Effective Collaborative Leadership During a

Pandemic—and Beyond
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One of the many hardships of the coronavirus disease 2019 (COVID-19) pandemic was the disruption it caused to
OR staff members and surgical procedure scheduling. Many leaders were forced to scramble to develop thoughtful
and innovative strategies for coping with the disruption. The OR leaders who were most successful in navigating
these challenges were those who collaborated with colleagues across specialty areas and disciplines. One such
success story comes from the leadership team at Memorial Hermann-Texas Medical Center in Houston, an
academic medical center and Level 1 trauma center where staff members normally perform approximately 26,000
procedures a year.
Memorial Hermann-Texas Medical Center perioperative leaders from the OR, postanesthesia care unit, and
anesthesia department share how collaboration was key to their development of an effective triage technique
employed during the initial phase of the pandemic and the delta variant surge. They also discuss how they are
continuing to leverage collaboration as an essential strategy for success. The leaders include Renee Taylor, MSN,
RN, NE-BC, clinical director of Perianesthesia Services Day Surgery, Anesthesia Clinic, Adult Postanesthesia Care
Unit, and Holding and Pain Services; Alesha C. Williams, DNP, MBA, RN, NE-BC, CNOR, CSSM, director of Heart
and Vascular Institute Surgical Services; and Omonele O. Nwokolo, MD, fellow of the American Society of
Anesthesiologists, OR director, vice chair of Diversity and Inclusion, and associate professor in the Department of
Anesthesiology.
AORN Journal: How did you triage patients for surgery during the pandemic surges?
Taylor: When we needed to limit elective procedures due to capacity issues in the hospital, I and members from my
team would review the surgery schedule each morning to see which patients would need a hospital bed. Initially, we
looked at patients who needed any type of hospital bed postoperatively, but when more beds became available as
the pandemic eased up slightly, we focused on patients who needed an intensive care unit (ICU) or intermediate
care unit bed.
We would then meet with anesthesia leaders either in person or by using the OR tracker application on their phone
to review surgery procedures. We also had a daily meeting at one o’clock in the afternoon with department chairs
from various specialties to confirm which patients would need an in-house bed postoperatively. We needed to work
ahead because patients had to undergo COVID-19 testing at least 72 to 96 hours before surgery. We also had to
consider that patients were traveling from all over the world, so we had to give enough notice to surgeons if a
surgery needed to be delayed so patients could be notified in a timely manner.
Looking at it from a collaborative standpoint, we worked very closely with the anesthesia department and our
surgeon partners to ensure that, at the end of the day, we achieved the best outcome for our patients.
Nwokolo: If there were issues with the number of available beds, I would call the surgeon to ask them what made
the procedure urgent (ie, a procedure that needs to occur within the next six to eight hours or there would be
possible loss of life or limb). If it was confirmed to be urgent, I would approve it and need to find a postoperative bed
for the patient. If the procedure was elective, I would ask the surgeon to reschedule it.
Williams: We have six ORs in the Heart and Vascular Institute surgery area, so our process there was a little
different than in the main OR. I initially met with our physician and anesthesia partners twice a week to review the
schedule, but because they are frequently in the ORs providing care, we switched our meetings to a hybrid model,

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combining email and in-person meetings. I would e-mail the schedule daily to the anesthesia chair, the surgeon
chair, the director of the inpatient units, and the inpatient associate vice president. We set a review deadline so we
could inquire about available resources, such as postoperative beds for the next 24 to 48 hours. In-person meetings
were held as needed.
If we didn’t have enough beds for patients, the director of the inpatient unit would notify me, and the expectation was
that the surgeon chair or anesthesia chair would let the surgeon know a procedure needed to be rescheduled.
Because we were communicating in advance, we only had to delay one procedure for a few days. At certain times
during the pandemic, we were only performing urgent procedures, so when a surgeon’s office called to schedule a
procedure, we would ask if it was urgent or elective. We were all working together toward a common goal.
AORN Journal: Can you explain the panel and their role in addressing urgent procedures in the main OR?
Nwokolo: If I was still not sure that a procedure was urgent after consulting with the surgeon, I would seek advice
from a panel that consisted of representatives from anesthesia leadership, nursing leadership, hospital
administration, and surgical leadership. Because we had representatives from each of the surgical subspecialties,
we could get a better sense of whether the procedure was truly urgent. If they felt it was, we would more forward; if
not, I would call the surgeon and ask them to reschedule the procedure. For the most part, the surgeons understood
the need to reschedule the procedures, but in some cases, it was a difficult conversation. The surgeon would
express their frustration, and I had to remind them that we were not the enemy here; the enemy is the delta variant. I
found that deep breathing and rehearsing what I was going to say helped me remain calm when dealing with
resistance and helped preserve effective collaboration.
AORN Journal: What elements were—and are—critical to successful collaboration?
Williams: We found that effective communication was the most important element in collaboration. I truly think the
pandemic improved communication in our organization because we had to look more closely at the continuum of
care and collaborate more closely with others. For example, we had to reach out to physicians at various points in
time and ask questions, such as whether they expected a patient to need an ICU bed postoperatively, to help the
ICU leader plan for an admission.
You can’t communicate enough—there’s no such thing as overcommunication. During a pandemic is not the time to
work in silos. It’s also important to use multiple modes of communication. For instance, if someone wasn’t
responding quickly enough via e-mail, we would send a text message. The increase in communication helped build
collaborative relationships between the perioperative leaders and inpatient leaders because I was working directly
with them.
Communication is effective when you are open and respectful to the other person, no matter their title or position. It’s
also important to engage your team and include both formal and informal leaders early on with process
improvements and other changes to encourage buy-in. They want to know that they have a voice, so ask for their
input before rolling out a process.
Nwokolo: Having open lines of communication is key to effective relationships—showing people that we are trying to
do what is best, what is fair, and—most especially—what is transparent. I think people trusted that how we were
managing the situation was fair because we were very transparent about the triage process, and we communicated
that process to everyone so no one felt that they were being unduly singled out.
The overall message is that we cannot be afraid to overcommunicate, and we need to build a relationship where we
trust each other. One of my anesthesia chiefs taught me that when you are working with other leaders, learn their
first names and cell phone numbers. There is a different relationship when you call someone by their first name and
have their cell phone number. You build a more collegial relationship, and when you have a collegial relationship,
you are better able to discuss things knowing you are working toward a common goal.
AORN Journal: What are collaboration lessons learned from the pandemic that would be helpful to perioperative
leaders?
Williams: Asking at the time of scheduling whether a procedure was urgent or elective was helpful, and we continue
to do that. I would also like to see the scheduling process include asking if the patient may need an ICU or

