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Kevin P. Carney, MD
Medical Director, Clinical Operations and Strategic Planning
Children's Hospital Colorado Emergency Departments & Urgent Cares
Aurora, Colo.
Q: Briefly describe your current role and professional responsibilities.
A: In addition to being a practicing pediatric emergency medicine physician, I currently serve as the medical director of clinical operations and strategic planning for the seven EDs and urgent care centers at Children’s Hospital Colorado. CHCO is a large, academic, pediatric tertiary care hospital system affiliated with the University of Colorado School of Medicine. Our EDs and UCs see more than 170,000 patients each year and are staffed by a diverse group of over 160 PEM physicians, pediatricians, physician assistants and nurse practitioners. My responsibilities include ensuring our system is designed to consistently provide safe and high-quality care, leading quality and process improvement initiatives, overseeing provider staffing, supervising and coaching each site’s medical director, and being the primary communicator of clinically relevant information with our ED and UC providers. In this role, I’m also the clinical liaison between our academic section and the hospital, meaning I’m heavily involved in helping develop strategic plans for the future of pediatric acute care in our hospital system.
Q: Can you describe how your organization responded to the COVID-19 pandemic? What challenges were you tasked with tackling and what solutions did you or your team devise to address those challenges?
A: I consider myself very fortunate to work at a world-class organization like Children’s Hospital Colorado where work began early in 2020 prior to the first known cases of COVID-19 arriving in the United States. What began as initial small meetings with our epidemiologists and microbiologists quickly expanded into a full-blown emergency management situation with a well-coordinated incident command team leading our response efforts. It has been inspiring to watch all levels of leaders in the organization put aside their normal work to contribute to the response.
Personally, I’ve been heavily involved in developing the hospitalwide PPE policies and recommendations, clinical workflows and viral testing algorithms. From an ED standpoint, we’ve had to alter many of our operational processes to safely manage this crisis. One example of a new solution we devised early in the pandemic was the development of a “surge tent” strategy that allowed for potential COVID patients to be safely and efficiently cared for in a large medical tent outside our main ED. As a tertiary care pediatric ED, we see many medically complex and immunocompromised patients, thus this medical tent helped minimize infectious exposure to these high-risk patients as well as protect our staff, providers and other families inside the main ED.
Q: What lessons have you learned about emergency room and urgent care clinic operations from the pandemic that can help improve patient care going forward? Has Children’s Hospital Colorado made any positive changes that you see extending beyond the pandemic?
A: ED volumes are down all over the world due to the pandemic, and pediatric visits have dropped particularly sharply. This is partly due to school closures and improved hygienic practices which have limited the spread of the traditional viruses that bring children to the ED. In addition, we also know people in the community are fearful of going to hospitals due to the concern of being exposed to COVID-19. To address this, our ED worked with our hospital leadership to create an After Hours Virtual Care program designed for parents seeking care for lower-acuity complaints. This video telehealth program is staffed every day by a pediatrician and has been very successful in managing certain acute pediatric conditions while helping parents avoid in-person ED visits. There are a number of tremendous upsides to a program like this and I have no doubt it will continue in the future beyond the pandemic.
Q: The pandemic initially created a lot of confusion and uncertainty. What leadership attributes and lessons have you found to be most helpful during these challenging times?
A: Like a lot of leaders this past year, I had to take a crash course in “crisis leadership.” What I observed early in the pandemic was that while there was a lot of information pouring in from many directions, it was often overwhelming, contradictory and not actionable. What our frontline team members needed was someone to help interpret and synthesize this information for them in a way that was clear, timely and helpful for staying safe on their next shift. As a leader, getting out on the unit, listening to our team’s concerns and anxieties, and communicating frequently have been the most effective actions I’ve used to help our team through this. Finally, it’s never been more apparent to me how valuable it is as a leader to connect with your team by acknowledging and validating where they’re at emotionally, as well as being willing yourself to be vulnerable, transparent and authentic. This basic human connection has been critical to help build trust with my team during such a stressful and uncertain time.
Q: Burnout and fatigue are major concerns for many clinicians right now. How is your organization supporting the wellness of your physicians and other front-line workers?
