Mayo Clinic physician leaders and executives look to 2021, discussing Mayo's ongoing response to the COVID-19 pandemic and lessons health care leaders can use to guide their institutions through this crisis in the present and the future.
Devyani Lal, M.D., chair, Rhinology, and consultant, Otorhinolaryngology, Mayo Clinic in Arizona; associate dean, Mayo Clinic School of Continuous Professional Development; professor of otolaryngology Featured expert:
Richard J. Gray, M.D, chief executive officer, Mayo Clinic in Arizona; professor of surgery . Featured expert: Paula E. Menkosky, chief administrative officer, Mayo Clinic in Arizona
Amy W. Williams, M.D., executive dean of practice, Mayo Clinic; chair, Department of Medicine; professor of medicine Featured expert:
David A. Etzioni, M.D., chair, Surgery, Mayo Clinic in Arizona; professor of surgery
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The views and perspectives shared in these resources are presented based on information available at the time of recording.
Well, good morning, everybody. On behalf of the Mayo Clinic School of Continuous Professional Development, I'd like to welcome you to the Mayo Clinic Cove in 19 webinar Siri's I'm Jeff Pat Aruca. I'm gonna be your host for today's WEBINAR on Cove in 19. Leadership strategies for 2021 like to go over a few items before we jump into this great discussion today, this webinar is accredited by the AM A. For one credit. There are no relevant disclosures for today's discussion, and we'd like to thank Pfizer for their support of this educational activity. Now, for a few more housekeeping items, I'd like to first year how to claim credit for today's webinar. If you would like to claim credit after the webinar, please visit ce dot mayo dot e d u back slash co vid 1208 You'll need to log into the site and of this is your first time visiting our Mayo Clinic website. You'll need to create an account. After you've done this, you've logged in. You'll see that there's an access code box now. What you want to do is type in today's code, which is cove it 1 to 08 So please note this code is case sensitive. This will allow you to access the course, complete a short evaluation, and you have the ability to download or save your certificate afterwards. The second item for today is that you'll see at the bottom of your zoom screen. We have both a chat function and a Q and A function. Now, if you'd like to ask a question to our Panelists today, please make sure you use the Q and A function. That's way that we could make sure that the Panelists see your questions for discussion. We have an up vote item. So if you see a question in the Q and A that you like, you can go ahead and click the up arrow, and that will make sure that that this high rank in the staff answering your question. Now I'd like to share. By the end of this webinar US learners will be able Thio, discuss current research initiatives related to the Kobe 19 pandemic, identify promising innovative solutions for treatment strategies In Kobane, 19 patients describe the expedited translational research related to Cove in 19 and describe innovative practice redesign principles to treat patients in a virtual setting. So I'd like to introduce are moderator for today's discussion on the leadership strategies for 2021. Dr. Law is the chair in the division of Ryan Ology in the Department of Auto Ronald Larry Oncology at the Mayo Clinic Arizona campus. She is an associate dean at the Mayo Clinic School of Continuous Professional Development, and she is a professor of auto otolaryngology Mayo Clinic Doctor Law. I'll hand it off to you. Thank you so much, Jeff. Um, for that kind introduction, I think, um, my primary identity at Mayo Clinic is as a physician and surgeon and certainly covered 19 has been an interesting journey because I'm Ryan ologists and and I perform complex trans nasal and aske OPIC surgery in the nose, The Sinuses in the skull base. Um, and my life involves working around aerosol generating procedures. I have served particularly in 2020 with great gratitude for the ability to deliver complex, high value care to my patients but also taking great comfort in the fact that Mayo Clinic has equipped my team and me with appropriate technology, pp for conducting the practice safely. And this would not have been possible without the strategies that were employed at a very high level at Mayo Clinic. So I am truly grateful to our Panelists who it's my honor to introduce. Our first expert is Dr Richard Gray, who is a professor of surgery and a colleague. But he is also a very important person in Mayo Clinic, as vice president, off Mayo Clinic and the chief executive officer off Mayo Clinic in Arizona. Our next expert is Miss Parliament Kaskey, who is a chief administrative officer at Mayo Clinic in Arizona, and his doctor, Grace administrative partner. I'm also very honored, uh, and and express gratitude to Dr Amy Williams. She is an extremely busy lady. She is professor of medicine, and she also leads our practice as the executive deep off mayoclinic overall, optimizing clinical care across all sides and across all specialties. Thank you, and I'm also truly and sincerely appreciative off the participation off Dr David Etzioni, who's a professor of surgery and chair of the department of surgery at Mayo Clinic in Arizona. He also wears a second very important hat as thes e air off the committee that oversees our surgical and procedural practice. And as you can imagine, elective care has been truly impacted during the pandemic. But it's also important to highlight his role in letting employees practice safely within the unit s Oh, thank you. To all our Panelists. I can just understand how truly busy you might be and how many competing obligations must be on a calendar. But to prioritize education and and be generous with your time in sharing some of our leadership strategies with attendees that come from all over the globe is deeply appreciated. So with without much ado, I'd like to jump into our objective for this next hour. And I hope that U S leaders at Mayo Clinic will be able to share with the attendees some of the high level strategies that you've utilized not only in dealing with the pandemic in the past, but also through the rest of 2020 into 2021 then also in the long term future. Um, I have highlighted some of these points here on the first slide that we will go in detail in, and I encourage our attendees to send in any questions that we have not captured within these discussion points. So my first question will actually be for Dr Gray, 2020 has been an interesting year that has resulted in much redesigning and a