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    James Brink

    From Communication Strength to Just in Time Reopening at MGH A conversation with Dr. James Brink, Chief of Radiology at Massachusetts General Hospital

    Dr. Brink was taught early in his career that empathy is a key part of treatment. He learned to value the least important person in the room, no matter the circumstance. And he was inspired to be a good physician and a good leader at all times. These traits have been critical to his work throughout the COVID-19 health crisis, allowing him to focus on what really matters in the midst of chaos. He shares what they have been with HPI.

    1. Never miss an opportunity to overcommunicate

    During this pandemic, particularly as people have been forced to remote work environments, the mantra at MGH has been communicate and communicate and communicate again, to all stakeholders, about what’s happening and what lies ahead, being as transparent as possible. Dr. Brink expands on this thought, highlighting that when there is uncertainty or a lack of clarity, our natural tendency is to presume the worst. His career experiences have clearly taught him to prioritize communication.

    I often think of communication in terms of layers of an onion, where my core group of administrators are a critical group to have dialogue and communication with. The next layer includes the next group of leaders, the next layer all the professional staff, and the layer beyond that all of the nonprofessional staff that are so important to our mission. At MGH, those layers expand from a circle of six people to the full boundaries of the department – about 1700 people and various layers in between. I can’t emphasize enough the value of making sure that communication is strong at every layer.

    1. Prioritize

    The seriousness of the current healthcare crisis hit Dr. Brink in early March, when his Incident Commander began discussing how to get people out of the hospital that didn’t need to be there.

    I think very highly of Anne Prestipino, our Incident Commander here at MGH, she’s a terrific leader. When she said that very early in the pandemic, I realized that there’s a real issue here. Trying to vacate this place with people who don’t need to be here was a very different environment than I’m used to living in. The focus really was how do we convert our work environments to be socially distanced, get people who can work from home working from home, clear out the corridors, throw people out of the reading rooms, clear out the conference rooms, and basically only have on site those who need to be present to do their jobs.

    Dr. Brink shared a few of the most impactful shifts in priorities that have occurred at MGH over the last several months.

    • Support frontline workers with others that are idle and qualified, always prepared for a surge.

    Radiologists were asked to cover COVID general care floors, doing general medicine work. It was challenging to recruit enough volunteers who were interested in doing this work. This is where our very strong and frequent communication became so critical. The week we needed to recruit volunteers, we had four separate town halls to address concerns about PPE, infection control, protecting our workforce and being an intern again for some who hadn’t done so for 20-30 years. In the end, 66 radiologists in total volunteered and attending radiologists were paired with residents so they could learn how to be interns again.

    • Consistent analytics to inform decisions.

    MGH has a number of units within the hospital that are known for strong analytics, supported in part by a Medical Analytics Group within the Department of Radiology. This group is led by Oleg Pianykh, PhD who has a keen eye for looking at problems and drilling down to practical analytics that inform those problems. The team leverages machine learning and artificial intelligence to help augment their models.

    The Medical Analytics Group has been instrumental to our department’s recovery efforts, as well as the health system at large – predicting the use of personal protective equipment and testing supplies, modeling whether we had enough, when we would need more, and how that can help inform our policies. They have provided updates every Sunday night, indicating what our utilization will be for the week ahead, what we’ve seen historically, whether we have the capacity to handle the forecasted demand, and so forth. When this team speaks, people listen.

    • Get doctors to feel comfortable coming back to work.

    As MGH began ramping up its clinical activities they needed physicians in house to provide live consultations and supervision, as well as continue training for new residents. With a new modus operandi for infection control, and maintaining a safe work environment, they welcomed teams back with new rules around social distancing and mask wearing.

    Our focus has shifted amongst three phases of the pandemic space. One was hair on fire, vacating the premises as much as possible, two was finding people to care for COVID patients who aren’t really accustomed to general medicine work anymore and retrain them to do so and three was bringing doctors back commensurate with the return of patients to the clinical arena. As a consequence, we’ve decompressed our reading rooms, found new places to put reading stations, and established new operating principles for what it means to work in a room with others.

