areas of leadership focus.

Click on the Response Wheel for more information. If you’d like the White Paper in a printable PDF, please submit the form below.

COVID-19 Leadership Response Wheel

Safety , First

Drive Good Process

Care & Communication

Lead the Way Forward

Rhonda Longmore-Grund

From the very beginning, we made it clear with our teams across the country that safety would be our first priority — the safety of our Team Members, and of our patients. This seems obvious as it is a basic tenet for all providers of healthcare, yet as time goes by, pandemic fatigue is real. It’s our job to be sure we continue to be vigilant about all of the components of safety.

Rhonda Longmore-Grund, President & Chief Executive Officer

Clinical Readiness, Then & Now

All healthcare organizations have ongoing quality and safety efforts; many like ours also have disaster or crisis response plans. Based on our conversations with customers and partners, however, not many had full, up-to-date pandemic response plans, and even fewer were prepared for the months-long experience we find ourselves in with COVID-19. As many organizations move from initial response to ongoing clinical management during the pandemic, assuring that the safety of patients and Team Members is paramount requires constant vigilance.

  • Provide clear personnel and patient safety guidance via consistent channels that you know will be used and accessed — and update regularly.
  • Don’t assume Team Members have retained initial COVID-19 guidance; continue to reiterate key components of safety (i.e., appropriate donning/doffing of PPE).
  • Update patient and Team Member exposure and symptom screeners regularly.
  • Adopt a site readiness process to assure that facilities continue to adhere to COVID-19-related policies daily, as well as over time (source control, screening, ICP, signage, social distancing, visitor policy, pens and paper use, etc.).
  • Provide ongoing training for Team Members in an easy-to-reach format — paying close attention to shifting safety guidance.

Create a centralized location for all COVID-19 related tools and resources, where all of your Team Members can find what they need — but remember to regularly clean out and reorganize the content as things change. Your intranet is the perfect spot!

Working from Home

Like most healthcare organizations, we have Team Members on the front lines of care, and others who are working behind the scenes to support those operations. Due to the speed of government and state actions, many Team Members were moved home quickly at the start of the pandemic. This has necessitated further action as of late to be sure Team Members have all of the tools and resources they need to be productive at home for longer. We also learned as time went by that a work-from-home scenario may seem idyllic at the outset — but can be quite challenging for Team Members. Creating ways for those Team Members to stay engaged, connected and productive has been a growing focus.

  • Establish and regularly update clear guidance for who should (and, can) continue to work from home, and why.
  • Be aware of and talk openly and regularly about concerns (or opportunities) related to work-from-home decisions.
  • Provide appropriate guidelines, tools and resources — which may include technology enhancements such as video conferencing abilities.
  • Be cognizant of the real impacts of work-from-home situations due to socioeconomic factors, family responsibilities or pandemic-related stressors, and work with your HR team on ideas and potential solutions.

Contrary to popular belief, working from home — particularly in today’s pandemic times — can create MORE stress and much longer hours for many Team Members, not less1. Take time to proactively work with leaders and their teams to put related guidance into place to help Teams get and stay engaged — without burning out.

1https://www.bloomberg.com/news/articles/2020-04-23/working-from-home-in- covid-era-means-three-more-hours-on-the-job

Clear Guidance, Short Horizons

We fall into patterns in healthcare management, one of which is updating policies and procedures on a quarterly, bi-annual or annual schedule. COVID-19 requires that guidance be updated much more often, with careful attention to trustworthy sources. Bringing together different teams — leadership, operations, clinical, HR, legal — has helped us continue to review, update and share important safety guidance with our teams at a time when the marketplace is flooded with tongue-in-cheek voices and inaccurate information.

With companywide guidance (for example, travel and meeting restrictions), we discuss, decide upon and publish monthly decisions to all Team Members. With clinical safety guidance, such as exposure risk assessments or screening protocols, changes can happen even more often and may be dependent on state, local or public health guidance within a community. It’s a lot to manage — but it’s necessary in a safety-first culture.