lot of re imagination. Um, to deliver high value care to our patients and empowering a staff for the same. Could you give us a blueprint off how these practices can be shared across the globe? Well, thank you, Dr Lal. Uh, interesting as one word for 2020. I've heard a lot of other adjectives to describe this year as well. Um, really, I I want to start by saying that while 2020 has been an incredibly challenging year for everyone in health care for everyone outside of healthcare and for Mayo Clinic in particular for me it has been incredibly inspiring to see how, especially within Mayo Clinic, so many people have risen to the challenge and have taken this on in a very, very effective way where we could keep the mission of Mayo Clinic our primary value being the needs of our patients come first where we could keep that in view and do the right thing based on that value, and that everyone could rally around that even in these difficult circumstances. So to your point, there have been so many adjustments we've had toe make in 2020. Of course, it began in the early portions of this spring and March and into April with a large degree of uncertainty and our initial redesigns. Our initial approaches had to acknowledge that uncertainty. And we had to prepare for a lot of different potential outcomes both for our patients, for staff, for the mission of Mayo Clinic and our financial stability and all of the implications for the many patients. The most patients, um, that we deal with who we're dealing with important conditions that were separate and apart from Cove in 19. So initially we tried to look at as much modeling foresight and use our expertise as possible to anticipate what might come our way. But importantly, we put in tow, put into process very early, um, ability to share best practices to coordinate and toe learn as quickly as possible, so that as new information came in, we could continue to refine that and come to a joint understanding across all of Mayo Clinic as to what is our best assessment of what is ahead, and what's working well and needs to be adjusted further. So like many healthcare organizations, we initially began with a focus on protecting our staff and protecting protecting our patients. We talked about the situation as figuring out how to be the Mayo Clinic. Our patients needed us to be even in a cove in 19 atmosphere. So to rise to the challenge of treating the cove in 19 patients but also being the Mayo Clinic that our other patients needed as well. Our largest adjustments were around safety mechanisms and protocols. So we put into place what many other organizations did. Um decided what was the best PPE for our staff in given situations. What was the best protection for our staff who were not engaged directly in patient care? Eso very early on male clinic required all of our staff, all of our patients and their visitors to be messed, and we have perpetuated that to this point in time. But we used cloth masks and other mechanisms for those not directly engaged in patient Karen and so again scale that PPE. So we started with safe. We then built on that into the uncertainty of what patients would it be safe to delay their care while we dealt with some of the uncertainty and made sure we had appropriate PPE and could take care of the patients that had more emergent and urgent health conditions? Both Cove in 19 and others as we got more experienced, we were then able to weave in mawr of, um, what we could offer, um, in a more refined way. We didn't have to make large group decisions and could make more of those decisions based on an individual patient situation. Dr. Etzioni, I'm sure we'll talk later about things around our surgical practice. As an example of that where we were able Thio, he and his team were able to define tears of patients and define which patients needed to go under what circumstances and which patients could safely have their have their care delayed. We, like many others, transition very quickly to telehealth. It was an interesting time for this pandemic to strike at at Mayo Clinic in that in 2019, we refined our strategy for the decade of the 20 twenties, and what we found that cove it brought was an acceleration of many of those strategies So we were accelerating our telehealth offerings moving into 2020 and what we thought would take a few years to learn and experience and refine instead took a couple of months or even in some cases, a couple of days or weeks to gain experience with and learn how to apply those. In addition, we have efforts in home hospitalization, and so that was underway. Pre pandemic and as cove in 19 hit, Having patients have the opportunity to get some of their care at home that they typically previous to our offerings in acute care at home would have had to have been hospitalized setting suddenly took on much more relevance, and there was suddenly much more acceptance to that. And of course, all of this was in a very different regulatory environment in the United States, with which allowed us a lot of opportunities to take these initiatives forward more quickly than we otherwise have. So as we've continued on through 2020 and we look ahead to 2021 much of what we're trying to do is to not go into that natural tendency of as we move further into the cove in 19 era and hopefully in 2021 move out of this cove in 19 era of just naturally going back to what we were doing previously because of what I just said, much of what we were trying to move toward. We've moved towards more quickly, and we want to not fall back into the old patterns. So both in terms of outpatient practice, especially around tele health and other services and inpatient practice things like acute care at home. Those will be things that we will continue to perpetuate and grow upon as we move into 2021. You did mention in your slide mitigating the financial impact. And But we, like others in dealing with uncertainty, didn't know what we would face. And we were blessed to have a have a staff who bought into this and made some financial sacrifices, took some decrease pay, decreased hours and other things as we were facing uncertainty. Once we could see that we learned how to navigate these waters and we could be at least financially stable. We very quickly brought that back to normal levels, were able to restore some of those reductions and even make up for them later as the year of 2021 on. So I would say that's the other thing that Mayo Clinic learned. And that's an example of we make an adjustment. We make a calculation based on the best information at hand. And as we learn mawr and as we gain more, we very quickly can change and pivot and and