Dr. Jacqueline (Jackie) Grupp-Phelan is the Chief of the Division of Pediatric Emergency Medicine at University California San Francisco (UCSF) Benioff Children’s Hospital

Dr. Kathy R. Monroe is the medical director of the Children’s of Alabama Emergency Department in Birmingham.

“Fear, fear, fear, fear” is what an ER Pediatric doctor friend described to me when explaining his experiences of Covid at the outset of the pandemic.

Nowhere has this covid crisis been more severe than in hospital emergency rooms. Healthcare workers were infected at rates three times as high as the general population and protective equipment were in short supply. The recent Delta variant has put extra strain on ER Children’s Hospitals posing a much worse threat to children than the original covid virus. This comes at a time when the mental health toll of living through a pandemic has meant more children than before presenting with psychiatric concerns. Hospitals have been triaging patients to make sure those with the greatest medical needs have beds while longer wait times have plagued other seriously ill children. Yet Covid, fear, or fatigue did not prevent the frontline workers from delivering care to those of us who needed it.

The ER doctor’s accounts urged me to learn more of the enormity of the leadership skill required to navigate and operate with such uncertainty and so much at stake. I wanted to gain a snapshot of leadership in such high-pressure environments. However, I learned from the first-hand accounts of two directors of children’s hospital emergency departments in Alabama and California, their leadership was about facilitating seamless and unbreakable links between all and every member of the team. Covid tested these links in the teams to their extremes, but unity is what made it succeed. With direct comparison to the character of military allegiance, these ER Directors share how teamwork and commitment to each other is what leads the way and can combat the greatest of forces placed against us.

The chief at UCSF Benioff Children’s hospital, in no uncertain terms, described the challenges presented by Covid’s unprecedented and ever-changing nature.

Comradery Makes A Winning Team

UCSF Emergency Medicine Group
UCSF Emergency Medicine Group

Jackie described the technical benefits of building effective teams and in particular how important it was “practicing together” and “closed-loop communication”. During a discussion with my friend who is an ER doctor, he also described how essential it was to practice scenarios of resuscitating patients with Covid while keeping your team safe. Curious to understand what he learned from this practice, he responded, “how hard it was.” Making sure orders are heard and carried out in the way intended has been more important than ever. To close the loop and be sure misunderstandings do not occur, the lead physician gives an order or makes a request. For example, I would like the patient to have this dosage of a particular drug. The team member repeats the information, and if properly conveyed, the doctor replies, “correct”.

Dr Jackie: The virus is wiley, it changes and adapts to the environment, reemerging when our guard is let down. It attacks unfairly, and preys on older and communities that are underserved.
There is a lot we don’t know about this virus. We are continuously learning about new impacts on health that we had not understood before

It was important that medical teams built even stronger bonds within teams and across departments. Kathy explained to me: “Everyone was checking on everyone else to be sure they were hanging in there. People were providing face shields for each other, or new filters were being given out to be certain we all had the equipment we needed to protect each other.

This care for wellbeing not only facilitates the concentration of delivery of care but also heightened thresholds of stress and strain. The greatest joy has been to see how each member of our team is so supportive of everyone else. And how we work together to take care of the children despite any challenges!

Birmingham Emergency Medicine Group

The Three Working Shifts

The strains on ER departments are highly publicized in the media but in addition to the emotional, physical, and functional challenges, both Jackie and Kathy brought to light the additional burden on mothers and families in employment at the hospitals.

Jackie: I am lucky to work in an institution and area of the country that has made a concerted effort to equalize disparities in gender roles. However, the pandemic has disproportionately affected our female staff since this group is tasked with child and household care at a higher rate compared to their male counterparts.

Even though women who have traditionally suffered from the “double shift” of household responsibilities when they return home from their jobs have faced a “third shift” of educating their children when schools were closed. Jackie: COVID has had a major impact on our families. Particularly those with children that are school age. They have been fighting this battle full time, with full force and then coming home after a 12 hour overnight shift to Zoom school their children. It was excruciatingly exhausting. I am in awe of their strength and commitment.

Jackie explains the long term effects that Covid had on the female workforce. ‘ The collateral damage is that we have lost so many health care workers who have elected to find more manageable jobs leaving us now with a staffing crisis right when pediatric volumes are surging.

The Associated Press reports how this problem is nationwide “Among mothers of children 13 or younger, the proportion who were employed in September 2021 was nearly 4% below pre-pandemic levels, according to Nick Bunker, director of economic research. For fathers with young children, the decline was just 1%.”

Kathy noted just the gaps in provision for the day-to-day realities of the women in their workforce: Kathy: I do feel that those who are parents of younger children have faced some higher challenges than the rest of us—in addition to being a health care provider during a stressful time they have had major child care issues. Daycares and schools have closed or sent home children with any symptoms that could be covid. These parent/providers have had to scramble to fulfil their work/home obligations.

So What Do These Children’s Emergency Rooms Teach Us About Leadership?

Women and men as healthcare providers stepped up in this crisis and fulfilled not only the job requirements but is, without doubt, the greatest battle of their profession in history. The medical teams did not let hardship obscure their mission, to administer potentially life-saving medicine to the most precious and vulnerable members of our society. Kathy and Jackie’s accounts give us a real sense of how our carers have operated on all levels of human abilities, from the rational-analytical, processing complex information, decision-making to carefully delivering medicine, enduring the physical and emotional demands, managing their families all whilst providing emotional support to sick children and their families.

A scene is filmed in the fields.
Teamwork Makes The Dream Work

Dr. Jackie: Children are not small adults. They require specialized care, with specialized teams that understand the physiology and changing needs of kids throughout childhood. Having expertise in this area improves outcomes for kids presenting acutely with illness or injury.

Battles of difference achieve very little, but the greatest of battles for humanity are won when faced in unity. We learn from these women chiefs and their remarkable teams that we can endure multiple layers of adversity when we stand alongside each other. From Jackie and Kathy we can see winning results is not about elevated positions of leadership, but about leaders standing beside their teams and facilitating their growth and connections.

Women are recognized in society as traditional caretakers, but men deserve to be respected and championed for their role in caring too. We see that there is much work to be done to support the parents. It is a sad contradiction that women have experienced so many gains in the career field, the medical field is a model of gender equity, but as these women care for our sick children, they are faced with so much adversity when balancing care for their own children. Covid has exposed the lack of support for working mothers whether due to traditional gender roles in the home or the lack of government policies to support families. Government is yet to respond with policies that are commensurate with the task of crisis remediation for these families. Family leave, affordable childcare, financial support for families, and, in general, family-friendly policies lagged behind in the United States before the pandemic. UNICEF reported in 2019, the year before the pandemic, that the United States ranked last among forty developed countries in offering paid leave, family, and maternity/paternity. This is not just a discussion for women, but men, too, as many wish to have more of an active role in raising their children but equally bear the burden of being the breadwinners.

Dr. Kathy: Focus on who you are with—- emergency medicine involves lots of patients and typically busy waiting rooms but an important lesson is when taking a history and doing a physical, you should be 100% focused on that patient and family at that moment. A good lesson for all of life.

Covid has certainly brought into focus the need for society to address the nearly impossible situations many mothers find themselves in. As women are fundamental support to these institutions of our society, the societal institutions are not supporting these women.

Last words from Jackie: Get vaccinated and wear a mask. We will be fighting this for the next decade.

Last words from Kathy: Wash your hands, wear your mask, get your vaccine. We are all in this together.

— End.