A: As all healthcare leaders know, clinician burnout was already a significant issue prior to the pandemic and has only been exacerbated by the crisis. Both CHCO and the University of Colorado School of Medicine have made great efforts to acknowledge this and help their teams deal not only with the stresses at work, but also at home. Ensuring adequate PPE and clinical staffing in the hospital have been critical to preventing burnout by making team members feel safe when they come to work. The CUSOM has also offered its faculty members free access to numerous mental health offerings via the Department of Psychiatry since early in the pandemic. Finally, both CHCO and the CUSOM recognized the significant stressors this pandemic has put on team members at home, and have developed expanded options to help deal with childcare issues, special PTO options for those who are sick (or have sick family members), and provided many other ways for our community to connect virtually while socially distanced.
Q: What role has ACHE played in your professional development?
A: I joined the ACHE in mid-2020 at a time when I was seeking more resources on how to become a better physician leader and expand my knowledge of healthcare systems. By then, I’d already been an avid listener of the ACHE’s excellent Healthcare Executive podcast and realized membership would help unlock more opportunities. It’s been invigorating to join a group with so many other like-minded individuals who are focused on sharing ideas for how to improve care for our patients, support our front-line team members and mentor others along their leadership journey. I’ve already made numerous professional connections via ACHE and look forward to the (hopefully!) not-too-distant future when we can start gathering again at in-person conferences.
Anesthesiologists Model Adaptability Amid Turbulence
By Mary Dale Peterson, MD, FACHE, FASA
In many ways, anesthesiology is the intersection of medicine and surgery. Anesthesiologists have considerable internal medicine and critical care training; expertise in disease and pain management; a complete understanding of how the surgical process, trauma and blood loss affects patients; and the ability to maintain vital functions during surgical procedures. Given the multifaceted nature of this role, the impact of the COVID-19 pandemic on anesthesiologists—and the way these professionals have responded to help overcome obstacles—has been particularly interesting.
The story of the COVID-19 pandemic for anesthesiologists across the country has been something of A Tale of Two Cities. On the one hand, postponing elective surgical procedures and other nonurgent care as well as considerable financial losses for healthcare organizations have led to the loss of livelihood for so many surgeons, anesthesiologists and other clinicians. On the other hand, where COVID-19 cases have surged, many hospital-based anesthesiologists have been redeployed to oversee ventilator management or reconfigure ORs to become ICUs.
Meeting Obstacles With Flexibility and Focus
Due to their training, anesthesiologists are used to running ORs, managing complex problems and putting the puzzle pieces together to find innovative solutions. The ability to ascertain the equipment needs, people needs and process needs of an emergency response has been an absolute necessity during the COVID-19 pandemic.
One example of how anesthesiologists have put their skills to use is by repurposing anesthesia gas machines into ventilators. The American Society of Anesthesiologists, with the Anesthesia Patient Safety Foundation, put together a team of experts and manufacturers to work with the U.S. Food and Drug Administration to release guidance on how to make changes to anesthesia gas machines to use them safely as ICU ventilators. In addition to the resources we released, we hosted webinars to educate clinicians and set up a hotline to answer questions for those in need of assistance to safely manage patients in the ICUs on anesthesia gas machines.
Another way the anesthesiologists have helped meet the demands of the global pandemic is by focusing on targeted reeducation. Cardiac and pulmonary physiology is a mainstay of any anesthesiologists’ training but brushing up on these areas specifically has been crucial, given the nature of COVID-19 and the medical issues patients with the virus have. The ASA created an ICU bootcamp with numerous resources dedicated to getting clinicians refreshed on the stages of acute respiratory distress syndrome, managing clotting issues with anticoagulants, and managing pneumonia and multiple system failure, as well as new information on the different presentations of COVID-19 and how the virus attacks organs like the heart and kidneys.
For hospitals and other healthcare organizations struggling to meet the changing demands of patient care during a global pandemic, I suggest tapping your anesthesiologists for their assistance and expertise. These clinicians offer a wealth of knowledge and can be particularly helpful regarding problem solving, scheduling, OR management, OR to ICU reconfiguration, gas machine to ventilator redeployment and so much more.
