From addressing staff anxiety to retraining physicians to practice in an intensive care unit, unparalleled challenges have confronted physician group leaders amid the COVID-19 pandemic.
Despite these challenges, Alexa B. Kimball, MD, MPH president and CEO of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center in Boston, was able to lead her physician organization through a surge in Massachusetts, develop a telehealth program and spur a culture of innovation.
Since becoming CEO in 2016, Dr. Kimball has managed a team of nearly 2,000 physicians and advanced practice providers who provide care at 15 hospitals in Massachusetts. Dr. Kimball also is president of Physician Performance LLC, an organization of physicians that participates in value-based contracts, aprofessor of dermatology at Harvard Medical School in Boston, an author of more than 300 papers and a practicing dermatologist.
Here, Dr. Kimball discusses how Harvard Medical Faculty Physicians at BIDMC altered operations to respond to COVID-19, describes what's next for the physicians group and shares a leadership challenge she overcame and advice she has for other healthcare leaders.
Editor's Note: Responses were lightly edited for length and clarity.
Question: How has COVID-19 affected Harvard Medical Faculty physicians?
Dr. Alexa Kimball: It has been a dramatic journey, as I'm sure every physician group has experienced. I kept a diary of the things that I was thinking about day to day during the pandemic. It was March 11 when I sat my team down and said, 'We have to figure out a telehealth program, immediately, because even though the framework for paying for it and the rules weren't completely established, there was no way we were going to be able to take care of the people who we needed to without one. So I said, essentially, 'Damn the torpedoes. Full steam ahead. Let's create a program.' We moved very quickly from establishing a telehealth program to thinking about how we needed to redeploy positions, retrain physicians and make sure we were staffed appropriately. In Massachusetts we were about two weeks behind New York's peak, so we had a little more information and a little more time to plan. However, it was all hands on deck, all day long, to figure out how we could prepare our spaces, our people and our physicians to manage the COVID patients we anticipated seeing, and at the same time, manage non-COVID patients that we needed to see.
In addition to adjusting operations, we also pivoted to two incredibly important things. One was taking care of our doctors. There was a lot of fear and stress that stemmed from hard work, new environments, new things to learn and shortages of personal protective equipment. We needed to spend energy and time figuring out how to support physicians through this. To help manage this, we worked hard to improve communication by sending a daily newsletter and creating town halls where I provided updates. In addition, we increased some of our child care capabilities and benefits, helped get them food and provided emotional support and resources. It was really important to reach out to our physicians, because some of them were at home and wanted to be working, and some of them were working in new environments, and some of them were working in their usual environments.
A second thing that we emphasized during the pandemic was innovation. If we didn't have something or we didn't know how to get it, we needed to invent it. We were really able to capitalize on the community here in Boston to help us innovate around all sorts of things at lightning speed. Those were really the first weeks of the pandemic coming to Massachusetts. Then we waited a little, and we managed our surge in a very organized and thoughtful way. It was hard work, but we were well prepared.
Q: What's next for the physician practice group as you navigate a potential second wave and work to reopen for electives?
AK: Reopening is more complicated than closing, especially across hundreds of ambulatory sites. Reopening involves figuring out how to reprioritize and find the patients who need us most. For example, in my practice, we reached out to patients who were on medications that might affect their immune response and actively made sure we engaged with them. Another part we are working on now is integrating telehealth into our business permanently. We've relied on it substantially for the past several months, and we need to figure out how it can be incorporated long term. Will they be separate sessions? Who should we offer it to? Which physicians feel comfortable? How do we optimize those platforms? The last piece is really reassuring the patients that it is safe to come back and important for them to come back in person, and so we've developed a lot of both policies and also campaigns around making sure the patients understand that.
Q: Can you describe a leadership challenge you faced as a physician group CEO amid the pandemic?
AK: I think the first leadership moment that I had to manage was when I realized that I needed to switch from my usual management style, which is more of a coaching style, to a much more decisive, immediate and central style. There was no other way to manage all of the information, organize it and make the decisions at the speed that was necessary. The whole team needed to change. We needed more touch points, more daily huddles, more communication. I also needed to change how I got information and how I involved myself in the decision-making. I think it is also important to remember when to stop and phase back to your typical leadership style and analyze what the best approach will be for the team through the next period that we're about to enter.
The other challenge was making sure that the teams don't get too tired or too burned out and that there is balance to their workloads, while also making sure that they had clarity around their responsibilities.
Q: What tips do you have to maintain your team's daily motivation, despite setbacks amid the pandemic?
AK:I think reminding people that the core mission in healthcare is so important. It's key to remind them that although there is anxiety and fear, in medicine we have a great responsibility and are privileged to take care of people. At the end of the day, we could do something that nobody else could do, and reminding people in that moment of the importance of that was really helpful.I think the other really important lesson was that everyone experienced this pandemic in a different way, and so empathy was incredibly important. Some physicians were at home, really wanting to work. Others were practicing in different environments, under very uncertain circumstances. Some had kids at home who weren't in school. Some had parents in nursing homes they were worried about. Some had financial crises because their spouses were laid off. You couldn't predict what people were going through, and so we really needed a culture that met people where they were and recognized that this experience was unique and that we cared about them and their experience, whatever it was.
Q: If you could offer a piece of advice to another healthcare leader, what would it be?
AK: Always remind yourself, your teams and the people you work with, about the core mission of what we do as healthcare providers. Always start with the patient first, move to the providers and their experience and their support, and then figure out the rest. If you stay true to that compass, you might not always have a completely straight path, but you're anchored to that philosophy, and that will be guiding.
Q: What is your proudest moment at Harvard Medical Faculty Physicians during the pandemic?
AK: I couldn't be prouder of what our teams and our physicians did over this period of time responding to the COVID-19 spike in Massachusetts. The heart and soul that people poured into saving people was just extraordinarily inspiring. It wasn't a single moment. It was the aggregate of many moments and many stories that ranged from small acts of kindness to large initiatives that were critically important at the time. So it's really the aggregate of what everybody was able to accomplish and how we pulled together to get there. We're not out of this yet, but we climbed the mountain and came out the other side. We made a lot of people better and saved a lot of people on the way. And there's nothing quite like that.