  • Identify who consistently drives updates to COVID-19-related policies and procedures. This can be a committee, function or person.
  • Make room where necessary for differences in state, public health or community guidance if you operate in more than one community or state.
  • Resist the urge to make sweeping decisions with long-term horizons — create a monthly cadence for what decisions will be made or guidelines updated, and stick to the timelines.
  • Be specific and repetitive when making a change. Team Members have a lot of information coming at them each day and can miss information or context.
  • When updating guidance, put processes into place that help assure Team Members understand and adhere to changes.

Set a date (or, dates) within each month when COVID-19-related policies, procedures, decisions or guidance are published, and use a cascading approach to communicate. This develops an organizational habit to “look for” updates and changes and reduces pandemic-related confusion.

Rich Jones

We assumed the need for a COVID-19 Task Force and ‘rapid response’ process would be important as the pandemic initially took hold. What we didn’t anticipate was the continuation — even expansion — of that need over time. For our organization, having a coordinated, sustained effort, driven by clear processes and supported by constant communication, has been a critical component of managing through COVID-19.

Rich Jones, President of Alliance Radiology

Rapid Response

With hundreds of sites across the US and nearly a million patients cared for each year, having a way for our Team Members — from Florida to Alaska, California to Maine — to get fast answers to emerging coronavirus questions was critical. Implementing a Rapid Response process to centralize these efforts, and to share expertise across not only geographies but services lines, was an immediate need and effort.

  • Be sure your ongoing response efforts include five key components: intake, evaluation/processing, response, tracking and communication.
  • Speed is key: Team Members will use a response mechanism openly and well if they feel they get a timely response — which helps drive good decision-making across the organization.
  • Clarify and coordinate roles within different teams involved in rapid response efforts. Focus on continuous improvement when positive or constructive feedback comes back to the team.
  • Use the latest guidance from trustworthy resources, including federal and state agencies, community public health organizations and internal policies and procedures when making decisions about coronavirus responses. In particular, stay up-to-date with changing CDC recommendations, especially those related to healthcare providers and employers.
  • Use existing technology and teams where you can, and scale efforts up or down as demands change.

One of the most challenging aspects of managing COVID-19 falls outside any of ours four walls — in the hands of federal, state and community leaders and public health officials. This is especially true state to state as reopening activities continue. For up-to-date information on state orders and other related guidance, here’s a great resource.

Optimizing the COVID-19 Task Force

Most organizations have put some sort of centralized committee into place during COVID-19; for us, that’s our national COVID-19 Task Force, which includes representatives from different services lines and our executive leadership team. We’ve learned a lot of lessons since March about how best to assemble, what tools to use and what process to follow, which we’ve summarized in the following checklist.

  • Keep the team small and diverse – meaning, no more than six people, from different functions and backgrounds. This requires expert communication with other teams and functions, but is crucial to speed and agility.
  • Touch bases daily to discuss ongoing initiatives, incoming questions or other priorities, so issues do not wait and turnaround times are faster back to the organization.
  • Clarify roles within the Task Force. Who will do the responding? Who will create related communications? Who will oversee legal or HR reviews? Who will provide clinical, quality or safety inputs? Understanding responsibilities on the Force will help it to move more quickly and avoid confusion.
  • Separate rapid-response work from ongoing projects and be sure you implement a closed-loop system that helps track each inquiry through resolution. Set a daily 30-minute check-in to be sure all questions requiring fast answers are addressed, and a bi-weekly or weekly meeting to discuss policy, tools or communications updates.
  • Insist that your Task Force not become insular. Force open coordination and communication across different functions, divisions and service lines to inform process and decision-making.

Minimize personal bias in decision-making by your COVID-19 Task Force by establishing a set of tools, based on dependable third-party guidance, that aid in decision-making, such as intake forms, exposure analysis tools, next-step algorithms, policies and procedures, and return-to-work guidelines. This is especially helpful when a Task Force member needs to make a decision without the benefit of a group conversation or meeting, or when a new member joins.

Douglas McCracken

Our patients come to us for cancer diagnosis and treatment — which already creates a high level of stress. Concerns related to COVID-19 only exacerbate that anxiety. And this is true for our Team Members, too, who are used to caring for vulnerable patients, but who are now themselves working and living very differently because of the pandemic. As an organization, we have a responsibility to do all we can to show our Team Members and our patients that we genuinely care.

