Initiate strategic and operational planning for the “now,” “near” and “far”

Quinn McKenna and Rick Majzun address strategic and operational planning for the pandemic in the “now,” “near” and “far”

As leaders of Stanford Medicine’s largest hospitals, Quinn McKenna, chief operating officer at Stanford Health Care, and Rick Majzun, vice president and chief operating officer at Stanford Children’s Health, had to rapidly respond and adapt to the emerging pandemic at the start of 2020, taking actions that would inform the Stanford Medicine approach to addressing the new viral threat.

Early on in the pandemic, hospital and School of Medicine leadership had one main focus: managing case count and hospital capacity. Within weeks, Stanford Medicine’s pandemic response grew into a multipronged effort that progressed through a key committee known as the Clinical Oversight Resource Team, or CORT. Now, McKenna and Majzun are continuing to lead that effort, working with research and health care professionals to establish strategic and operational plans pertaining to hospital capacity, testing expansion, SARS-CoV-2 research, and the management of uncertainty and anxiety in the workforce, among many other aspects of the COVID-19 response. As McKenna and Majzun devise plans for the future, they and an extensive team of experts are prioritizing adaptability, ongoing communication to the community, and alignment across all entities of Stanford Medicine.

Can you speak to the strategic and operational approach to addressing what was happening at the beginning of the pandemic and how you responded?

McKenna: In early January our infectious disease group took out our pandemic plan — yes, we actually do have existing pandemic plans — and dusted it off. Once the organization was aware that a threat was looming, we pulled together the plan to figure out how we should prepare to respond. From there we continued to make progress, and the key body that we brought forward to support this was the Clinical Oversight Resource Team, or CORT.

Leading during a time of this much uncertainty is just as important as the technical aspects of providing health care services

Often with these types of emergency command structures, you actually get all of the experts in a room 24/7, in perpetuity, but we recognized that this wasn’t a long weekend event, or even a few weeks. This was going to be substantially longer. We used CORT as a structure through which we continually identified the issues that needed to be addressed — such as capacity needs, our role in the community and how to keep our employees on the front lines safe — and organized teams and sub-teams to execute on that work. We’d then come back and report to the team.

Majzun: Throughout this experience, it has been a blend of art and science. And I think the science piece has actually been the easy piece — our technical know-how at Stanford is really strong. The art piece aligns more with managing people as anxiety and fear is building, and that’s exponentially more challenging. Leading during a time of this much uncertainty is just as important as the technical aspects of providing health care services. If I think back to the beginning, really understanding the role that anxiety and fear would play in this crisis would have served us all well.

Fast-forward to today: What does our strategic and operational planning for the pandemic look like?

Majzun: In the beginning, we were mainly focused on keeping one pot — case count and capacity — from overboiling. Now, we have numerous pots and each one is bubbling: PPE, staff anxiety, staff availability, changes in science that dictate changes in practice, testing and occupational health, among many others. We have the right structure and people to maintain all of these facets, which is good, because this isn’t going away anytime soon. For many of our leaders, COVID and COVID-related anxiety is probably more than 50% of what they’re grappling with right now. Many of the regular management functions we had planned are being postponed, and that’s OK. Right now, we’re really figuring out how we continue to advance our strategic and operational plans for Stanford Medicine in a way that respects the fact that our teams are limited because of what the pandemic demands of them.

McKenna: We need to be adaptable. As I look out my window right now, I see no blue sky outside. Fire season is upon us, and that impacts our air quality and our ability to keep our employees safe. These environmental factors are forcing us to ask new questions: Can we work outside? What’s the air quality inside the building? Are we safe to be inside? What happens if other local hospitals get overwhelmed and need to transfer patients here? There are many parts of our organization that are overwhelmed and have been for six months, and now there’s fire season on top of it, all while we’ve taken a significant financial hit. We need to be adaptive and able to adjust our operations to absorb these hits and continue forward. Often when you don’t know when the end is, it can feel overwhelming, and that’s a big part of where we are right now — we need to ask how can we support the emotional strength and endurance of our teams so that they don’t get overwhelmed. For instance, we have broad operational redesigns and plans that were put together long before the pandemic, and we should be right smack in the middle of them, if it weren’t for COVID-19. But we have to purposefully slow that down. It’s important for us to keep a clear vision of what we see for the future of our hospitals, but we must acknowledge the urgency of what we’re living with right now, in this minute, so that we don’t overwhelm the system and our teams.

Where do we go from here — what comes next?

McKenna: In terms of how we execute our strategy, we need to prioritize staying connected to our community, especially as parameters around COVID-19 — such as case count — ebb and flow. Staying connected and keeping our community informed, both internally at Stanford and externally, as we adapt is going to be very important. The second thing is, as we at Stanford Medicine continue to work on our individual areas of expertise, we need to ensure we’re also coming together and are intentional in having representation from Stanford Health Care – ValleyCare, Stanford Children’s Health, Stanford Health Care and the School of Medicine in CORT so that the structure can continue to serve us well as we plan for the future. If you make decisions all by yourself, without any communication, you might inadvertently impede other efforts already underway.

What research areas do you think we could still stand to benefit from as we plan for a future coexisting with COVID-19?

Majzun: We could really benefit from learning more about how to best manage teams during periods of great anxiety and uncertainty. Right now, there just isn’t a good comparison for what’s happening, and it’s taking a toll on the mood of our entire nation. Really understanding how to lead people and organizations through a time like this, and understanding how you help them stay connected, will be imperative — and doing so in a way that is cognizant of the fact that some pieces of this process are very resilient, but some are fragile.

Do you see opportunities for either internal or external stakeholders to get involved in some way? What would that look like?

Majzun: From a technical and scientific standpoint we have access to the best of the best, and leveraging our experts around Stanford will be crucial.

McKenna: I agree. I see a lot of potential for our labs, pathology teams and experts to play a guiding role in some of the pandemic’s most pressing questions, such as how you know if you have immunity and how long that immunity lasts. There is an opportunity for our scientists to help the nation better understand the progression of this disease.