    1. Reopen “Just in Time”

    From the beginning of the pandemic, the radiology department at MGH adopted a “just in time” imaging approach. Mary Theresa Shore, our  Senior Clinical Director, was the champion of the effort, creating an approach that plans for patients to arrive in time for their appointment, be escorted straight to the scanners that are waiting for them, and to exit the facility immediately following their scan. This approach minimizes time in waiting rooms and other interactions. It’s been a successful approach in making patients feel comfortable and minimizing risk, for them and for our caregivers. The “just in time” approach has allowed patients to feel that they are the most important person in the room.

    Pandemic Pros, Cons and Unintended Consequences

    At first blush, it’s hard to think there could ever be anything good to reflect on as a result of the pandemic. However, Dr. Brink helps us take that step back as he shares his insights on what could qualify as good, and what we know is not and need to still keep an eye on.

    • Pro: Community First

    The focus on community during the pandemic brough the social determinants of health into the light. Certain populations suffered as they had less access to healthcare, living conditions that didn’t allow social distancing, and work requirements that didn’t enable work from home. Our department, our hospital, and our health system have engaged with our surrounding communities to do everything possible to minimize the impacts of such social determinants in the area – and will continue to do so.

    • Con: Research came to a grinding halt

    Research was deemed non-essential as the pandemic took hold and is only now being reinvigorated. MGH had a very strong research portfolio going into the pandemic. The concern now is what it will look like a year or two from now, after grants expire. However, at MGH, researchers became critical volunteers during the surge in and around Boston. I’m so proud (to share that) many of our researchers served as ventilator listeners during our city’s surge. We didn’t have networking capabilities to tie all the ventilators being used into a central alarm network as we set up pop-up ICUs, and the cacophony of so many alarming ventilators in one place made it very difficult for doctors and nurses to figure out which one is alarming. Individuals in this role work for eight hours at a time listening to a one ventilator – watching the ventilator, watching that patient. It’s somewhat grueling work, just watching. Like a line referee at a tennis match but for eight hours. Our researchers really stepped up.

    • Unintended consequences

    I think often about patients who, at the height of the pandemic, were unable to come for routine visits while the severity of their disease progressed. And others who didn’t come in for screening exams, such as mammography, that we’re trying to catch up with as fast as possible. We know statistically that there will be some cancers among those individuals that would have been detected had we performed their mammogram on time. Similar to the aftermath of an earthquake, I’m hopeful that there’s good news at the center of the rubble, that you’re finding survivors and people who are still able to be saved. I think we’re still in the process of unearthing that rubble at the moment.

    Additionally, our educational mission has been greatly affected by social distancing and the need for remote reading. We don’t know the impact this will have on our next generation of radiologists, or even the next generation of trainees.

    As we peel off the layers of the onion Dr. Brink illustrated earlier, we’re beginning to see true impacts of COVID-19. The most terrifying has been the fear that your health system, your hospital, your care environment, will be overrun – that the demand for your services will exceed your ability to deliver them.  No one in healthcare wants to feel that they’re in a position where they can’t keep up. We’re very fortunate here at MGH that we never got to that point. There was tremendous planning and execution here by terrific leaders. We got past the height of our peak and hopefully we won’t return to anywhere near those levels. If a second wave comes, it’ll be more about cleaning up the pieces and trying to rebuild a healthcare delivery system that looks different than it did before the pandemic but is equally effective.

    That, in itself, is why Massachusetts General Hospital – and physician leaders like Dr. Brink – continue to be at the forefront of clinical education, research and community engagement. Our healthcare system has been challenged like never before but the strongest amongst us will learn, reflect and embrace change as we pick up the pieces of 2020 and prepare for what’s next.

    James Brink

    James Brink

    Chief of Radiology, Massachusetts General Hospital