have that be refined based on the current situation. And although it was hard to have some of this back and forth in this example around finances for our staff, I think everyone was very appreciative that we were transparent about the fact that we're making the best decisions available. But when when things change, we will reveal those, and we will adjust based on that. So that's another thing that we will try to continue into 2021 Is that level of dialogue and interaction and transparency and ability to adjust quickly to the situation at hand. And I think that will serve us well as we move into 2021 the rest of the decade of the 20 twenties. Thank you so much, Dr Gray. Um, I wonder if the Panelists have, um, input from their perspectives as well. All right, Sorry. I was the first one toe, not a mute. Now everyone's clear. Um, So what? I totally agree with what Dr Gray just said. And I think one of the part of the magic of Mayo Clinic in my mind are the teams. And we were able to stand up teams to get things done to communicate a clear message to all of our staff across all of our sites that our number one concern waas safety, safety for patients and safe and safety for the staff. And we really concentrated on that which was part of that pause at the beginning, so that we had timeto learn timeto learn from our colleagues on both coasts throughout the United States and internationally. What did they know about coat? About how to manage Koven An and one of the wonderful things about this pandemic. If you could even say that is theory way that the the entire medical field came together to fight that to try to prevent a pandemic in the United States and still coming together to fight that pandemic and learn from each other, and that allowed us to really continue to be agile and to move and to implement new learnings as we go on. And we continue to do that. And and that has been, we're going to take all of those learnings Teoh 2000 and 21 beyond, because we will still be living with Kobe, even after vaccines. Hopefully not in a pandemic anymore, but we need to continue to build on these learnings as we move forward. Thank you so much, Dr Williams. That's a good segue into my next question, which I hope Dr Williams, you'll answer as well. And that is I'm sharing how male clinic leadership developed a strategy to lead through this crisis. Andi, I stopped agree, alluded to a great degree off uncertainty and a dynamically evolving environment, giving new data that was constantly streaming in. Um, so if you could talk a little bit about the overall philosophy, uh, very high level strategies that were utilized, how you optimize communication not only with the staff and our patients, but also getting information from state and federal agencies keeping on top of communication chains with our suppliers, etcetera. Glad to talk about this well, and we're still on this journey, learning as we go forward. But it Mayo Clinic again. It is all about teams. The other thing is that it's about empowering teams. It's about building a team around you, too, as a leader, not a team that agrees with everything you say, but a team that that cause out your biases, understands your blind spots and calls you on it. A team that feels empowered toe have critical conversation, so that at the end we come out with a better solution, a team that fills in the leader of the team's gaps. And as part of that, it's you build a trusting environment within your team. When I'm talking about teams I'm talking about throughout the Mayo Enterprise and at the Mayo top of the enterprise with top leadership. And then it is about empowering. The team's trusting the individuals to do the right thing, and in this case, initially the right thing was, we need to stay safe. How are we going to stay safe, making sure that as we got Mawr information about appropriate PPE e keeping safe and procedural rooms in the outpatient practice and the inpatient practice on our way to and from work, etcetera, that we sent out constant communications to our staff. We also learned along the way, when it comes to communication, get to do it multiple ways. Everybody knows that with emails with town halls that had to be virtual. And then also, once you get the processes in place that you need to be in place, which needed to happen rapidly is to step back for a minute, slow down and take time to listen. Time to listen to the staff on the front lines. Timeto listen to the staff that's behind the scenes, making the frontline work even easier and listen to their concerns and understand what they are. And we put together teams to do this, Thio out Mayo Clinic to really get the voice of everybody, bring it back and have discussions on an enterprise level and at a regional and site level to make sure that we were getting the message right. People were interpreting our messages correctly and feeling that they were getting the truth and then also giving them an opportunity to respond to the messages toe. Ask further questions that made us rethink some of the decisions that we had made we continue with this having frequent frequent conversations to those I mean every day, talking to individuals and, um, the team members and the leaders of the team. We have practiced chairs at all of our sites, making sure that we all have the same information and that every day, really, every day we learn from each other and then we communicate rapidly to try to pivot very quickly and the agile as we get new information. And every day we get new information about Covidien and how to manage patients. But we've come a very long way in this journey. I'm just looking at some of the other things. Our overall strategy, part of the other, is a. We continue to expand those teams to make sure that we have the subject matter experts in those teams. We also needed to simplify how we made decisions instead of going through multiple multiple steps to get things approved to just say I trust you. You know what our goal is now go do it and and making sure that people understood they had the resource is to do it. They had the they were empowered to make decisions. Rial time so we didn't have to wait along with that came, okay? You made a decision. Was that the right decision and making sure that many people had their eyes on that decision toe help decide. Okay, we need to tweak it here. We need to change this a little bit. And it was absolutely inspiring. Dr. Gray already used those words, but absolutely even today. Ah, good example is with monoclonal antibody infusions in the Midwest. We realized that we had nursing homes, that we're having outbreaks and we couldn't get them on it. And