Monday, March 15, 2021 6:15 pm

The Stress, The Changes and The Challenges Ahead

If you pull together a nurse, a physician and a healthcare IT expert, you could pretty much run any kind of medical organization you wanted. West TN Medical News gathered them together for their take on one of the most challenging years in healthcare history and to look ahead as well.

This year in our feature story we spoke with Kelly Harden, DNSc, Dean and Professor of Union University School of Nursing; Ronald H. Kirkland, MD, President-Elect of the Tennessee Medical Association and Scott Krodel, Chief Information Officer at West Tennessee Healthcare. Enjoy.

How would you describe your style of leadership?

Kelly Harden, DNSc, APRN, FNP-BC, FAANP Dean, College of Nursing and Health Union University

HARDEN: I use a mixture of styles, depending on the issue at hand. We use a team approach in the College of Nursing, so I like to interact with team leaders but give them latitude. I enjoy hearing the perspectives and suggestions from all faculty and staff. I believe my job is to advocate for our team and ensure quality education for our students.

KIRKLAND: I view my role as President-Elect (soon to be President) of the Tennessee Medical Association (TMA) as being the representative of all Tennessee physicians to the public, to the media, and to our State Legislature. Further, there is my role as lead cheerleader for our more than 9000 member physicians in over 2000 practices across Tennessee. Finally, there is my role as consensus builder on our Board of Trustees to try and keep our TMA ship on course. Each of these roles involves having a positive attitude and a continuing emphasis on improving health care for our patients.

KRODEL: I believe my style of leadership aligns with strategic and transformational leadership. In my role, it is vital to have vision and the plan to accomplish it. At the same time, I recognize I need to lead with the mindset and heart of a servant leader. I'm very open and have a great desire for my team members to grow professionally and personally. We are here to serve and make a difference in each other's lives.

How has Covid-19 affected your profession/organization and how much of your time has been allocated to ensure the safety of your staff & patients?

HARDEN: As an educator the impact has been significant. We have had to find creative ways to keep our students safe, both in the classroom and in the clinical arena. Last spring, all of our classes were online. Utilizing new technology and resources was very time consuming for faculty. Thankfully, we have a fair number of classes online anyway. One of the most challenging things was deciding how to move simulation experiences and clinicals to a virtual format for those programs where that was allowed by accrediting bodies. I am happy to say that with a lot of hard work and perseverance, we did it! Some people have the impression that online classes are less work for the professors and the students - that could not be less true. Countless hours were spent working all of this out.

The nursing profession has been front line in the fight against Covid-19. Nurses place themselves at risk every day anyway, but in this pandemic that has been exponentially magnified. There is not only great physical risk, but I believe we have not really begun to imagine the psychological effects on nurses (and other healthcare workers). The sheer number of hours alone that nurses have worked during the pandemic is unbelievable. The safety issues extend to family as well.

KIRKLAND: Like so many other industries and business nationwide, our TMA was not immune to the effects to the pandemic. When the coronavirus first presented, Tennessee physicians went on high alert, first to provide high quality patient care, and second to measure the impact of the pandemic on our profession. In March, while frontline physicians, healthcare workers and hospitals were besieged, the other half of our profession saw reductions in patient care volume by up to 75 percent in some areas. It was difficult to predict how long these changes might last, or whether a practice could sustain itself and retain employees.

Historically, most of our member events have been in person, requiring travel by leaders and staff. As did many organizations, TMA began to deliver our events and services virtually.

As a volunteer membership association our physician members pay dues annually. We anticipated a 20 percent reduction in revenues and modified expenses accordingly. Thankfully, the depth of reductions was much less. Meanwhile our staff began to work safely from home and, as necessary, in our offices to a limited extent.

Scott Krodel Chief Information Officer West Tennessee Health Care

KRODEL: I believe every crisis can have a positive and negative affect. Covid-19 has impacted healthcare organizations in a dramatic way, and for me the "after crisis" realization has not hit us. It will change how we do things in the future as it relates to future care models and the continuum of care.