Douglas McCracken, President of Alliance Oncology

Transparency & Persistence

In a national survey of our leaders in late May, respondents identified the intentional increase of consistent, dependable, open communication as a significant help in pandemic times — with a request that we continue even after COVID-19 subsides. We are sure we aren’t alone.

  • Decide, based on your culture and communication philosophy, what types of information your organization will continue to share with all Team Members, and why. Develop or update your template.
  • Stick to the agreed-upon frequency of communication and methods. Only veer from them if you opt to change intentionally — and then talk about why that is happening.
  • Adopt a cadence that helps your teams communicate in healthy, productive ways with each other. That may mean a cascade from leadership through to the front line. The objective should be to help leaders effectively communicate with their teams, provide Team Members with a way to stay up-to-date easily, and help open channels of two-way communication.
  • Provide multiple ways for Team Members to respond, ask questions and engage.

Record regular updates from leadership so that Team Members who cannot attend are able to get up-to-speed offline. Publish talking points for leaders after all-hands meetings to help them review important points with their own teams. Take time to review the “why, what and how” of your communications within the context of what will help your team the most.2

2 https://www.forbes.com/sites/tracybrower/2020/03/16/the-coronavirus-makes- communication-more-important-than-ever-9-tips-for-communication-that- reassures-and-reengages-people/#66ee4b95140c

Compassion & Grief

In late March, Harvard Business Review published an article titled, “That Discomfort You Feel Is Grief.”3 In it, the writer interviews David Kessler, an expert on grief and loss. Our leadership team felt this resonated with our coronavirus experience; we shared the article within our organization, and one of our executives developed a short virtual workshop as a conversation starter for regional leadership teams across the country. Though virtual, sessions were confidential and personal. Providing a way to show Team Members there is care about how they feel, and that there is compassion for the difficulties COVID-19 has brought, is a powerful experience.

3 https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief

  • Recognize that social distancing, remote work, anxious patients and even the constant use of PPE creates anxiety and loneliness for some Team Members – even while others are not affected. Work with your team to discuss ways you can connect safely with one another.
  • Make room for – but don’t force – your Team Members to recognize stages of grief in healthy and productive ways, and make sure Team Members know what assistance is available to them if they find themselves unable to cope (i.e., through an Employee Assistance Program).
  • Come up with creative ways for people to show care and compassion for one another and encourage that outreach.

Remember that every crisis — even this one! — has a life cycle, and within each stage our teams may be feeling and acting in different ways. As leaders we can help foster trust and take action by communicating openly and directly about the situation at hand and related actions — and more. We can demonstrate our vulnerability as leaders in careful and appropriate ways. Sometimes the simple act of sharing your own experience or feelings can help others on your team feel comfortable sharing theirs.

Cultivating Hope

A Gallup study of more than 10,000 employees found there are four things needed from leaders: trust, compassion, stability and hope4. Gallup contends that at this time, hope is more crucial than ever — and it’s not due to sentimentality. Hope in the workplace is crucial; as a matter of fact, Gallup found that employees who strongly agree that their leader makes them feel enthusiastic about the future are 69 times more likely to be engaged with their work. We all need to believe that we will get through these challenging times — and that a better future is ahead. At Alliance, we take care even when sharing difficult news or decisions to also put it in context of three related tenets of hope: objectives, enthusiasm and new ideas.

4 https://www.gallup.com/workplace/308459/lead-workplace-hope-covid.aspx

  • When communicating news — good, bad or otherwise — take care to identify the “why” connected to the future state. Is the action your team is taking helping you create a better future for your team? In what way?
  • Create a way for teams to share not just difficult times, but to celebrate wins and good news. This is hard in a socially distanced world, so creativity is key.
  • Reconnect to your mission with your team. Help them bridge actions they must take today, to your organization’s purpose.
  • Give room for skunkworks projects. Innovation can and does take place amidst crises like the one we are all managing through now — although it can feel counter-intuitive. Give your teams permission to do some problem-solving. They may have limited funds and limited bandwidth — make up for it with a dose of creative freedom.

Start a “Stories of Good” repository — and share widely. Invite your Team Members to submit stories experiences they’ve had that give them hope or help them appreciate others. Make it easy for them by providing a dedicated email, a survey, an ad-hoc request ahead of a meeting. Share the stories in ongoing communications or by highlighting them in meetings.

