Restarting with Realigned Values

Wendy Dean MD
President/CEO, and co-founder of
The Moral Injury of Healthcare
a nonprofit organization addressing
the crisis of workforce distress

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In 2006 my family moved to a farm built at the turn of the 18th century in rural, south central Pennsylvania. Not infrequently in the years since, while working on defense or preparedness projects with national agencies, I took comfort in the fantastical notion that in a crisis the farm would be a refuge. With the right horse and harness, We could quickly pivot to self-sufficiency.

For three months in 2020 that apocalyptic fantasy became reality. Our entire family sheltered on the farm, which had witnessed and weathered Yellow Fever, the Civil War, the pandemic of 1918, two World Wars and Hurricane Agnes. In our profound stillness, we got back to the basics—the daily rhythm of caring for livestock and land, and cooking our meals with food produced close to home by farmers we know.

As restrictions eventually loosened, we thought carefully about how we would reengage, considering which parts of strict lockdown we wanted to carry forward because they served our larger purpose and which parts of our previous lives we would sacrifice in the bargain. It felt like a hard restart, with our values taking the lead.

In medicine the pandemic experience was not a uniform retreat as on the farm. It was dichotomous. In viral epicenters, frenetic emergency rooms, intensive care units and urgent care clinics already strained by pre-pandemic efficiency measures that pared staff, supplies and space to bare minimums the gaps and vulnerabilities of our current systems of care were illuminated in ways impossible to ignore. The sudden illumination also highlighted both the extraordinary capacity of clinicians devoted to their peers and patients, and the inescapable if unintentional—betrayal inherent in systems with misaligned values.

Other areas of healthcare experienced a temporary lull in operations. Clinicians reflected on their previous practice. They had thoughtful, healing conversations with patients when telemedicine glitches forced longer visits. And they had time and energy to reconnect with colleagues and to think creatively about their work. Many felt the contemplative pace was better for both doctors and patients. Too many doctors had forgotten the “luxury” of a few extra minutes with patients—to better understand what was truly important to them, to carefully craft treatment plans around patients’ individual wishes and constraints. The pandemic reminded us all that in medicine, the real value lies in connection with others—patients and peers—and in strong, resilient communities.

What healthcare organizations must carry forward out of the pandemic is a new appreciation of the societal contract between their institutions, their employees, their patients and their communities. As with my family, health system leadership must be intentional about deciding with their employees and their communities which lessons from the pandemic serve a larger purpose and should carry forward, and which earlier practices are best left behind. We need a hard restart, with our collective values taking the lead.

Orienteering in the Moral Landscape 2020