Collaborative leadership, communication and compassion: How the Critical Care team is navigating the COVID-19 pandemic

Collaborative leadership, communication and a whole lot of compassion for patients and each other characterize Schulich Medicine & Dentistry’s critical care team’s approach throughout the COVID-19 pandemic.

“The entire experience has been one big challenge,” said Dr. Wael Haddara, Chair/Chief and Medical Director, Division of Critical Care. “But we have gotten through by observing our peers in other countries and developing our own standards of care and organizing approaches to deal with equipment and human resource issues.”

Critical to managing care has been effective communication of the standards. Early on, Drs. Paul Cameron and Marat Slessarev, held education sessions for physicians, nurses, therapists and residents on topics such COVID-19 therapies and standards of care to ensure everyone was up to speed and felt confident in the approaches to be taken.

While the first two waves were manageable from a patient care standpoint in London, there were threats to the system. During the first wave, personal protective equipment (PPE) shortages forced people to ration masks and accept medical gowns created by a homegrown industry that shot up in the city and around the country. There were also some drug shortages, which led to careful changing of doses where possible.

The end of the second and third wave have been completely different experiences, putting the standards of care to the test.  

“It wasn’t until December and January that we saw increased patient volumes,” Haddara said. “Right now, we have more than 100* patients with just under half in the intensive care unit.”

With each passing week, new protocols and guidance for patient care were introduced nationally requiring frequent, clear and consistent communication across all care teams in London.

Decision-making was also challenged. Under Haddara’s leadership, the team accepted the principle that whatever decision someone makes in the moment with the information they have at hand, it would be the best decision. If different conclusions are reached later, then that becomes the right decision.

“In a fast-paced environment when you have people’s lives in your hands, you make the best decision with the best information and best judgment,” he said.

Each wave has also impacted clinical training experiences for residents. While residents in the subspecialties have been involved with some of the most critical COVID-19 cases, offering unique learning experiences, junior residents in the core medicine program have had limited diversity in their patient care experiences.

Adding to the overall challenges has been the persistence of the pandemic and how it has infiltrated every aspect of people’s lives.

After a full day on the front-line, caregivers haven’t been able to simply go home and relax. Often there are challenging situations at home.

“There is no place to escape the stress,” said Haddara.

As the Division lead, Haddara felt a responsibility to support people through the emotional and psychological toll of the pandemic.

He’s proud and grateful to the entire critical care team, who he says have stepped up. “We are tightknit group and people have happily and very professionally carried their share of the responsibility, demonstrated and executed initiatives, offered great ideas and through it all, we have been able to advance research, knowledge, education and provide excellent care,” he said. “People have been doing great work."

He’s also proud of how the Department, the School, Western University and the hospital have responded. “There’s been such a great sense of responsibility and solidarity,” he said. 

Looking ahead, Haddara says that in the short-term the pandemic will likely cause some individuals to leave health care, as many have reached the point of mental and physical exhaustion. Still, he does remain hopeful that some of the lessons we have learned through the pandemic will lead to positive changes in the delivery of care. He also hopes that globally, we can address the inequities in health care that have become more evident throughout the pandemic.