Finding a New Normal for Our Palliative Care Team in the COVID-19 Era

It is ironic that it took a pandemic to magnify the profile of palliative care so significantly. As we prepare for yet another wave, we cannot just ask everyone on the team to simply shift back to routines and processes we all took for granted before COVID-19. Instead, we need to apply the lessons learned and move forward to tackle the next challenge, with a revitalized sense of purpose, and a renewed commitment to palliative care. By doing this, we can try to achieve a sense of a “normalcy” in a decidedly abnormal scenario.

Our inpatient team at Oschner Medical Center (New Orleans) was growing and ramping up when we were first hit with COVID-19 in 2020. Suddenly, it was all hands on deck. We abruptly went from 115 consults per month (on average) to 200+ during the worst of the initial crisis. Amid very difficult circumstances, one constant for many patients and families was the palliative care team.

Even we, as palliative care leaders, have emerged with a better appreciation of what palliative care can do, and what it can offer. One of the silver linings of this terrible event was making a concerted effort to say we are going to see every single patient admitted to our ICU, see them early to allow the patients to have a voice, and also later on, when they may not be able to participate in conversations.

While a pandemic is not something we would have ever wished for, it has presented a rare opportunity to educate our health system, and its clinicians, on the importance of palliative care. Through this education and creatively leveraging our pre-existing relationship with the pulmonary critical care team, we were able to expedite our integration into the COVID ICU.

As we became fully integrated there, we normalized early palliative care consultation and involvement. Our elbow-to-elbow work with the ICU teams further demonstrated the value of palliative care, and elevated the appreciation of other clinical teams, as well as patients, families, and colleagues.

Our ability to support other clinicians serving these patients made us a mainstay. We are confident we can build upon the momentum, with the investment and focus from the executive level to ensure palliative care is broadly available to the patients and families we serve. Ochsner has made this commitment, which gives us the ability to seize the moment.

As a relatively new service line, we are looking to build and scale quickly, outside of the needs of the pandemic. But, it is a balancing act—growing quickly and offering palliative care to more people in more settings, while also taking into account what our teams have just been through, and trying to ensure we are not creating the circumstances for burnout or exhaustion. We routinely talk about this as a team.

We start by simply acknowledging that it is a unique time. We stay in regular contact with all of our team members through multiple touch points. We are trying to navigate this new reality as best we can, to continue to evolve, while simultaneously supporting our colleagues so they feel this is sustainable. We cannot be so static to say, “okay, back to the grind,” but rather, “how can we do this in a way that best supports you for the long term?”

It is not just about meeting our goals as program leaders, but also about highlighting the value of the individuals that make up this great team. Each team member makes unique contributions to the program, which are aligned with their particular interests and strengths. It is very much a work in progress, but we strive to empower each other, to help shape and mold our program alongside us.

Several changes have helped to balance growth with team support. We supplement our twice-monthly staff meetings with more one-on-one time with our clinicians, administrative assistants, clinic nurses, and medical assistants. This gives everybody a safe space to confidentially discuss what is or is not working well. It allows them to share success stories and the things they are most proud of, or how they are hoping to grow and develop professionally.

These meetings have yielded many good conversations, insights, and informed our practices moving forward. We talk about ways we can better promote a balance between work and family, and how to achieve success at both ends. We have encouraged team members to contribute to the program without always being in crisis mode—through academic pursuits, writing, teaching, clinical improvement projects, or anything else where those desires exist.

We do not want to lose the momentum that we have, nor do we want to lose the attention of our stakeholders. Knowing that this truly presents a challenge, we can start with something simple, like a six-month plan, that asks:

• Where is the team today?
• Are people taking time to rest and recharge?
• Where are people asking us to grow?
• What is the organization’s focus right now?

Asking larger, open-ended questions provides a reality check for the short term. It is one thing to make plans. It is quite another to see them executed and really understand how it influences the day-to-day life of the people carrying out the work. We have found that the process of planning and asking the team these questions helps us connect more closely with each other, and our patients. As part of our discovery, team members also share stories of patients or families they work with, making this exercise of planning forward even more personal and relevant to those on the frontlines.

Instead of remaining frozen in the moment, we have learned that there are actionable steps that we can take, which make sense regardless of what could change around us—whether realigning with the organization’s priorities or preparing for the next crisis. This exercise is a first pragmatic step in moving forward, without jumping forward. It is a great opportunity to plan forward, while anticipating and preventing challenges down the road.

As part of taking care of ourselves and the emotional well-being of our team members, we have allowed for time and space to heal, and work through personal and/or professional anxieties of the pandemic—whether not being able to hug their children, fears of getting sick, or many other anxieties. This has allowed our colleagues to be present and really deliver. We cannot celebrate their resilience enough.

While we are still figuring out how best to facilitate long-term sustainability and resilience, we have learned some important lessons:

We take time to share unique talents, perspectives, and interests, and actively solicit ideas to help our palliative care program evolve. Creating space to shape a sense of program ownership, and an ability to make a unique contribution as an individual, facilitates long-term resilience and gives people the desire to come to work every day.

Our team routinely discusses the patient population we work with, who we really want to care for, and how we want to develop that practice. Once this is understood, we work together to develop an outreach plan to partner with the practices which care for these patients, and jointly design how palliative care can support the highest-priority patients. It is a very collaborative approach. The response has been tremendously enthusiastic.

As we anticipate yet another wave of COVID cases, the combination of flexible and formal structures of communication allow us to stay close to our team, and ensure that we are aware of a certain mental morale. This approach has also improved team cohesion. As a result, we are more confident that we can grow sustainably, because we now have these lines of communication and cohesion, which can support that growth.

Our team has evolved and grown as a result of the initial COVID waves, so we feel well-prepared to tackle the onset of yet another surge, as difficult as that is. We realize not just our team, but everyone on the front lines, is threatened with exhaustion. So we also pay attention to their emotional well-being—because if they’re not in a good place mentally, they won’t be able to perform well.

It all starts and ends with communication and transparency. We will continue to stay close, listen, and be receptive, while encouraging our team members to be their best selves, to accomplish everything needed to serve their patients, families, clinical teams, the organization, and themselves.