Dr Ravi Dasan is a consultant in emergency medicine at University College Hospital in London. His job is to lead the Accident & Emergency (A&E) department—managing and organising NHS staff and resources—and save as many lives as possible. It’s a crucial role that demands planning, expertise, leadership skills and a level head at the best of times, but even more so during the Covid-19 pandemic. No matter what your industry or experience, every professional could learn a thing or two from medics working on the frontline. Here Dr Dasan offers his expert advice on how to maximise productivity in times of crisis.
Every day, we will save lives and lose people to this horrible virus. And we’ll come back tomorrow to do it all again.
Being an A&E leader during a crisis has strong similarities to leading a team at wartime: limited resources, high demand for services, no end in sight and a significant number of people in dire straits. It’s my job to lead the team through the crisis, keeping motivation as high as possible.
Every day, we will save lives and lose people to this horrible virus. And we’ll come back tomorrow to do it all again. Much like a war, we have no idea how long this crisis will last, but we do know that it is going to get worse before it gets better.
So how do I lead a team of junior doctors and nurses to deliver the best possible care to our patients? These are my top productivity tips for leaders who have found themselves amid the Covid-19 crisis:
1. Identify resources
Managers need to make the best use of available resources and know that there may be substantial gaps.
In the same way as many project teams in companies, my team is constantly reforming. In our case it is a daily change according to who is on shift. Our working patterns are such that we provide 24/7 cover for the critically ill. As a result, each day (or night) I have a different mix of people who come together to perform various roles in nursing and doctoring across the department.
In every workplace, sickness levels are increasing, just as they are here. The first part of my day is to identify who is working and who is sick or self-isolating. The rota teams are doing an amazing job, but there are always those who call in on the day to say they cannot work.
Resource planning is “in the moment”, and I’m looking at who I have working with me, who is missing, and identifying the deficits and the skill levels across the team. I have to make immediate decisions, so knowing my team is key; their strengths and development areas, their ability to cope with pressure and their state of mind. This process only takes a few minutes but it is essential.
2. Deploy those resources
Make sure your team is the perfect mix for any given project or task.
Fluidity in deployment is a critical concept, and as a leader, you need to be constantly aware of the changing situation
In a huddle, I tell people where I want them to work. I need to ensure that they are in the right place at the right time. In A&E it is easy to throw people at a problem, but I need to consider it in a more strategic manner. I cannot put under-qualified staff into situations that could cause more pain than good.
I also need to ensure that there are appropriate numbers of managers and the right mix of doctors and nurses. I’ll amend and change the resources depending on demand, and the mix of patients during the day. Fluidity in deployment is a critical concept, and as a leader, you need to be constantly aware of the changing situation and amend your resourcing plan as required.
3. Be clear about roles and responsibilities
In any given moment, there are a number of people on a team who have the skills and abilities to do the same jobs. As a result, it can sometimes blur the boundaries.
I make it extremely clear what each team member is responsible for doing, so there is no confusion when patient levels peak and everyone is working frantically to keep people alive.
Clarity ensures that there is no duplication, and we effectively have a “factory line” approach to managing patient care. In an extremely stressful situation, it gives staff confidence to act when they are clear about their role.
I am also adamant that people should act within their roles and not take on extra responsibility without discussing it with me or their managers first. Encouraging people to do more can fit within some business settings, but in the A&E department it can lead to significant problems as staff need to act with speed and efficiency, and anything which impacts their clarity to act impacts patient care.
4. Regular communication
Check in regularly through the day with your team and managers.
In A&E, we are used to life and death decisions every day but the extent and depth of this crisis is unprecedented. I am very aware of the impact it will have on the mental health of our teams…
I have informal meetings with the senior team throughout the day or night to review progress and touch base. Regular checkpoints to assess the temperatures of team members is vital. I can address any areas which are not performing optimally, and I can have a clear view of anyone who is struggling and who might need extra support.
In A&E, we are used to life and death decisions every day but the extent and depth of this crisis is unprecedented. I am very aware of the impact it will have on the mental health of our teams, and ensuring that we are monitoring their wellbeing, talking to them and encouraging them to talk to their manager or colleagues. This is vital for their mental health.
Regular communication between yourself and managers, and from them to their teams, means that you are making decisions based on the best possible information.
5. Plan for the unknown and be decisive
All workplaces are facing unprecedented change that requires careful planning, but also flexibility.
The speed of decision-making has a direct impact on our patient’s lives.
Planning is essential when dealing with the coronavirus in A&E; at any point we may have a significant increase in patients. It’s my job as a leader to have a contingency plan to put into place at any point in time. It might include closing the minor injuries/illnesses unit to accommodate increased numbers of significantly ill patients, opening up new areas in our A&E or engaging specialist teams at an earlier point than normal.
Whatever happens,I need to be prepared to review my resources, to look at the challenges, and create an immediate plan to address. It is critical to act, there is no opportunity to take time to review and think about actions. The speed of decision-making has a direct impact on our patient’s lives.
6. Keep talking to your teams
From key workers to home workers, many of us are struggling to mentally deal with the crisis.
Keeping up communication between teams and colleagues can help immensely. In A&E, being responsible for patients means seeing people live and die. It can feel overwhelming. However, it is absolutely vital that the team are resilient and mentally prepared. Myself and my fellow consultants always give the following advice:
Take your breaks! We all need to recharge our batteries, and working a 10-hour shift is a long slog. It’s absolutely critical to ensure that staff take breaks, and even get some fresh air. It has a really positive impact on the overall performance of healthcare professionals—and professionals in every sector—if they are having periodic breaks.
Never feel it’s your responsibility to save a life. This might sound odd, but our role is to do our jobs to the absolute best of our ability, and act within our roles and responsibilities. People will die in A&E, and it is a tragedy each time, but as long as we have followed protocol and fought as much as we can, we cannot feel emotionally responsible for every single life. It would end up crippling our teams.
Eat well! There can be a tendency to fill up on junk food when you’re working under pressure, but eating healthily and having fruit rather than chocolate is one of the small ways that I encourage my teams to look after their physical health.
Try and leave work behind when you go home. We see tragic situations every day in A&E, and it’s only going to get worse when the peak hits in a few weeks. We are also husbands, wives, parents, sons and daughters. We’re worried about our own families, which is only natural. Leaving work behind, and not mulling over what we’ve seen or specific patients, is an important coping mechanism for our own mental health.
Start the next day fresh. It’s really important that every day is a new day, and everyone starts with a clean sheet of paper. We learn the lessons at the end of each day, and then we move on to start the next day afresh.
It’s my job to ensure that we provide the best possible patient care, and keep my teams strong and resilient as we work to look after you and your families. We have the courage to continue.
I always have a wrap-up at the end of the day, and reiterate these messages. Clear and consistent communication to the team is an important part of any leadership role.
I work with 15 consultants and we have our own support networks as we move through this challenging time, including regular communication with each other. As leaders, it’s important that we take the time to focus on ourselves and understand that it will have an impact on us and our mental health as we fight this virus for however many months ahead.
Coronavirus has changed us. It will change society, our finances, politics, the way we work, our schooling, and most importantly for me, it’s changing our NHS and our medical world. It’s my job to ensure that we provide the best possible patient care, and keep my teams strong and resilient as we work to look after you and your families. We have the courage to continue.
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Dr Ravi Dasan
Consultant in Emergency Medicine in University College Hospital, and a Private GP on Harley Street
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