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intermediate care unit bed so the unit can be prepared. Another lesson learned was the importance of planning, not
just for things like storms, but for events such as a pandemic. It’s important to put what you did for this pandemic in
writing so you have it as a resource for future situations.
Nwokolo: One of the lessons we learned was that as much as we want to specialize and hone our skills, we need to
be able to look outward and collaborate with other team members. The only way to collaborate is to build
relationships, and the way to build relationships is by interacting with each other. If we don’t interact, we don’t build
relationships; if we don’t build relationships, we don’t have trust. If we don’t have trust when situations like this
happen, we have to start from scratch. So there always need to be collaborative efforts across the system,
particularly at big academic centers, so when situations like this arise, it’s easy to fall into that rhythm to take care of
the situation.
Regular meetings with leaders inside and outside the OR provide opportunities to see each other and get to know
each other, so when we need to come up with a team to address a situation, we can quickly do that. Meetings also
provide a means for improving processes. For example, we’re now working on improving first-procedure starts and
turnover times. We also continue to look at how to best take care of COVID-19 patients; this care is evolving.
Taylor: I believe the pandemic has improved our collaboration and enhanced our partnerships between all parties
involved. I feel that any time I need support from colleagues, they are here to help. The pandemic also reinforced
that, at the end of the day, we’re all working toward achieving the goal of safety for everyone.
AORN Journal: How has the pandemic helped you learn about other areas in the organization so that you can
collaborate more effectively?
Williams: The pandemic helped me look at the bigger picture for patients and for throughput. For instance, the ICU
receives patients from multiple entry points, such as the emergency department or the cardiac catheterization lab,
not just the OR. Perioperative leaders don’t usually think about this because they are focusing on their own
department. This change in thinking has truly opened my eyes to other areas’ staffing needs and struggles.
Taylor: I have built stronger relationships with surgeons as well as nursing leaders in various departments, including
the ICUs, intermediate care units, and nursing units. Throughout this time, we built our relationships by
communicating daily as it related to numerous patients.
Nwokolo: Interdepartmental collaboration during the pandemic facilitated my understanding of how other
departments function—who does what and who reports to whom. I needed to know whom to go to for what I needed,
and I gained a lot of insight into what personnel in other departments do, including educators, nurse managers, and
directors. For example, I am currently working with the nurse educators on a project about how to train students and
residents to work in the OR environment.
AORN Journal: How have you grown as leaders during the pandemic, including your ability to collaborate?
Nwokolo: I was appointed to my role in March 2020, at the start of the pandemic. Being a leader during this time has
helped me grow in the sense of how to handle crisis situations, how to delegate (because there was no way I could
do it all myself), how to collaborate, and how to talk with difficult people—because in a pandemic everybody is
scared because nobody knows what’s going to happen. I realized that when people are scared they get angry
because they feel they don’t have any control. I’ve learned not to take these things personally, but to work with
people through their fears and anger to come up with solutions.
Taylor: In the sense of resiliency, I have grown tremendously. I know in the back of my mind that I can get through
anything even though the process may be grueling. Your overall mindset is essential to be an effective leader—and
an effective collaborator.
Williams: It made me even more flexible and better able to think outside the box. I understood the need to go outside
my comfort zone to figure out other ways of doing things; for example, using e-mail instead of meeting face-to-face
every day to facilitate collaborating with others.

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 Publication title: AORN Journal; Hoboken

Volume: 115

Issue: 2

Publication year: 2022

Publication date: Feb 2022

Publisher: John Wiley &Sons, Inc.

Place of publication: Hoboken

Country of publication: United States, Hoboken

Source type: Scholarly Journal

Language of publication: English

Document type: Editorial

Publication history :

Online publication date: 2022-01-27

Publication history :

First posting date: 27 Jan 2022

DOI: https://doi.org/10.1002/aorn.13609

ProQuest document ID: 2623223755

Document URL: https://www.proquest.com/scholarly-journals/effective-collaborative-leadership-

during/docview/2623223755/se-2?accountid=17242

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Last updated: 2023-10-09

Database: Coronavirus Research Database

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