Physician leaders need to be thinking about and preparing for the next crisis that is waiting around the corner. Whether it’s minor or major, whether it’s environmental, financial, or reputational, the chances are very good that it will need to be addressed head-on.
This transcript of their discussion has been edited for clarity and length.
Mike Sacopulos: My guest is Aimee Greeter, MPH, FACHE, a principal at SullivanCotter based in Charlotte, North Carolina. She has worked with some of the largest healthcare systems and physician practices in the United States. She is also co-author of the book Effective Crisis Leadership in Healthcare: Lessons Learned from a Pandemic, published by the American Association for Physician Leadership.
Aimee, welcome to SoundPractice.
Aimee Greeter: Thank you so much for having me, Mike. I couldn’t be more delighted to be here.
Sacopulos: Excited to talk about your new book. Maybe you can tell me what inspired you to write this book.
Greeter: Well, I think it’s a culmination of many things. However, I have to confess that coming into a global pandemic really lights a fire under a person to write a book on crisis leadership. We had talked about writing a book on this topic, and specifically, the impacts for the healthcare industry. And that was really spurred on by the start of the COVID pandemic. If you take yourself back to the March 2020 timeframe, think about what that looked like, and how many questions we had, and how few answers we had, you can see how it was an absolute recipe for crisis.
I felt particularly called to draft some correspondence that would help people when they found themselves in situations like these. My intent was to provide a practical playbook with actionable solutions that people could follow so they knew what to do when they were in this situation.
It isn’t meant to be a massive 500-page book, but rather more of a manual on how to approach something like this. How do you handle it? What do you need to be thinking about when you find yourself preparing for, in the midst of, or coming down from a crisis?
Sacopulos: Who’s the target audience of your book?
Greeter: The target audience is really those who are operating within the healthcare industry. The book is meant for physician leaders. It’s meant for health system administrative leaders. It’s meant for those who are running independent medical practices. Everyone who operates inside the industry, and yet has the ability to both be impacted by and have an impact on crises as they’re developing would benefit from reading this book.
Sacopulos: Why don’t we talk a little bit about crises in healthcare that your book addresses or could act as a manual for, because I’m not sure that your definition and my definition of a crisis in healthcare match up. Can you give me some examples?
Greeter: Absolutely. And I hope that people are sitting down as they’re listening to this.
Sacopulos: Well, that sounds like fair warning.
Greeter: It really is. So, if you’re not, take these three seconds to get yourself somewhere safe. But I give that caveat just because the range of potential crises within healthcare is pretty massive. I mean, there is a broad spectrum of things that can impact us as healthcare providers or as healthcare leaders, and that’s things like financial crises, not being solvent as an operating entity, not having dollars to be able to pay your next payroll. That’s a crisis.
It can be things like reputational crises. We have all seen a bad outcome that has made the front-page news, and it creates some really unsavory attention toward an organization. I recognize there is an organization in the Southeast that, of all things, was found to be washing their joints for their orthopedic joint replacements in elevator lubricant, and that made the national news. Well, that’s a pretty clear indication of a reputational crisis because I don’t think people are going to be inclined to get their total hip replacement at that organization.
And then it’s things like cybersecurity, technological-type things. How many times do we see that ransomware has impacted an organization? You’re shut out at the EMR. And unfortunately, that happens more and more every year. Since 2018, we have seen an ever-increasing incidence of cybersecurity crime within the healthcare industry.
I don’t think we can overlook the natural disaster crises that befall us. We look at Superstorm Sandy and Hurricane Katrina and all those kinds of things that have, in essence, washed away not just the power and electricity and all those kinds of things, but critical infrastructure for providing healthcare services.
So, the gamut is large. That’s not meant to be frightening, but it is meant to be illustrative of how many things we, as leaders, need to be thinking about and preparing for as we ready our organizations to face whatever it is that’s thrown our way.
At one point in the book, we make another alarming claim: The next crisis is waiting around the corner for most organizations. To think, “Nah, I don’t have to worry about any type of crisis. I’m insulated here wherever I sit,” in California or Maine or Florida, wherever it may be, is operating with a sense of naivety. The reality is that’s just not going to be the case.
Whether it’s minor or major, whether it’s environmental or financial or reputational, the chances are very good that you’re going to have some experience in that realm. It’s important to figure out how to address that head-on.
Sacopulos: The title of your book connotes a team approach to addressing crises. Is that generally how healthcare systems work?
Greeter: Great question. I will tell you that while my industry knowledge has very much focused on healthcare in recent years, the concept of team is incredibly pervasive here and, I may say, it’s significantly more than may exist in other industries. If you’ve ever been a patient or had a family member who’s been a patient, you’ve heard the phrase “care team.” That is exactly how healthcare embodies this concept. It’s not just one person who’s treating you or seeing you, it’s this care team.
The same is true when we think about how we deal with a crisis. It’s with a crisis team. It really can’t be one person. Now, a team can be too big to be effective. Research about teams actually suggests the right number for a team is something like 7, 8 people. There is this sense that a team adds value, and if you can keep it to a manageable size, a team is a really effective way to get in a cross-section of perspectives, to get in some new ideas, etc.
One of the things that we talk about in terms of preparation for crises is developing an incident management or incident response team that is cross-sectional. We all have seen the literature that supports the fact that heterogeneous teams result in better and faster decision-making. They result in decisions that yield higher stakeholder returns, whether those are true shareholders or just people invested in the process. So it’s important that you develop a team that has that cross-sectionality.
