Four Key Lessons from COVID Command Centers

One of COVID-19’s defining impacts on healthcare operations is the widespread, large-scale, long-term activation of Command Center operations. Command Centers aren’t new to healthcare – they’ve been locally deployed for disasters like hurricanes for decades. But never has every health system in America had to prepare, activate and operate under a Command Center model simultaneously and for such a sustained period. Until now.

Across the nation, health systems convened COVID Command Centers last spring and found themselves achieving outcomes in days that used to take years. Ambulatory groups launched thousand-visit telemedicine platforms in barely a week. Urgent Cares transformed into dedicated respiratory evaluation centers in just a day. And in a matter of hours I’ve seen labs flip entire COVID testing platforms, then flip again, then flip again.

How has all of this been achieved? There are at least Four Key Lessons we can pull from the Command Center model to dramatically improve “routine” operations long-term:

Start with Shared Situational Awareness

Command Center meetings are grounded in communicating a core set of information in a routinized manner, ensuring that every team member level-sets on the organization’s most important strategic, operational, and logistic challenges. Without shared situational awareness, sub-teams tasked with delivering on a goal risk losing sight of how their goal connects to the organization’s overall response and leaders risk ping-ponging resources among whichever concern is voiced loudest each day.

I found this approach especially crucial in mid-March, when rules were changing by the hour and many fires seemed to start all at once. At WakeMed, shared situational awareness allowed the Command Center to simultaneously focus resources on each day’s most concerning fires while standing up the foundational pillars that could begin “clearing the brush.” Once pillars like the Capacity Management, Business Continuity, and Critical Resources Teams were in place, fewer fires could start and those that did couldn’t burn long without dedicated first responders ready to deploy and the fully-aware Command Center standing ready to support.

Ground Operations in Easily-Communicated, Must-Achieve Goals

When faced with crisis, organizations must empower their people with clear, simple guidance from which to make hundreds of aligned but independent decisions. Johnson & Johnson defined this approach during its 1982 response to the Chicago Tylenol murders, focusing on the organization’s core values embodied by its credo which “became the compass” for both local and central decision-making.

In the COVID Command Center, these goals manifest both strategically and tactically. Strategically it became both easy and natural to point the health system’s reason for existence – to serve the community and our people – as the guiding principle for decision-making. Tactically this core purpose translated into simple to communicate (though often hard to execute) key objectives like “we will maintain a CDC-defined low-risk encounter for as many people in as many situations for as long as possible.” Combined, these strategic and tactical imperatives functioned just like the J&J credo, serving as a compass for team after team to drive local decision-making while ensuring all row in the same direction.

Focus on a Metric-Driven, Action-Oriented Agenda

In a world where “meetings about meetings” are too often the norm, Command Center meetings offer an easy antidote. They are protein-heavy, packed with the meat necessary to create shared situational awareness and drive progress on easily-communicated, must-achieve goals.

To meet these dual imperatives Command Center meetings must focus on the data that demonstrates whether or not a team is on track to deliver an outcome. If they are on track, teams can be recognized for their work and resources allocated as needed. If they are off track, the right people to help the team problem-solve are already in the room to redirect, redeploy, or redesign as needed. As a result, Command Center meetings combine the yin and yang of highly-effective operations – support *and* accountability – and are generally both high-yield and highly productive.

Pull on Talent-Based (not title-based) Teams

Health systems in the 21st century are complicated, highly matrixed environments. While matrixed team structures solve for connection on paper, in practice they often made it more challenging to get the right people in the right room at the right time to drive rapid progress. COVID-19 forced us to break through the solid and dotted lines of our org charts and instead marshal anyone with the talents needed to solve truly existential problems.

The WakeMed Critical Resources Team is a terrific example of such a group. Bringing together critical care providers, pharmacists, supply chain experts, infection preventionists, performance engineers, experts in research and innovation, nurses, operators, and more, the Critical Resources Team helped the organization stay on top of frequently-changing PPE guidance and deliver on key objectives like “maintaining a CDC-defined low-risk encounter.” They created entirely new PPE supply chains, worked with NC State to manufacture specialized face shields from scratch, and perfected a 3D-printed KN-95 mask brace. All while still doing their day jobs, proving that titles alone do not begin to describe the full spectrum of people’s talent.

Conclusions

We are nowhere near the end of the “COVID Era” in American healthcare, and we clearly will learn much more as the depths of winter settle over early 2021. Yet as widespread vaccination rapidly becomes a reality and the world begins to envision a new day without mask mandates, now is the time to lock-in lessons we have learned through painful experience over the past year.

These four such lessons – Starting with Shared Situational Awareness, Grounding Operations in Easily-Communicated, Must-Achieve Goals, Focusing on a Metric-Driven, Action-Oriented Agenda, and Pulling on Talent-Based (not title-based) Teams – have proved invaluable through the first year of the “COVID Era.” Hard-wiring them now into our operational DNA offers health systems an opportunity to lock-in their demonstrated success in driving high-functioning teams to previously unimaginable progress.

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