Continuing to Improve as a Leader—Leveraging Repetition

“Watch out for that first step. It’s a doozy!”¹

Many are familiar with Groundhog Day, a 1993 film directed by Harold Ramis in which Bill Murray portrays Phil Connors, a cynical TV weatherman covering the annual Groundhog Day event in Punxsutawney, Pennsylvania. He becomes trapped in a time loop forcing him to relive February 2nd repeatedly.¹ The term Groundhog Day has since became part of the English lexicon as a means to describe a monotonous, unpleasant, and repetitive situation or “a situation in which events that have happened before happen again, in what seems to be exactly the same way”.² It has also been invoked to describe the experience of the pandemic, most often referring to the repetitive and monotonous day-to-day life that many are experiencing since the pandemic-related shut downs began in March.³

As I write this column in mid-November, between COVID-related command center calls and meetings, my sense of Groundhog Day is more about the COVID surge, as we again focus all of our energy and attention to a surge of COVID that is exceeding the number of cases and hospitalizations that we saw in the spring. Once again, we are ramping up our COVID surge teams, cancelling elective surgeries and procedures, flipping to virtual visits, providing PPE refreshers, supporting patients and families in a time of visitor restrictions, and imploring the public to wear masks, socially distance and wash their hands.

While there is much familiar about this “Groundhog Day” surge, there is also much different. There are many positives, such as:

• we have learned from the “gift” of repetition, and from science
• the evidence base to inform our care for COVID patients is much improved
• while much is still unknown, we understand the disease, its manifestations, and how to treat it much better
• we are seeing better outcomes and lower mortality
• we are dusting off and refining procedures and processes that were developed in prior surges rather than started afresh
• we are less reactive and more proactive.

For those of you familiar with the Groundhog Day film, back in March we were repeatedly stepping into the icy pothole and glaring at Ned Ryerson when he says “Watch out for that first step. It’s a doozy!”¹ After repetition, or multiple Groundhog Days, we now (mostly) avoid the COVID-equivalent of the icy pothole.

There are also negatives, such as:

• the human toll is significant and real—fatigue, both physical and emotional
• the level of distress that I see is prevalent across all domains
• the sense of heroism and community recognition so prevalent in the spring surge has significantly waned
• clinical research that was just getting back on track is again stalled
• educational and training programs are once again threatened as trainees are pulled into helping cover clinical services.
• with higher community spread, more of our colleagues are getting sick themselves or having to quarantine, furthering staffing shortages, and concern for the health and wellbeing of our colleagues.

So, what are we doing with this Groundhog Day “opportunity”? In the film, the lead character, Phil Connors, learns over time to think of others instead of himself and discovers his purpose. During the first surge in the spring, it felt like we were so busy blocking and tackling as we dealt with this entirely new situation and all of its incumbent unknowns that we missed out on some of the “people” aspects. As I am living the Groundhog Day of this surge, I am hoping that, like Phil, I am continuing to improve as a leader, and as a person, with each repetition. Some of my lessons learned as we face the current surge are as follows:

1. Communicate, communicate, communicate—through as many means and venues as possible. In uncertain times, people want to know what is going on, and what their organization is doing to address the situation.
2. Be present—physically, mentally, and emotionally for those on the front lines
3. Show vulnerability—none of us has all of the answers and we are all affected by this in both our professional and personal lives. It is OK to admit this!
4. Pay attention to peoples’ basic needs—provide them with what they need to feel safe and cared for
5. Practice patience and grace—give people the benefit of the doubt and assume good intentions, even in the most tense interactions
6. Take care of ourselves and each other—as healthcare professionals, we tend to give and give and give, until we have nothing else to give. During the first surge, our entire executive team worked for something like 82 days straight through. We have now purposively created depth at each of our positions and are enforcing time away from the front line leadership intensity.
7. Seek out and celebrate even small acts of kindness and positivity.

What does this have to do with SGIM? I am here to share my reflections as a leader during this turbulent and unprecedented year. This past year has certainly highlighted the many critical ways in which general internists are leading and contributing—in the clinical, policy, public health, research, and educational arenas. There is no doubt that general internists, and SGIM, have been cemented as key and steady voices and experts as the nation, our communities and our institutions have faced this pandemic. As we look ahead to 2021, I remain hopeful that we will continue to learn, grow, and contribute to achieving our envisioned future together. To paraphrase Phil Connors from Groundhog Day:

When Chekhov saw the long winter, he saw a winter bleak and dark and bereft of hope. Yet we know that winter is just another step in the cycle of life. But standing here among the people of [SGIM] and basking in the warmth of their hearths and hearts, I couldn’t imagine a better fate than a long and lustrous winter.¹

Thank you, SGIM, for providing warmth of (virtual) hearths and hearts as we have weathered this winter together.