they couldn't get transportation to come to the Mayo Clinic in fusion centers in the different reasons regions. So immediately, we set up a mobile unit to go to the nursing homes to infuse monoclonal antibodies early in the disease of thes very at risk individuals to avoid hospitalizations and to decrease the severity of their disease. So we continue with this. Just do it. You know what the goal is? You've got the resource is and making sure that we trust each other. It's been it's been energizing, to say the least. I would just add quickly Dr Lal Thio. What Doctor Williams said I would reiterate the importance she talked about teams and empowering people to make decisions. I heard the leader of a significant organization, significant sized organization in the U. S. Um, say that he didn't expect to have to make five years worth of decisions in five weeks. And when you're in crisis, there are so many decisions to be made. If all of those have to be made by these Panelists that everyone is seeing today, there is no way that we among just us, can have the wisdom to do that. Number one, the energy, the time and so forth to make the quick decisions with all of the new information that Dr Williams Waas referring thio. So it just stresses that importance and that learning that we should take away from this, that we have toe have great leaders in place because we have to diffuse the decision making and make it as close to the work as possible. But we have to have every person in the organization feeling empowered and understanding those decision making rights so that they can do so very quickly and we saw the value of that and that's something we have to perpetuate. It's much easier for people to feel empowered and for us to empower individuals when you're in crisis mode, it's much more difficult once that crisis starts toe Wayne and so carrying that forward and taking that learning is certainly something for me. And I think for Mayo Clinic and for all of us that we should take away. And I noticed on the chat, someone said said, presumably from Mayo Clinic, that they never felt more in the loop in terms of the communication, Dr Williams was referring Thio. In many cases, we took some of our formats to update staff from quarterly to daily during this and eso that ability to have those interactions. And I think in building trust by saying, You know what? What we told you yesterday has changed today, and we admit that the information has changed and we're now giving you different information, and we're now saying what we best understand right now, but we're gonna update you tomorrow again in case that judgment has changed. And so I think many times leaders have a hesitance to admit when they don't know or when they've had Thio. When their past decisions need to be adjusted. And I think that's another learning we can take away from this year of. If we're transparent, that we're making the best decisions possible and carrying things forward and changing and admitting when they have to change that builds trust, it doesn't erode trust. Thank you. Art of part of that is just being authentic and being honest. You out. And I as clinicians, we all are like that and that we know that when we talk to a patient, we know they're complex and we may not have all the answers. And it was the same thing here is that, you know, I I don't know the answer to that, but together we can figure that out, and we will eventually learn and and adjust what we do. So I think for many of us that that's something we do every day. And it just then expands into our leadership roles. So So I heard themes off delegation empowerment, Um, honestly, transparency, communication, uh, scrutiny, pivoting a strategies that you would utilize through this uncertain crisis. I have a question from Dr Ready, and this is truly something that pertains your uncertainty. What is the forecast for the overall Covad 19 pandemic. Do we see any light at the end off the tunnel? Well, you know, one thing that we do have at Mayo Clinic is we have incredibly robust modeling, and that has helped us a lot. And we keep adding, almost every week we keep asking the modeling team toe ADM or to the modeling. In fact, now they're even modeling. They give us an idea of staff exposures and being out of work because of exposures, both in the communities and at work, which we have very few at work. Um, and it's usually over 93% are from community exposures, so that modeling has helped us very much as we look at the future, we are we in the We have been expecting a bump post Thanksgiving, but we haven't seen that we do see in the Midwest. We haven't seen it, of course, in Arizona and in Florida, they're having a surge, although it seems that we're hopeful things are starting to maybe level off. And I do think more people are masking social distancing, etcetera. But we the vaccines will help. We do see that we do see in the modeling that things will start to drop off. But we're still gonna have to mask and social distance after the vaccine because we it'll take a couple months to get everyone vaccinated. And we don't know exactly how long it takes to develop immunity. So we need to stay safe. Number one thing is staying safe, masking social distancing and he and hygiene. In fact, we were looking at numbers of the of influenza, and basically there's been no influenza because everyone's because of the masking hand hygiene and social distancing. So I do think that there's an end to this, but we're gonna have co vid 19 in our communities, So we're going to need to remain cautious. Thank you. Any comments from other Panelists? So I really wanted build on our teams that we just explored. And and next, I'd like to talk about building trust and engagement, uh, within the community with employees, patients boosting and maintaining staff morale and staff health. Um, and I would like for our chief administrative officer, Miss Minkowski, to discuss and give us some of the highlights and priorities that you used to build trust and engagement for. Thank you, Doctor LOL, and building trust and engagement with our staff and our patients has been key to successfully navigating the pandemic. And you already heard from Dr Williams and Dr Gray really about our communication strategy? And I can't over emphasize enough how important that was to us on making sure that we were engaging with our staff, educating, informing them and as you heard it evolved over time and, um, from doing kind of daily updates, leadership updates where we were bringing infectious disease experts in and our nursing experts in our human resource experts in, um Thio Weekly recorded messages. Thio