Greg Wallingford, M.D., MBA, has supported patients and families through some of their worst days. A former emergency medicine physician and management consultant, and now one of Dell Med’s inaugural palliative care fellows, Wallingford hopes to apply lessons from his prior careers to enable clinician leaders to better support their teams following stressful events.
What’s the problem you’re trying to solve, and how did you come to recognize it?
COVID-19 has thrust medical students, residents and physicians into an unprecedented number of high-acuity clinical encounters and simultaneously made it harder to connect with our colleagues and our patients.
This was especially challenging for teams after codes — fast-paced, high-stakes attempts to save a patient whose heart has stopped beating — which occurred with a much higher frequency during the pandemic. Traditionally, debriefs following codes focus on operational events, such as the number of chest compressions per minute or delays in giving medication. I wanted to supplement these discussions with activities that acknowledge the human side of medicine to allow a safe space for teams to honor their patients and support each other by highlighting what also went well.
How are you tackling the problem?
Our team created a structured debrief, designed to be used at the bedside in five minutes or less, that enables teams to humanize their experience of participating in codes.
We started by speaking with about 50 physicians at Dell Seton Medical Center at The University of Texas about team activities that they found particularly helpful after challenging clinical events. We then created a structured debrief to address three major themes that emerged from our interviews: acknowledging our emotions, honoring our patients and supporting our team.
We piloted our supportive debrief in mock code simulations and revised it several times. With the assistance of multiple service lines in the hospital, we then educated others in how to conduct this brief supportive debrief.
We also partnered with the Center for Health Communication to create “badge buddies” — cards that outline the debrief activities and can be worn on any hospital badge. Since implementation, we have been collecting data to analyze the impact of this intervention. Our results have demonstrated strong support as well as significant uptake, occurring after over 50% of codes.
Numerous parties and additional service lines have indicated interest in utilizing this structured debrief, and we are excited to expand this tool to as many clinicians as we can.
What makes you positioned to solve this problem?
My training under the bright lights of the emergency department has exposed me to some of the toughest parts of medicine, and my training in quiet conversation with patients as a palliative care physician has given me insight on how to support others on their worst days. This combination has given me empathy for my colleagues’ experiences caring for sick patients, but also the communication skills of palliative care to support my colleagues as well as my patients.
My experience in business and management consulting enabled me to better tackle the challenge of culture change. Supportive debriefs can connect us, but they are not commonplace in many institutions. It takes courage to try something new. Creating psychological safety, seeking frequent feedback, crafting language carefully and equipping leaders to effectively facilitate supportive debriefs were crucial to successful implementation. By drawing upon aspects of my various backgrounds, I attempted to not only create a tool, but also to operationalize and integrate it into the culture at Dell Medical School.
The New York Times asks readers to tell their "Tiny Love Stories" in just 100 words. What's yours?
In medicine, we work tirelessly on behalf of our patients and often overlook opportunities to connect with the human side of our work. COVID-19 has put a tremendous strain on physicians, who have witnessed an unparalleled amount of sickness. Through supportive debriefs after stressful events, I hope to help my colleagues create space to pause, connect and support each other. By better supporting ourselves, we enable ourselves to better serve our patients.