I started with West Tennessee Healthcare the week of the pandemic, and the team here started rollouts of technologies as quickly as possible to align with new care models. Everything we did needed to align with keeping the patients safe and giving them the appropriate care. We followed a pilot and scale model.

Like many healthcare organizations our Virtual Care program was not in place. There are multiple technologies that support virtual care. For example, our footprint in telehealth was very small. The pandemic required us to do rapid install of multiple telehealth platforms that aligned with the business and care needs of our community. Our number one priority was to provide patients an option to continue receiving care.

The technologies we implemented will continue to allow West Tennessee Healthcare to enhance and continue to offer access to care in rural areas.

Telehealth was a spring-board for us as we continue to roll out technologies and plan for a larger virtual care strategy. I believe our internal tracking systems will be enhanced, we will be working toward a care-at-home model, and we will be reviewing the opportunities around EICU to enhance our care. These steps bring in Artificial Intelligence to assist our care providers and manage patients virtually.

The true heroes are the care teams at West Tennessee Healthcare. Our physicians, our nurses, the teams at the patient side. My job was to bring safe technologies that could help them and the patients during an historic time. I'm humbled and proud to witness the care these teams provided during these times.

What is the stress-level of your team/staff/profession in the Covid crisis environment and what is your strategy or advice to help them?

HARDEN: Well, nurses are known for keeping calm in a crisis. Of course, this crisis is not one we have dealt with before in our lifetimes. Students were stressed at the beginning, but with much education about how to protect themselves, and moving things online for a while, they adapted well. In addition, faculty spent so much time interacting individually with students via phone, zoom, and FaceTime - that helped to reassure students. As a faculty, we began preparing for this early. Of course, our plan changed frequently, but we were nimble in the rapidly changing environment. Union had a task team early on that met several times a week, and that was reassuring to faculty and staff. I must say that our team coped well and worked together to help each other. In my opinion, the most helpful thing you can do during a crisis is to plan. Don't just let things happen without thinking through how you should move forward.

For nursing in general, I think ensuring PPE and other safety protocols (to the best of ability) was helpful. We were able to donate many of the supplies from our labs to hospitals. Our engineering department manufactured face shields to distribute to local facilities. Administration keeping nurses abreast of new information is also key to decrease stress. Nurses are accustomed to do what is needed, so I think that we may not see the full effect until things slow down.

For our students, faculty, and staff, the most helpful tool we have had is prayer. We have gathered to pray for our clinical partners, and of course patients and families. Even in this storm, God has blessed us.

Ron Kirkland, MD Pres Elect (May 2021 installation) Tennessee Medical Association

KIRKLAND: The unexpected and urgent shift in our manner of doing business caused stress due to the immediacy of that shift and the sheer magnitude of unknowns we were dealing with as an association. Our association staff is a tightly knit unit, accustomed to working closely in an office environment. The pressure on them to not lose momentum in their daily projects and to work in a brand-new environment was immense in the early days of the pandemic. Fairly quickly our TMA staff adjusted aptly and kept a business-as-usual sense about them. This was also very helpful to our volunteer leaders, who were dealing with similar stresses in their own practices and communities. The shift to virtual meetings greatly aided our ability to stay on track and to stay in contact with one another during trying times. Our best strategy was to over communicate during time of crisis.

KRODEL: With any crisis your stress level goes up, and we had times where we had to step back and change a process or technology in a rapid fashion. We needed to support many areas of technology, and we were moving our teams virtually as much as possible.

The key for us was honest and open communication. We changed priorities and staffing models to meet the need. Our CEO entrusts our team to do what we have to for our community without any restrictions. That was key for us to do things in a rapid rollout model.

Ultimately my key advice is keep it simple, communicate, and validate. Things were moving so fast it was key that each individual worked with this mindset.

What is the biggest challenge you/your organization/your field (physicians, nurses, HIT) are facing in 2021?

