Looking back … and looking ahead: Q&A with Jeff Desmond, M.D., chief medical officer

A lot has changed since Michigan Medicine cared for its first COVID-19 patient in mid-March. Faculty and staff have stepped up in remarkable ways, and the organization has faced down challenges that hadn’t been seen in generations.

But what have the past few months been like for clinicians? And how will medical care and education change in the future — throughout the remainder of the pandemic and beyond?

Headlines caught up with Chief Medical Officer Jeff Desmond, M.D., to learn his thoughts on these issues and more. Here’s what he had to say:

Q: First, can you reflect on what the last few months have been like for clinicians at Michigan Medicine?

JD: The last several months have been both challenging and rewarding for all of our employees. We have made changes at a scale and pace previously unseen. In less than two weeks, we went from our regular, busy daily operations to a dramatic ramp down in both ambulatory care and hospitalized patient activity. We did this to create capacity to meet the predicted demand of COVID-19 patients and to limit risk to other patients.

On top of these operational uncertainties and massive system changes, our front-line staff, nurses, doctors, respiratory therapists and others cared for patients with a new disease. Learning to recognize appropriate symptoms, make a diagnosis, assess for severity and provide appropriate care for a new disease is challenging on its own. To do so in new or unfamiliar areas of the hospital or with teams that normally do not work together was an incredible challenge. We all came together, focused on what our patients needed and delivered exceptional care. 

Our employees have witnessed substantial tragedy as some of the patients with COVID-19 did not survive. But there have been moments of profound happiness as well. We have had patients who survived tremendously severe illness and were able to go home to their families. I am not sure that would happen at every hospital. 

Q: What will be some of the major lessons learned during this time that can be applied to the future?

JD: I think one thing we have known, but demonstrated yet again, is that we can do incredible things when we come together with a shared purpose. We learned the value of teamwork — individually we can do great things, but together we accomplish so much more.

There were many plans made which did not in the end require execution, such as planning for the field hospital and an off-site Emergency Department at East Ann Arbor. We’ve learned a tremendous amount from those efforts — about our facilities, staffing models, management of supplies, interaction with the state and FEMA. Those are valuable lessons that will serve us well even in non-crisis situations.

We were also able to make rapid and clear decisions through the command center structure which we utilized to manage this event. There are several components of that structure which we are looking to incorporate into our routine operations. We also put many of our HRO skills to use in this challenging time and the SBAR became a tool widely used.

Finally, we learned the value of listening to diverse perspectives when faced with complex problems and how to incorporate that into our decision-making.

I think we saw many examples of how empathy, kindness and sometimes a bit of humor in a stressful situation can have a tremendously positive impact. 

Q: Looking ahead, how do you foresee clinical care and education changing as a result of managing both COVID and non-COVID patients at Michigan Medicine?

JD: Many things will be different in the future. I believe COVID will be around until there is an effective vaccination, so we will need to continue to safely provide care for COVID and non-COVID patients for quite some time.

We dramatically expanded use of virtual care options and we expect this to continue into the future. PPE use will continue to be routine for us, as well as social distancing, wearing masks and other interventions that have been put in place to reduce risk to patients, visitors and staff. We previously had a strong focus on hand hygiene and that will clearly continue into the future.

In terms of education, we will have to create innovative ways to continue our mission. In addition, we will need to provide clinical experience for students and trainees that limit their risk of exposure but teach them how to safely care for some of the sickest patients. Already there is interest in pandemic response being incorporated into the curriculum and interest in crisis management and leadership.

Q: As the organization ramps back up, how can patients and staff members be reassured that they will be safe coming back to the academic medical center?

JD: We have taken many steps to assure that our patients, their families and our employees are safe as restrictions loosen and we are able to bring more patients back to the health system.

We have redesigned operations to take into account social distancing, enhanced cleaning protocols, instituted the wearing of masks, and have more access to testing for rapid recognition and isolation of patients with concerning symptoms. We will continue to monitor and assess the situation as we ramp back up to ensure everyone’s safety. As always, that is our top priority, and that’s one thing that has never changed.