This spring has been a challenging time as our health system dealt with a surge of Covid-19 patients. Although this was stressful time, looking back I am gratified at how well our department served. You courageously rose to the challenge of caring for critically ill Covid-19 patients; you stepped up to provide care for patients with other life-threatening surgical problem; and you answered the call for leadership by organizing, strategizing, and operationalizing change at an unparalleled pace.
Now it is time to work together to build a new normal. We still have the same vision to advance clinical care, science, education, and culture. But the ongoing public health threat of this pandemic require us to use new strategies to achieve this vision. Each part of our mission will require ongoing innovation, experimentation, and implementation of novel best practices. We need to work together to forge a new delivery system. The exact shape of our “new normal” is not yet clear. I cannot yet paint a full picture but will try and paint with a broad brush and then finer brushes as it becomes clear. Below, I will make a first pass with some of these broad strokes.
Clinical Care
Because so much of our surgical practice was postponed, our most important clinical imperative at this time is to find a way to provide care for our patients. Our health system is still limited in capacity due primarily to staffing (redeployed or on leave) and limited hospital beds. Our duty right now is to use all available capacity to care for our patients. This may include operating weekends, extended hours, and new locations (e.g., Chelsea, Brighton). We must also commit to ushering patients through our virtual, and in person clinics, as effectively as possible. To this end, I have asked each Section Head and Division Chief to undertake a planning process and present their vision for virtual care and share innovations on our weekly Wednesday morning faculty meetings. This new temporary state will evolve over time but is necessary due to limits on our hospital capacity and the need for social distancing in our clinics. We are hoping to be back to a relatively stable “new normal” OR block time by July.
Research
Bench research will begin to come online this next month. This will be done in a staged process building by building, and with public health safety measures, including social distancing taken into account. Dry lab research has been ongoing and will continue to be remote until the imperative for social distancing has lessened. Because of the lack of interaction and networking, we need to redouble our efforts to ensure that we are collaborating virtually. This includes not only lab meetings, but also interactions across laboratory groups, and mechanisms for new entrants to be exposed more broadly. We are fortunate in that we have several communities that serve these needs including groups in health services research (Center for Healthcare Outcomes & Policy [CHOP]), basic and translational science (Center for Basic and Translational Science [CBATS]), education science (Center for Surgical Training and Research [CSTAR]). Beyond these larger groups, numerous individuals have been forming their own virtual lab meetings. I encourage all of you to look around for those most vulnerable during this time (e.g., new and junior faculty, residents in academic development time, students looking for mentorship), and create opportunities for networking and engagement to support them. We will be working at the department level to collate these and make them available for those interested.
Education
This pandemic has presented many challenges to our training programs. Many of our trainees served courageously on the front lines as our department greatly expanded our ICU footprint. But I also know some were frustrated at not being able to help more, including those in academic development time. The latter were challenged by labs closing and meetings being relaunched virtually, which did not happen overnight. Now as ORs ramp up our training program rotations are returning to some degree of normalcy. We will need to work hard on innovations to reintegrate house officers and students into the parts of our clinics that are virtual. There will no doubt be many challenges to address in this new normal. But we have a fantastic, talented group of house officers, and a faculty committed to their training, and I am confident we will solve these problems together.
Culture
We have been working hard to shift the culture of surgery from hierarchical, and exclusive, to inclusive where everyone has equal chances of succeeding. With social distancing, and lack of interaction, we will need to launch new initiatives to make sure we continue to make progress on this part of our vision. With social isolation, I believe it is even more important to pursue initiatives that foster an inclusive environment. The social isolation of the pandemic has caused many to fall back on existing networks, making new relationships supporting mentorship and sponsorship challenging, especially amongst our most junior and most vulnerable colleagues. Imagine being a rising 4th year student applying into surgery and spending the spring at your parent’s house. We need to create new virtual spaces for these connections to occur.
Establishing the “new normal” will be a complicated puzzle, and we will solve it one piece at a time. Right now, we are a temporary state, with no travel and no meetings, where we can afford to be more on demand for clinical care wherever we can fit it in; this is necessary to catch up to the care we owe our patients, and to facilitate a financial recovery. Building this future will take us the course of this year, overcoming each of these challenges as they arise This will require strong leadership, and innovation, from every level of the organization. This will depend on us reflecting and harvesting the valuable lessons that come from successfully navigating a crisis. And this will be accelerated by the invention and experimentation borne from necessity However, there is no doubt this new normal, once clearly painted, will be a stronger, better Michigan Surgery.