Emails. Now we're doing podcasts. We all learned how to do slide Oh, for Q and A. And I don't know how it will live without slider or zoom now. But really, from a staff perspective that our ability to communicate and connect to our staff, um, in a very transparent way, I think, has been one of the reasons we have done so well at Mayo Clinic, just really navigating through the challenges. So maybe I'll pivot for a moment and talk more about our patients and our community. And so I can say for our patients. We've had to learn how to communicate with them as well in different ways. And we've leveraged our portal. We were fortunate at Mayo Clinic to have a very robust patient portal, and we've learned toe leverage that to make sure that we are giving our patients the latest information as well and what they should know as we've changed from allowing visitors not allowing visitors doing screenings when they come in and taking temperatures, um, to changing their appointment from an in person appointment to a virtual appointment. Really making sure that we're been able to connect and engage with our patients has been important, and I can say the feedback we've gotten from our patients is they appreciate that they appreciate us making sure that they're informed, Um, and they also appreciate that when they come on site, they can see that we're taking all measures to keep them safe, whether it's the screening we're doing at the door, the social distancing I mean, we had to change our whole physical footprint to make sure that we had social distancing for our staff and our patients and then just the investment we've made in the cleaning an extra staff Thio go around and make sure that every area is cleaned on a frequent basis, and so our patients tell us that's been important to them, to feel safe, to come back into our facilities. The other thing I would mention is on the community, and I'll speak specifically on Arizona. But we are in a large metropolitan area here in Maricopa County of about five million people, and there are several large healthcare systems here, and historically, we've all sort of been competitors, if you will. But this pandemic has brought us all together, and that has been one of the positive things that has come out off this particular challenging time. As healthcare organizations. We've all come together to really make sure that we're saving lives here in the Valley and that we're coordinating our care and we created amongst the large um, health care systems. A surge line was created in order to transfer patients and and sort of make sure that patients are getting the right level of care that they need. Andi also are CMOs. All of our chief medical officers have come together really for the first time ever on have you know weekly phone calls. In fact, actually, I think it's more than weekly. It's a couple of times a week where the CMOs air coming together and sharing best practices sharing, you know, the latest information, and really working collectively together with our Arizona Department of Health. And that really has been fantastic to see and again in a historically in a big city where we've been sort of competitors. It's nice that we've gotten beyond that and got beyond that very quickly to say, You know what? This isn't about competing. This is about keeping, um, the residents of Arizona safe on. That's both those that lived here America, Maricopa County, but also many of our out of state in rural population that needed additional care and how we were able to get them into into the Valley. So it has been a engaging staff. Engaging patients engaging with our community has been a big part of what we have been doing over the last eight months or so. Well, I can certainly assert that as a Mayo Clinic patient, a swell as an employee, it is with gratitude that we received honest, transparent communication, and I think that, um within people that come as patients and staff that work alongside. I think the degree of engagement and the degree of resilience that has been fostered as as a result, is truly remarkable. And the pandemic has just brought us together. Um, I have some questions from our attendees and that pertains, I guess, the building trust and engagement. And it's to do with the vaccines that are coming through. We anticipate at least a couple through the end of the year that are going to be authorized with emergency use authorization. We had a communication in the last couple of days stating that employees were being encouraged to get the vaccines. Uh, could you speak Thio building trust and engagement with the vaccination, understanding that there are some uncertainties with regard to something that is being authorized on an emergency basis? Yeah, and maybe I asked Dr Williams if she wants to comment on that from a Mayo Clinic perspective and then certainly Doctor Greek, and talk about we're a little bit unique here in Arizona with how we will be vaccinating our staff. And so I'm sure Dr Gray would be happy toe give some insight into that. I'll be glad to comment on this. Well, as you mentioned, because this is an emergency use authorization, it is voluntary. And but we want to give all of our staff all of our communities, our patients as much information as possible so they can make the right decision for them. And what we're seeing is that we'll get Pfizer initially and the Pfizer vaccine and then the modern A vaccine. And both of these vaccines are effective over 95% or so effective they also, through all of the tens of thousands of individuals that received the vaccine during that during the trial initial trial periods, very, very few had adverse reactions to the point where they needed to miss work. Now, with the second dose of the vaccine, they both need second doses. One is 21 days after the first. The other is 28 days after the first, that they that they people do feel like they have the flu. And on Lee, very small percentage of people needed to miss work because of that, it was some of them. It was, you know, it was fevers, my al jas just feeling rotten like you have the flu and it lasts for about 2 to 3 days. So we know that that is part of getting the vaccine very few with the first dose, but with the booster dose or the second dose. That's when you get that's when people get this. But the most adverse reaction was that people had to miss work for a day, and so that we're planning for. Our staff were planning that as we start to roll out the vaccine to our staff to make sure that all staff in one area don't get it on the same day and get the booster shot on the same day so that we do have people that can come toe work and staff that area. The