Looking Forward to Lasting Changes
The COVID-19 pandemic may have thrown the healthcare field for a loop, but many changes and lessons that have come out of the experience will last. For instance, during 2020, a good deal of the pre-operative evaluation process has gone virtual. Physician anesthesiologists, surgeons and nurses have leveraged telehealth and video conferencing technology to speak with patients to collect medical history information, evaluate the risk of COVID exposure and decide if testing for the virus is necessary and when, and explain the upcoming surgical procedure. Some of these changes will likely stick around, even post-pandemic.
Another shift I’ve seen is how hospital administrators view anesthesiologists more now as experts who can manage ORs, oversee surgery schedules, lead intubation teams, provide insight into improving care efficiency and champion safety efforts. I have had several anesthesiologists contact me to say the pandemic changed how they were viewed by colleagues and how they have become a go-to professional for helping streamline care processes or lead safety efforts in different departments.
Ultimately, the pandemic has highlighted the importance of clear communication, effective collaboration and respect between and among healthcare providers. Those are values I think we’d all like to see continue in the future.
Mary Dale Peterson, MD, FACHE, FASA, is the immediate past president of the American Society of Anesthesiologists and the executive vice president and COO of Driscoll Health System in Corpus Christi, Texas (mary.peterson@dchstx.org).
ACHE understands the COVID-19 pandemic has impacted healthcare professionals across the globe. To help healthcare leaders continue to grow and learn, we are offering a 25 percent discount on the registration fees for all paid live webinars, webinar recordings and online seminars now through Dec. 31, 2020. Learn more here.
Exciting 2021 News for Physician Executives Forum Members
It has been an extraordinary year, and we are looking forward to the changes 2021 will bring. ACHE is transitioning the Physician Executives Forum—along with two other forums—to no-fee, online communities in January. This change reduces any financial barriers and offers the opportunity to expand our reach to more ACHE members, including those impacted by the economic challenges of the pandemic.
With the new online community, members will not only continue to receive exclusive content but will also be able to communicate with each other by posting questions, offering advice and sharing best practices. Current forum members will be automatically transitioned to the new online communities and do not need to take any action during the dues-renewal process. You will receive updates as the details are finalized.
Thank you to all the inaugural Physician Executives Forum members and those who have become members since. We invite all forum members to help spread the word about these new complimentary communities. With your help, the communities will quickly become vibrant, interactive spaces to stay connected with other clinical leaders.
Register Now: 2021 Congress on Healthcare Leadership
Registration is open for the 2021 Congress on Healthcare Leadership, March 22–25. Join us for this reimagined virtual experience and earn up to 12 ACHE Face-to-Face Education credits for an early bird fee of only $449. Register by Feb. 22 to receive the discounted early bird registration rate.
Our Congress agenda features keynote speakers including:
- Anthony S. Fauci, MD, director, National Institute of Allergy and Infectious Diseases.
- Keller Rinaudo, co-founder/CEO, Zipline.
- Amy Walter, national editor, The Cook Political Report/host, “The Takeaway.”
- Atul Gawande, MD, surgeon, Brigham and Young Women’s Hospital/writer, The New Yorker.
Sessions and speakers are being added to our Congress lineup every week, so visit ache.org/Congress often for updates.
Important Change to FACHE® Membership Tenure Requirement
Becoming a Fellow of ACHE has long been the gold standard for leadership in our field. After much discussion and consideration, and with the support of the Membership Committee, the ACHE Board of Governors has decided to change the membership tenure requirement for initial Fellow advancement from three years to one year, effective Jan. 1, 2021. We hope this change will make attaining Fellow status possible for more Members who wish to reach this important leadership level.
The FACHE credential is one of the most recognized and respected symbols of a leader’s competency and commitment to healthcare management excellence, and this change in no way diminishes the hard work and ongoing commitment to the core values of ACHE that board certification represents. Candidates must still meet all of the other eligibility requirements, including holding an executive-level healthcare management position and having a minimum of five years of healthcare management experience at the department head or director level. The experience requirement also ensures candidates demonstrate responsibility for departmental budgeting, planning and staffing, and accountability to senior management for departmental and team performance.
If you have any questions about the change to this eligibility requirement for initial advancement, or any questions regarding certification or recertification, please reach out to our Customer Service team at contact@ache.org or (312) 424-9400, Monday through Friday, 8 a.m. to 5 p.m., Central time.
Connect With Forum Members
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Please note that any views or opinions presented in this online newsletter are solely those of the author and do not necessarily represent those of ACHE.