Leading with Compassionate Agility During a Global Crisis

Agatha Okobi, Princeton University

Introduction

As a patient I was often faced with moments of despair, pain and isolation. Even with providers bustling around me in and out of my room. It was often a gentle reminder from a clerk asking if I was ok or if I needed anything else that reminded me that these small moments of reading between the lines can mean the most of patients in crisis. Health care is often more care than health. And teaching our future professionals this is of utmost importance alongside reading the lines of the EKG we need to train reading between those lines as well and be agile in knowing when to act. 

We are all being tasked how can create compassion during a time of crisis. However, a crisis requires agility and resilience. Agility, combined with compassion, needs to be well understood along with courageous conversations. These terms cannot be assumed to be known to all healthcare providers in a crisis. Our patients deserve healthcare leaders of the future that are prepared to address 21st-century challenges head-on.   

To counteract the numerous current health crises and make health professions training more comprehensive, agile leadership combined with compassion and empathy, training should be incorporated early in health professions curricula. Furthermore, other authorities such as hospital leadership and federal and local governments would benefit from integrating agile concepts into policy. Agile leadership is a people-centric leadership style that prioritizes collaboration and adaptability [1]. Compared to more traditional methods of management, Agile leadership training is a more flexible model for healthcare. In an ever-changing world, issues like racial inequality, COVID-19, and the opioid crisis must be addressed with agility, courageous conversations with compassion. 

The Case for Compassionate Agile Leadership

Agile leadership would greatly benefit the broader healthcare arena because research has shown a growth mindset to improve learning outcomes and flexibility [2]. Along with other aspects of developmental psychology, growth mindset, the mindset that capabilities can develop over time with effort and learning, is a central tenet of agile leadership. The enhancement of learning outcomes and plasticity that come with a growth mindset could translate into the realm of healthcare because of the necessity to adapt to changing medical situations and arising crises.   Collaboration, another major element of agile leadership, between emergency physicians and hospitalists, decreases treatment costs, and increases the quality of care. Specifically, the rate of readmission for the same diagnosis decreased [3]. This finding indicates an untapped potential in healthcare. Collaboration in medicine can be greatly beneficial and useful.  Collaboration is also necessary for the broader healthcare sphere because people of many different professions regularly communicate and work together to provide healthcare. Though existent, this communication is often ineffective. The concepts of agile leadership can augment cooperation among healthcare professionals.

Physician Empathy: Avoiding Implicit Bias in Medicine

Cultural humility, a vital prerequisite for challenging implicit bias, comes from empathy and open interaction [4]. Thus, to reduce racial bias and discrimination, medical providers need to be empathetic. However, evidence suggests medical school students experience a decrease in empathy throughout medical school [5]. There are various methods of increasing and maintaining physician empathy. One measure that effectively serves this purpose is more hands-on experience [6]. 

Exhibiting agile leadership by listening to and collaborating with scientific authorities on infectious disease transmission may limit the spread of COVID-19. The virus can be spread from person to person primarily through respiratory droplets [7,8]. Consequently, the CDC recommends taking precautions that limit person-to-person contact and contact with respiratory droplets [8]. Collaborating with the Center for Disease Control and Prevention to create policy would be beneficial to public health.  Health policy should also be updated in response to healthcare crises. For example, adaptability is essential in the Opioid Epidemic response. Policymakers must continue to collaborate with scientific experts to create the best policies for public health. It is vital to note that over-prescription of opioids contributes to opioid misuse [9]. Thus, the government should work with insurance companies, scientists, and medical professionals to decrease prescription opioids.

Recommendations

Agile collaboration must be implemented in hospital settings. One way to initiate this into a hospital setting is to incorporating agile leadership training into job training. Though relatively short because it would cultivate soft skills, the training would be precious. Additionally, agile concepts could be practiced in a weekly meeting or forum context. Collaboration and feedback, vital aspects of agile leadership, are means to amplify marginalized voices when upper management has not yet been diversified. Hearing a more diverse set of voices and perspectives is an effective method of generating previously unheard ideas.

The integration of developmental psychology education into health professions curricula outside of pediatric residency is essential. Introduction to concepts like growth versus fixed mindset would be beneficial for both learning and general adaptability.  The addition of more and earlier hands-on experiences in medical training is also essential because, as earlier evidenced, these experiences foster compassion. While in-person experiences may not be feasible during the pandemic, telemedicine and virtual simulation would allow for experience without exposure to COVID. Additionally, empathy can be fostered by limiting the amount of turnover in medical education. Decreasing the number of block rotations and increasing the number of integrated longitudinal clerkships accomplishes this purpose. Longitudinal integrated clerkships are programs that allow medical school students to work with the same staff and patients for a more extended period. This model is beneficial because it strengthens the healthcare provider-patient relationship, which in turn drives empathy. Moreover, interacting with a decreased number of different doctors and patients reduces the risk of further spreading COVID-19.

The government must listen to scientific authorities to limit the spread of COVID-19.  Federal and state governments should do everything to follow and enforce the World Health Organizations and Center for Disease Control and Prevention’s advice. Furthermore, to foster more government collaboration with scientists and medical professionals, the United States should be open to international consultants from countries that have already controlled the virus. One more step that could help manage the infection is the airing of public service announcements from the patient perspective endorsed by the federal government. A lot of skepticism exists around COVID-19. Thus, messaging from the White House and the federal government urging people to take proper precautions may reduce the spread of the virus. Furthermore, the announcements may be more effective if the information comes from everyday people.

Federal and state governments must also reform healthcare and insurance policy. In particular, the expansion of medications covered under national health plans would reduce the opioid crisis. This policy would allow for a shift away from the over-prescription of opioids. Medications like gabapentin could be included in this expansion to serve as an opioid alternative. If other drugs are available to prescribe and take, opioids would not have as great of a negative impact on the population. The expansion proposed above may require increased federal spending on public health insurance. However, the impact that development would have on controlling the opioid crisis would justify this cost. 

Conclusion 

To conclude, significant steps are necessary to adapt to the crises in which we find ourselves. Healthcare is in dire need of innovation if there is any chance of combating implicit bias, COVID-19, the opioid epidemic, or any of the other issues that exist today. Thus, the willingness to collaborate and flexibility is essential. The government can foster these characteristics by working with scientists and adjusting policy accordingly. This could entail instructing the public to follow WHO and CDC guidelines by bringing attention to patient stories and expanding medications covered under public health insurance. Healthcare leadership can become more flexible by incorporating agile leadership training and listening to a variety of perspectives. Likewise, healthcare educators can promote flexibility by integrating developmental psychology education, increasing the amount of hands-on experience, and introducing integrated longitudinal clerkships. The changes mentioned above have the potential to improve healthcare workers’ and policymakers’ agility in difficult and uncertain times.

References

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