initial wave, of course, who qualifies depends on the state, and every state is different. In Minnesota, it is the front line workers who are actually working in Kobe designated units or CO been designated spaces. Those that are E. M s, um, personnel, those that are in the I C. Use that have co vid and those that do procedures with Kobe, as well as those who are in the morgue or in long term care facilities. The in Minnesota we will not be giving Male won't be giving the vaccines to the senior citizen long term facility living facilities. The state is going to be doing that through other organizations, but every state is different. How this will be allocated. We anticipate that in, you know, by February, we will have everybody vaccinated. We know how many vaccines were going to get on a weekly basis. So we will continue, um, to move forward as quickly as we can with the's vaccinations. But the bottom line is, it seems like they're safe. We just need to give people the information and part of the research or part of what we will do. I won't call it research, but we're going to be studying this and monitoring everybody who gets back who gets vaccinated by Mayo Clinic to see when they actually develop immunity to see what the side effects are. And I would add this. This fits in with what Paula was just talking about, of meeting people where they are in communicating where they are, so that's true for our patients. That's true for our staff around vaccines as well in providing this information, so there will be some different logistic state to state. So one additional thing that will be meeting to communicate in Arizona and I think at our site in Florida as well that's maybe a little different from Minnesota is that there is a bundling in metropolitan areas of where the initial vaccines will be delivered. So that so the prioritization is very similar to what Dr Williams just mentioned. But, um, we will be combining with another health care organization to take an entire region of the Phoenix metropolitan area to administer the vaccines to healthcare workers and first responders. And so our staff will actually go prov of a Mayo Clinic campus onto the campus of one of our, uh, what we previously at least would have referred to as a competitors er and receive their vaccination there. And it may be from a Mayo Clinic staff member that's there. But it may be from this other organization as well. So just communicating around some of those things, in addition to the safety profile, is, you know, going to be very important for us to have our staff feel comfortable taking that important step of getting vaccinated. Thank you. I think this runs into our next question, which I'll direct the Doctor Etzioni, who chairs a surgical and procedural committee. And this is about 150 plus year old institution cultivating agility and adaptive nous, and particularly in the surgical discipline. And as as well as three surgeons, I here we will probably attest to the fact that we're not the most, um, easy. Thio have disruptions to a surgical practices, but you have led us through this pandemic with many of the strategies that were discussed. But we've had several pivots based on supply chain based on staff from the operating room being, uh, deployed to other units. Certainly staff being put on quarantine due to exposures in the community. Etcetera. Um, can you share with us some of the strategies that you and your team have utilized? Absolutely. Thank you, Dr Lal, and pleasure to be here on this webinar with you all today, e wanna talk from at first about the role that I have as the chair of the Surgical Procedure Committee. And in that role, I worked together with a group of leaders representing anesthesia, representing nursing representing surgical services representing our central sterile processes. And it's a great team, and it's really through that group of people that were able to provide, hopefully a coherent leadership framework for for a hospital. Dr. Gray mentioned that he heard somebody say that because of Kobe had had execute five years of decisions in five days. And I will say it's very hard to do that on your own because thes decisions are impactful. Thes decisions change how patients receive care. So the burden of that day to day decision making, sometimes our to our needs to be shared within a leadership structure. And I think that one of the strength that may have brings the table is what we call sometimes our diet or triad model. Our diet models, usually clinician leader, working together with an administrator to govern, uh, in area our tribe Models from the include nursing, but really, our model includes, I think, a very robust, collaborative decision making framework and because I think we're able to be nimble even though we do not lack for committees in our institution. Um, that being said, I think hospitals are highly complex systems I've heard estimated that a hospital is just as complicated in terms of processes and structures as a country is, I think that's actually true and what Cove it presented tow our system and to every hospital system and the country was, in effect, a disruption. And I think what I'm gonna focus on for a little bit is how exactly do we manage a disruption, a shock to a system that is as established, that is, as in some ways rigid as a hostile system is. I'll go through some of the lessons that we learned as we dealt with a shocked our system. The first thing I'll say is that you know, one of my favorite quotes when it comes to leadership in times of change is it's actually quote for the military. And that quote is that no plan survives. First contact with the enemy and the ending of the situation. It's it's not. It's not the patients, not even the disease. It z the impact of the disease and the associated problems with it on our way of doing business. And one of the things that we learned very quickly is that no matter what we thought, the impact on our practice is going to be. If we looked ahead of time, we said, Oh, gosh, this is about to come. Next week is gonna be bad because we're gonna run out of gowns every time we try to predict. But the real impact on our system is going to be. It ended up being something other than that. So because of that, I came up with a philosophy that it's really better to be nimble than prepared, not the preparation is unimportant, but probably the best preparation you can make is to be prepared to be nimble, and that seems like an oxymoron. But it is actually true. And part of that corollary is that one of things we found, especially in the O. R. Where we rely on a very broad spectrum of different types of staff