When Medical Team Leadership Becomes Frontline Chaos Management

Routine to remarkable—-overnight. That’s what has happened to frontline medical triage with the rapid, unprecedented and unrelenting onset of the COVID-19 pandemic. EMT, ER and ICU staff are well-trained to handle emergency crises of all types, just not of this magnitude, intensity and duration. Medical team leaders face life threatening issues on a regular basis, but not to their own lives at the very same time. Their training and experience prepare them to rapidly assess, execute and adjust medical protocols to fit the needs of a medical crisis, and then usually the crisis ends. Reports from the frontlines of the COVID-19 pandemic have medical professionals describing themselves as “soldiers in the fog of war” physically exhausted and emotionally overwhelmed.

What are the four things frontline medical team leaders can do when a medical crisis devolves into “controlled” chaos?

First- Be the order in the midst of chaos: The team leader must be perceived as fully engaged in the job of creating order out of chaos. As a leader, take the time to stand back and assess the needs of the specific moment. This is not a democratic process. Your team is looking to you for structure and “sense making” in the midst of chaos. When the team perceives the leader as “in charge” of a chaotic situation they are more likely to feel confident that things are under control. Confidence that things are under control will support team focus on the job to be done. Tough decisions must be made quickly, and you are the one who can make them. The leader must demonstrate keen situational awareness and unflinching decisiveness under unrelenting pressure.

Second- Be the source of credible, timely and actionable information: The frontline team will be utterly focused on delivery of patient care, as they must be. It is the team leader who must be the source of credible, trustworthy and timely information so the team can make coherent sense out of their moment-to-moment activities. In a time of crisis, it is human nature to fill gaps in information with gossip and rumors; likely not positive ones. It’s the frontline team leader’s challenge to ensure that the entire team is always working off of “one truth”. The leader can ensure that information is being absorbed by team members by using the 3 R’s: review, repeat, reinforce. This will reduce the considerable emotional distress caused by the unknowns inherent in chaotic situations. The leader must make the “unknowables” as knowable as possible.

Third- Be the source of support: The team leader must ensure staff rest, restoration and rotation. Just as in any military operation, fresh troops are needed to sustain consistent and high-quality team functioning on the front lines. Ensure that your team members are getting the rest needed to function optimally over the longer term. Unlike typical crisis management, there is no known end date for a pandemic so success will be measured by the effectiveness of staff and team functioning over time.

Fourth- Be empathetic to the severity of the moment: The team members will likely be experiencing a range of fears, anxieties and concerns for their own physical well-being. Stress and fatigue will exacerbate the emotional challenges, as well. It’s important for the team leader to acknowledge and validate how people feel. Ignoring the emotional side of the equation will only magnify it. Medical professionals are used to morning “huddles” before they spring into action so leaders can use this format ad hoc to surface and “give voice” to the myriad and justifiable concerns of a chaotic and evolving situation.