HARDEN: Many nurses are "burned out," what we now call "compassion fatigue." It is hard to say, but I hope seasoned nurses will not leave the profession. We do not yet know the full effect of the pandemic on healthcare workers, and I believe new challenges will arise as time passes. Around the world, adequate resources (PPE, vaccine, human workers) are still not available. There are financial issues because so many businesses have had to close, and people have lost their jobs. Access to care due to loss of insurance will be a challenge.

KIRKLAND: We are still operating in a remote work situation eagerly awaiting the time our staff and our volunteer leaders can be together again to reconnect and regain the synergies that only come from meeting in person. We can complete most daily functions virtually, but nothing replaces meeting in person!

A large part of our association focus is advocacy work representing physicians and patients. Most of this involves working with our State Legislature which itself is meeting with very little direct contact from outsiders. While we can present our information and interact with lawmakers by phone and by video conference, once again we are much more effective in person.

KRODEL: I think of the word recovery. There are multiple areas that are going to be key challenges for many healthcare organizations. This includes staffing fatigue, crisis support models, finances, and for my team, entering a new era of technology.

I do believe our journey in 2021 is the start of many great things to come. West Tennessee Healthcare's mission and vision will be stronger than ever. Our physicians, our staff, and most importantly our patients have a healthcare organization they can rely on.

What are you most looking forward to in 2021?

HARDEN: In nursing education, our students now have had the unique opportunity to work during a pandemic. They have seen how the pandemic affects clinicians, administrators, and all areas of healthcare. They have experienced firsthand not only the medical impact, but the impact on the economy, and the effects of health policy. I am looking forward to using this experience to add to our curriculum in future courses.

I think that many nurses now see the importance of leadership, and I hope they will move into leadership roles, and maybe even run for political office!

Thanks to the foresight of this University, our classes have mostly been face to face since the fall semester. I am looking forward to continuing that model, and someday not having to worry about masks and social distancing, etc.

I am looking forward to the positives that will come out of the pandemic: innovative use of technology, more cost-effective care, increase in the number of people wanting jobs/education in healthcare, and a better positive opinion of healthcare workers.

KIRKLAND: Without a doubt, TMA is looking forward to reconnecting with our colleagues in person. The core purpose of any association is to bring people together to share experiences, learn from one another and unify our opinions and voice. We can and have been able to do that virtually, but human interactions cannot be replaced.

KRODEL: Meeting our care teams and delivering new technologies that will improve the care to our patients. There will always be funding priorities, but I believe healthcare organizations have seen their IT limitations and opportunities during this pandemic. I think 2021 and 2022 will be the start of something new for the West Tennessee Healthcare Information Services team. Our focus is "IT THAT WORKS" and it has a personal meaning to each of us.

If you could give one piece of advice to someone thinking about going into the healthcare profession today, what would it be?

HARDEN: There are some people who go into healthcare for "good money and a four-day work week." Good luck finding that job. Although there is a fair degree of job security (many healthcare workers were placed on furlough during the pandemic), you better love what you do. It is hard. My advice is to shadow someone in the role you aspire to for several days to be sure you enjoy it.

Healthcare is a very rewarding profession. There are many avenues down which to journey, and if you grow weary of one area you can often move to another. To me, it is a ministry. God has entrusted us to care for His most precious creation - man - at his most vulnerable.

KIRKLAND: No one knows the future, but our newer physicians may have to fight to maintain the physician-patient relationship and protect it from the rise of technology and artificial intelligence. While high tech can be a great aid in diagnosis and in-patient care, it should never replace physicians and hands-on care. If someone is interested in working to preserve our most honorable profession, come on!

KRODEL: I have been in Healthcare IT for 30 years. The technology and the opportunity to impact people's lives in a positive way is very rewarding. It gives IT a perspective beyond nuts and bolts. Everything we do has a purpose with our patients in mind - meaning the mission of most healthcare organizations is to provide the best care possible. I believe if you are thinking of a healthcare profession you need to be purpose- and mission-driven.