4 steps toward building durable trust upon COVID transparency

Leaders of academic medical departments could and should act now to turn the present public-health crisis into an opportunity for ensuring long-term team cohesion, suggest radiologist leaders who write from firsthand experience at Vanderbilt University Medical Center in Nashville.

Their case study on maximizing leadership’s transparency during the pandemic—and, in the process, enlivening team members’ trust—is posted online in JACR.

Stressing the essentiality of “bidirectional communication”—listening as well as speaking—Lucy Spalluto, MD, MPH, and colleagues separate the content of these recommended discourses into two categories: department-specific and virus-specific.

For the latter, they offer a brief primer on coronavirus epidemiology, infection control, potential treatments and related matters.

For department-specific communications, the authors describe their activities keeping team members current, and thus involved, with developments in four key areas:

1. Keeping the team up to date on COVID case volumes. At Vanderbilt, radiology leaders have supplied regular updates on infection and mortality statistics not only at the local, national and global levels but also at their own institution.

“Detailed information on the number of COVID-19 related institution hospitalizations, ICU hospitalizations and intubations/ventilated patients provides department team members with transparency on the institution’s current capacity,” Spalluto and colleagues explain. Radiology leadership also goes as granular as distribution of hospital cases, number of available inpatient and ICU beds, and plans for handling overflow if needed.

2. Taking charge of personal protective equipment (PPE). The leadership appointed a peer—the department’s quality and patient-safety officer—to supervise PPE distribution and maintain departmental policy.

Along with leading weekly discussions on current PPE guidelines, the PPE point person is “readily accessible at all times to answer questions from all department members,” the authors write. “She maintains an open dialogue on the institution’s current supply of PPE and the backup plan should shortages arise.”

3. Understanding concerns about fiscal impact. To hold the line on guesses and rumors about what’s going on out of team members’ earshot, Vanderbilt’s radiology leaders strive to be open about sharing what they know, as they know it, about financial implications for stakeholders at all levels.

“During this stressful time, when numerous businesses and healthcare systems across the country have announced layoffs and furloughs,” the authors report, “we have found honest discussions about potential staffing changes to be helpful in alleviating undue department member stress.”

4. Adjusting policies as needed. At Vanderbilt as elsewhere around the world, standard operating procedures have changed at Vanderbilt University Medical Center as the COVID-19 crisis has unfolded. To keep everyone apprised of changes that get codified into policy, the radiology leadership holds regular discussions at the section level as well as within the department.

“This includes policy regarding which radiologic procedures and staff are considered essential vs. non-essential, which procedures and diagnostic studies should be ordered and which should be placed on hold,” the authors write, adding that the department has come up with five guiding principles to help providers and staff make the call on whether to hold or proceed.

Also in these discussions are updates on the status of research projects and, perhaps of great interest to individual team members, any advance word on whether faculty or staff might be temporarily reassigned within the institution.

“During a pandemic, healthcare workers experience rapid, unexpected change,” Spalluto et al. conclude. “The resulting stress and the fear of the unknown can drive department members to envision a worst-case scenario. To alleviate department member stress and build trust, leadership can increase transparency through regularly scheduled, bi-directional communication.”

The authors further comment that the need for COVID-specific communications is likely to decrease over time. However, going forward, “transparency and bidirectional communication will remain relevant and necessary tools for effective radiology leadership.”