In healthcare, we think about a team with representatives from nursing, physician leadership, finance, communications, and HR, so that as decisions are made, the experts in their respective fields can add some thoughts to that process. Does that decision make sense? What are the ramifications of the various alternatives? How do we find the one that’s going to be the most positively impactful, while also minimizing the negative potential downstream effects that any one decision may have?
So, the short answer, Mike, is that, yes, teams are important. They’re important in healthcare and they’re very important in how we react to a crisis.
Sacopulos: By nature, many crises are epicritic and call for immediate response. How can healthcare organizations prepare for sudden unforeseen events?
Greeter: Well, I definitely didn’t make this up, but the best offense is a good defense in terms of how we prepare. In healthcare, solid preparation is important, like having a team that’s in place and ready to go. But it’s also about having a process for how to mobilize in times of crisis. What are our communication channels if, for example, we’re locked out of some of our technology? Do we have something as old-school as having a directory of important phone numbers? Do we have people’s cell phone numbers so we can contact them if we can’t use our email system? Having a very defined process is critical.
Other aspects of the preparation that I think are important are developing partnerships with community stakeholders. When a crisis hits, it may not just be your organization that’s impacted. Think about any type of natural or environmental disaster. Often in those cases, it’s a whole town that’s affected by the tornado, the hurricane, or the flooding. In that situation, it may be that you are called upon to help others, or reciprocally, that you need assistance from other organizations. So part of your preparation needs to be reaching out to other people and developing those relationships so they’ve been stoked before you need them.
Sacopulos: Do you advocate doing tabletop exercises so people can actually put some of these policies or lists into practice?
Greeter: Absolutely. Creating low-stress environments in which to practice for a crisis is critical. And that’s where things like tabletop exercises come into play — having people in a room walk through various scenarios when the stakes aren’t nearly as high. Again, not trying to alarm you, but it may be sooner rather than later that you find yourself in a crisis, so having opportunities to practice is incredibly important.
Having documentation that you can revisit during, for example, a monthly staff meeting, is valuable. You can pull out that process, the crisis response document, and say, “OK, today’s tip of the day is, if this happens, our course of action is going to be X, Y, and Z.” Creating opportunities for this to be a recurrent conversation, as opposed to a scramble when we need it, is really important.
Sacopulos: Aimee, it occurs to me that there could be categories of crises. For example, IT or health information crisis may be different from a natural disaster. Are there different types of systemic approaches to categories of crises?
Greeter: Absolutely. The first step is don’t panic, whatever the crisis. It’s not going to do anybody any good. Once you get past that step, there are differentiated strategies based on the type of crisis.
What I think is important is this concept of having an emergency operations center that has a chain of command defined, so when a crisis hits, we understand who is going to be our go-to person. In a medical practice with 10 physicians, you may not have resources a page long differentiated to help you in different types of crises. In larger organizations, however, that may be the case. If it’s an issue with a physical plant, a whole team might lead the response, as opposed to an IT team that would help if it was a healthcare IT issue.
So, one of the strategies is having that chain of command, or chains of command, set up, and having it focused within that emergency operation center. When it comes into play, we know what we’re supposed to be doing, we know who’s going to be leading it, etc. And in many cases, those leading the response vary. Having them ready to lead the response is equally as important.
Back to our conversation about tabletop exercises, it’s also important that we have some depth in terms of our responsiveness. So, for example, Aimee Greeter is responsible for the marketing team communications. If she’s not there that day, there’s another Aimee Greeter who’s going to fall in and take over.
In addition to having an established chain of command, make sure that there are redundancies built into whatever your response is anticipated to be, whether that’s your personnel or, as was the case during the pandemic, your PPE.
Sacopulos: Aimee, you mentioned earlier that part of your inspiration for the book came from being in the midst of a COVID pandemic. How has COVID impacted crisis leadership?
Greeter: I think COVID tested more people than would otherwise have been directly impacted by the crisis. And I think in some ways that’s a positive. We forge our irons by fire, and in this case, we gave more people more exposure to what frontline crises look like and allowed them to develop and practice their leadership skills through their part in remediating this crisis. So, if anything can be seen as positive, it’s that there has been this broader exposure to crisis and the development of leadership skills in the face of it.
One of the challenges we saw during COVID is how to sunset a business unexpectedly. How do you find roles for displaced people? That’s its own type of human capital crisis. Unfortunately, I that’s something that we’ve seen more of in the last year and a half than we would have seen otherwise. So, we’re seeing disproportionately more of that type of crisis, in addition to the clinical crisis that we’re experiencing now.
Sacopulos: As we wrap up our time together, Aimee, could you share what readers of Effective Crisis Leadership in Healthcare can expect to gain from reading the book?
Greeter: My intent is for people to gain actionable strategies for how to proceed in a crisis. This is not meant to be merely an academic text; it’s meant to be, as I said earlier, a manual that gives you the support that you need, that gives you checklists and things to think about as you work your way through your own preparations, response, and then ongoing maintenance of crises.
So my hope is that you find it immediately useful. And I hope that you gain some context around what a crisis is and then what your role is as an individual, as a leader in an organization, as a part of a broader system — the ways that you can help remediate the crisis. I hope it is something that you take a pen to and a highlighter to and figure out what you’re going to do based on it the next day. That’s my fervent hope: That you take it, and you use it.
Sacopulos: Well, for all our sakes, I hope our listeners do that. I highly recommend the book Effective Crisis Leadership in Healthcare. Aimee, thank you so much for having been on SoundPractice.