Tracy Wise

It’s one thing to respond to a crisis. It’s an entirely different challenge to help a team turn from 100% response, to simultaneous response AND recovery. Especially now, when we’re still in the thick of the COVID-19 battle, making this shift can be challenging — and for all of us involved in providing improved, efficient, equitable healthcare in the U.S.: it’s essential.

Tracy Wiese, Chief Strategy & Marketing Officer

From Managing to Leading

Deloitte, in its series on resilient leadership in context of COVID-19, discusses the need for leaders to understand a mindset shift we must undertake when we and our teams move from responding to COVID-19, to recovering from COVID-19 as an organization5. It is critical to help our teams define an interim normal out of a chaotic situation, and there is an opportunity to help teams create a new future together. If your team has not started the hard work of recovery planning — today is a great day to start.

5 https://www2.deloitte.com/us/en/insights/economy/covid-19/guide-to-organizational-recovery-for-senior-executives- heart-of-resilient-leadership.html

  • Begin to socialize the idea of recovery with your team. What lessons are you learning together that can be applied to a new future? What good is coming from this experience for the team? Where are you seeing “rays of sun” amidst the difficulty?
  • Turn your focus as a leader to the terrain. What is happening with your patients, partners, providers and other stakeholders in this crisis time, which will “stick” in recovery? What implications will that have for your organization?
  • Reach out to those you know can help you as a leader think through recovery – including those from outside your own organization. Gain perspective and partnership where needed.
  • Set a process for recovery planning that’s summary form, and visual.

To help your team move from internal to external focus, identify your most important stakeholders and begin to document how their worlds, work and needs have changed. Share this with your team, and ask them to add their insights and what potential implications might be for your organization going forward. What will be short-term? What will be more permanent? What does it mean for your organization and your team?

Engage in Recovery Planning

Depending on your organizational culture, performance and approach, you likely have a pretty detailed strategic plan, which you were executing with gusto, until about the second week of March. For the last several months, healthcare organizations have largely had to pause portions of their tactical execution to work through COVID-19. And though it is tempting in recovery to pick up where we left off, we should pause as leaders to assess impacts and opportunities that were not present before the pandemic hit. In some organizations, this may lead to a complete reinvention of the plan; in others, it may adjust or push some priorities but leave the foundation largely untouched. How might you approach recovery planning? Here are a few ideas.

  • What does your recovery plan need to incorporate? Take time to detail out the components of that plan, and what it means for you and your organization or service line(s).
  • Set a process for recovery planning – and resist the urge to drag it out. What will define recovery for your team and organization by the end of this calendar year? What will be the implications for 2021?
  • Engage and keep your leadership team involved. This is more difficult in a virtual workplace, but it can be done. You may need to balance pre-work with video sessions and offline conversations with summary sharing.
  • Work with your teams to create tactical plans that can be tracked, executed and flexed, especially in the short term. The pandemic means we will all need to be more agile than ever for the time being – and at the same time we still need guidance from a plan.

One of the most challenging aspects of planning today is the inability to “be in the room” together. When face to face, facilitators can help draw out quieter voices, watch body language, and encourage collaborative discussions or healthy conflict around key strategy areas. Virtually, this is much more challenging to accomplish. Help the process by using online tools such as pre- or post-meeting surveys to draw out opinions; provide homework for leaders to complete ahead of the session to help with efficient conversations; chunk out the work to minimize meeting fatigue. It’s not easy to be in a Board room for 8 hours — but it’s downright unproductive to be on a virtual meeting for that long!

About Our Services

Alliance HealthCare Services partners closely with more than 1,100 hospitals, health systems and physician groups and has spent over 35 years delivering and optimizing industry-leading solutions, partnerships and patient care in the fields of advanced diagnostic imaging, cancer care and pain management. We are committed to helping our partners provide safe, high-quality healthcare services that are essential to our communities. Alliance remains focused on helping partners build exceptional, sustainable, profitable and competitive businesses.

Contact us today to learn more.

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All materials have been prepared for general information purposes only to permit you to learn more about our COVID-19 approach and the experiences of our corporation. The information presented is not legal advice, is not to be acted on as such, may be outdated from time of publication and is subject to change without notice.