and staff who aren't really fungible. You can't take a pre op nurse and put them in the cover room. You can't take a recovery room nurse and put me though our our staff are not fundamentally widgets that could be plugged in anywhere. But we did learn very early that staff or the most important resource. Um, and we've learned that now going to this second surge? I think that we are much better off because we've learned that lesson in some ways, the hard way. One of things that we also learned pretty quickly is that operating rooms and procedural areas foremost but also, I think, across the hospital, all of our hostel processes. All these areas are creatures of habit, and if we're going to change daily work clothes, do so at your own peril. But do carefully do in a way that's planned, do in a way that's consistent and make sure that you implements, um, innovative things to point people towards the change in policy, change in structure, change in process that you've implemented. I want to bring up one example of a way that we did that in a way that worked for us. We established levels of PPE for different types of patients based on aspects of the procedure based on aspects of their sins. Mythology based on whether not the patient had a pre operative pre procedural covert test that was negative. So based on that, that body of data, we establish a patient's being in one of three different risk levels. What we developed was a green, yellow or orange piece of paper that was laminated, that we hung on the gurney that explained exactly the level of PPE exactly the right processes that you had adhered to and take care of that patient and that laminate piece of paper. Wherever the patient went, it got hung on the outside the our door. If they went to the O. R, you got put back on their gurneys assay got transported back to the recovery room. So systems like that can really help everybody to be on the same page and to avoid confusion and chaos. One of things also say is that as we deal with with changes to our system, we can't always predict what every change is gonna bring. We can't have a policy in place that covers every situation, so I think we do have to be consistent. But in some ways we also to be flexible when it comes to some of our clinical and associated decision making. Now, a lot has been said by Dr Williams by Dr Gray and by Mr Makovsky about the importance of communication. And I think of communication when it comes to processes and change. I heard a great quote once about voting in Chicago that voting in Chicago voting should be performed early and often, and you could make the same statement about communication. I think the communicating frequently, but I think also communicating very concisely and clearly really coming to the point regarding what people need to uptake. I think that that's been something that we've been able to do well. I think that it's been very powerful in terms of making sure that everybody is rowing together in the same direction. Um, the last lesson learned that I mentioned is that you surgery procedure care. It really is a team sport. It's very hard to take care of any patient at the whole team on board when you have a new shock, a new stressor, the system, there's always going to be some confusion, and there will occasionally be a dissenting voice. A dissenting voice is somebody who needs to be brought on board and their voice. The reason for their descent needs to be heard. But if you try to move forward with significant rapid change when you haven't addressed appropriately all dissenting voices, that's the kind of situation that can grind, change and adaptation to a halt, thinking for a little bit about future strategies. Um, I'm going to not spend much time here because, as I mentioned before, every time we think we know what we're about to deal with, it ends up not being that. So. Our future strategy is to deal with what comes down the pike in a way that's hopefully appropriate, nimble. I think that we are better prepared now, but I think that the most important paradigm that I use when it comes to thinking you had a step and surgeons pride themselves and think he had a a step. But the big thing that we're doing differently is that we're constantly conceptualizing our ability to provide care in terms of the resource that we need In our ability to move. Resource is from one place to another, and I think that seems very simplistic. But that's one paradigm I think has been really helpful for across to adapt to change and then last thing I'll talk about for a moment to supply chain optimization and we've been very lucky in the surgical procedural areas, toe work with a fantastic supply chain team that works not only within our enterprise but also across other regional sources of materials. And I think that that's been critical for us to avoid any significant supply chain shocks. But any supply chain optimization process really has to have an early warning system that functions well. You have to know ahead of time. You can't find out on Monday. They're out of gowns on Tuesday. That's a that's a failure. We've been very lucky to not have any failures of that character. But every time you have a supply chain threat, I think all options have to be on the table. One of things that we did very early in response to our supply chain threat of insufficient gowns as we switched hospital wide to using reusable gowns, especially under floor areas. We deploy that early and we were able to avoid any situation where we were out of supplies. But the last thing I'll say about supply chain is that a lot of times when you have supply chain threat, you are going to be relying on staff to do things differently. And there's always a concern that staff aren't going thio. Take it well and I will say that every time we have stepped up to the microphone and ask people to change behavior because of a threat to supply chain, I think we've got a fantastic response. I don't think that's just a Mayo thing. I think that that's something that that leaders should be unafraid to do when it comes to asking their staff to chip in and to change processes. And I'm gonna stop there and take any questions that Dr Law would like to mediate and saying once again how how honorably empty part of this, uh, this group. Thank you so much, Dr Etzioni. And I think that a lot of the questions that are now coming through pertained to immediate strategies. Um, for vaccination, Um, how to maintain human resource is there were some questions with regard Thio when staff developed fever after vaccination. And if health system does not have the ability to test for cover 19 and rapid fashion, how