Committees/Workgroups

Careers

Don’t Return to Your Silo

Article by MassAFP's MaryAnn Dakkak, M.D., M.S.P.H.

I remember when I was asked to lead the family medicine night COVID-19 team at Boston Medical Center in mid-March. I had been reading everything I could get my hands on, and I jumped in.

The first few nights were full of rapid responses and codes, and within days we developed a new structure for COVID-19 teams. For the day shift, at 1 p.m. twice weekly, the infectious disease assigned lead met with the attendings of the inpatient teams. For the night teams, at 9 p.m. nightly, the inpatient team leads met with the ICU, anesthesia, infectious disease and resource nurse teams to discuss the highest-risk patients. Conversations with these team members is how we managed the sheer amount of work to be done and survived the emotional toll.

In the midst of pandemic surges, silos were broken. We all leaned on one another. We all worked together to build on what we knew, use our collective knowledge, take care of our patients and communicate with their families. In terms of patient management, we learned that not only weren’t our silos useful, they were barriers to flexibility and to mobilizing new types of care during a pandemic.

Indeed, collaborative care models have been shown to improve patient care across the board, specifically patient safety, outcomes and duration of hospitalization. These care models also improve clinician satisfaction. Now COVID-19 has shown us how efficiently and effectively different specialties can work together to innovate and improve patient care while simultaneously improving the clinician experience.

I’ll acknowledge that the first of these meetings was a bit uncomfortable – a mix of imposter syndrome and just getting to know other teammates. Surely someone would know something I didn’t.

The meetings quickly revealed that we all knew something that someone else didn’t. Many of us had never met, or only knew each other in passing. Those meetings became our organizing moment, our learning, our planning and building, our community.

In the months between the surges in Boston, our meetings decreased in frequency. During one two-month period, they essentially paused. Leadership kept meeting across disciplines, but there were fewer meetings on the floors. Individual specialties automatically shifted back into our silos. We stayed in our team rooms; we consulted one another when we had specific needs. However, the impact of the team meetings we had was lasting. I would still run rapid responses with the same resource nurses – and the benefits of having worked together so much previously carried into our regular shifts. If I consulted the ICU, chances are I knew the team better, and they knew me. These cross-sectional meetings had lasting impacts on regular patient care outside of COVID work.

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