do you engage with that? And I know that we've already addressed some of the logistics associate with vaccination, but I hope we could talk a little bit about, um, the testing on vaccination aspect as well as maintaining a healthy workforce aspect. I can start that, um, there a lot of questions within that question I'll take if you get the vaccine and you get that that second dose and you start to develop a day or so after the symptoms. The, um I would recommend that, and this is what we are doing here with our occupational health. What we'll be doing is that they call and they call your provider, let them know that you have these symptoms. Now, if you just got the vaccine and it's a day or so after the vaccine and you have had no known exposure, it's most likely the vaccine, and it will be gone soon after that. Those symptoms within, they say, last 23 days, and that's it. So you don't have to come to work at that time. Um, if you don't feel well enough to come toe work, but, um, but that you don't need to get tested at that time now, If those symptoms last longer and or they start to get worse after three days, then that's another question. And you may have had an exposure that you didn't know of you may have influenza and not Kobe 19. So it's getting tested appropriately for that at that time. So I hope that that that that helps with how to differentiate after that vaccine. It's anticipated that people are not going to feel well for a little bit, but you might feel well enough to go toe work. Or it might be that you just don't feel well enough to go to work. Thank you and and moving on from there. Thio The next light, which I'd like for all of you to comment on how what we've learned from the pandemic in building readiness for the future for the long term. What are the lessons learned? How are we dealing with the mental health of employees? That's another question to just came up. Um, how we leverage technology? Do we anticipate that health is gonna continue indefinitely? Do do we anticipate that PP requirements are going to be the same as we have now? I was just going to speak to the doctor lawyer is going to speak to sort of the wellness side of it, and I would just add because we haven't touched on it and I have seen some of the questions come up. We have created a lot of online. Resource is for our staff around wellness stress management resiliency. I'm really have promoted those throughout the organization. I would also say we have wellness champions identified in departments so that those folks can help bring Resource is to the department to the work unit. Make people aware of what's available, and the other thing that we have done is focused a lot on joy. And even though we're have been in the middle of a crisis in a challenging time, how we can bring joy to each other. Onda We had something we created here at Mayo Clinic called in Arizona. Spread your jam with jams stood for joy at Mayo, and it was giving out small amounts of funds to work units to dio kind of random acts of kindness. If you will create virtual art tours, create virtual balloon making, have have some fun with each other in a safe way and allowing them like I said, the little bit of funds to do that. We've had very creative staff, and I can tell you we get messages from our staff just thanking us for that and that spread your jam has brought a lot of joy to our staff during this very challenging time. And I would only add that we're just reemphasize that were. You're just trying to keep the momentum moving forward. The things that you mentioned in your question, Doctor LOL leveraging digital technologies, leveraging new infrastructure, the platforms such as acute care at home. All of those. Now we've we've gotten some learnings from. We've understood now how they can provide value and way just need to continue to build upon that and not fall, just fall back into old patterns when we're able to take our masks off. So you know, Paula mentioned, uh, communication with our patients are patients have responded very well thio to a synchronous communication through text messaging and the portal, for example, for covitz screening. That was something we weren't sure how patients would respond to it. And yes, the atmosphere will change. But we've learned that yes, we can leverage that and there's at least a certain amount of our patient population, so there's so much that we've experienced quickly that we just need to keep the momentum moving forward on The other thing that we learned with virtual care is that we can help each other across our enterprise without helping on a plane to do it. And that has been absolutely amazing. We've people from Florida individuals from Arizona helping the Midwest during our recent surge. People from the Midwest with special for specialty care helping our colleagues in Arizona during their summer, uh, serves that they had absolutely fantastic. And the other thing is that we have ah, Frontline Kobe care team that have followed over 15,000 patients across the Enterprise who don't need to be hospitalized. But they test positive for Kobe. 19 and they're a home and they're monitored by this team. And the team is across the enterprise monitor monitoring these patients, which is absolutely spectacular and being able to say, Okay, this person's deteriorating. We need to get in there and help them get them, get them what they need, or have them go to the emergency room before it's too late. So it's leveraging technology to really come together. Even Mawr, as an institution to help patients no matter where they are and to help colleagues no matter where they are, has been really a great learning from this pandemic. Thank you so much to all our Panelists for your expert and generous discussion. Uh, and unfortunately, our time is coming to an end, and I am going to hand back the control to Jeff Puerto Rica. Well, thank you, Dr Law, And thank you all for joining us today. Um, if you enjoyed this Webinar, your conference is scheduled to end in two minutes, January 20th, where we'll be taking a deeper dive into the supply chain. Considerations for delivering that Kobe 19 vaccines where the boots hit the ground. Also, I'd like to remind you that you can claim 1 a.m. a credit for today's webinar. To do that, you want to go to our website ce dot mayo dot e d u backslash cove it 1 to 08 You'll get yourself registered and logged in. You'll find that access code box in this case sensitive code here covert. 1208 You could go ahead, enter that access the course completely evaluation. And that obtained your credit. So we appreciate you all for joining us this week. We hope to see you next month.