It is a new year, and I’m tired of all-COVID all the time. My new year’s resolution is to be normal again in 2021-even if this means finding a new normal.
This is actually a perfect time to define our new normal-not just because it is the start of a new year, but also because I’ve just been renewed for my third five-year term as department chair. In fact, everyone in every industry should be thinking about a new normal – this is what resilience and growth is all about.
So how do we find our way to our new normal? I like Don Berwick’s perspective in a recent JAMA Viewpoint that “Fate will not create the new normal; choices will”. I too believe that our new normal should not be something we just stumble into – we need to be intentional and make choices based on experience and a vision for a better future. This is why we will be starting our new departmental strategic planning process this month.
Dr. Berwick has described several domains or “properties of care” outlined below where he believes choices need to be made. I found these to be thought-provoking cross-cutting themes that prompt reflection on where our strengths are and the choices that may need to be made within each of our missions. By being intentional and reflective, we can hopefully create the durable and meaningful “normal” that I think we all long for:
- Speeding up the tempo of learning and innovation: Nationwide, departments of pathology and laboratory medicine brought testing for COVID-19 in-house in record time – for our own department, this happened in just two and half weeks after the first community-spread patient in the US was identified here at UCD Health. We also quickly ramped up testing volume, set up research protocols, received rapid IRB approvals, and established new processes for banking and sharing specimens. This unprecedented rapidity has demonstrated what the new normal can and needs to be. What choices can we make that will allow us to continue this level of performance around innovation and translation of research findings? Here at UC Davis Health, can we leverage our new Center for Diagnostic Innovation and our Clinical Research Oversight Committee to speed up the tempo to create sustainable change?
- Renewed recognition of the value of standards: The COVID-19 pandemic has highlighted the importance of standardization, an important area that our specialty has long recognized. As pathologists and laboratorians, we are experts in clinical standards – we create and apply evidence-based policies and procedures that provide standards to ensure accurate and high-quality patient-care service. How can we step up more prominently to share our expertise more broadly and serve as a resource to others? What choices can we make to ensure that our standards don’t become a barrier to change, but evolve in a timely, creative and collaborative way to meet emerging needs?
- Working conditions, proximity and virtual care: These are separate categories in Dr. Berwick’s Viewpoint, but for our department and specialty, I see these as very related. Berwick asks “Will the new normal address more adequately the physical safety and emotional support of the health care workforce in the future?” Our department has readily embraced the concept of distance work during the pandemic – this has been important to safety needs and for family care and home-school needs. Whether our departmental members realize it or not, they have made a choice to put aside previous biases regarding “face-time” at work, and have instead emphasized outcomes of performance and supportive relationships with colleagues – I think this these are choices that we should all be proud of and work to sustain. We need to think more about how we can use virtual tools even more effectively and broadly, and find other ways to address safety, flexibility, and emotional needs for those whose work must happen on-site.
- Preparedness for threats: This is not the first time we have prepared for and met disaster – but it is the first time we have had to implement our plans so broadly across all of our laboratory sections, as well as in our research and teaching missions, and sustain the plan for so long. What lessons have we learned? Can we do better scenario planning around other types of threats so that we are better prepared to make the right and more sustainable choices in the future?
- Equity: Berwick draws attention to “the unequal toll of COVID-19 on the poor, the underrepresented minorities, the marginalized, the incarcerated, the indigenous peoples.” In pathology and laboratory medicine, we are fairly blind to our patients’ race, ethnicity, social or economic status since a specimen container or tube of blood doesn’t reveal much at first glance. But that does not mean that we should ignore the opportunity to make better choices to improve health equity. How can we make our services more efficient and more cost-effective so that they are more readily offered to all? And are there long-standing biases that should be explored and addressed, like the race-based reference ranges for GFR that we are collaboratively addressing right now with our colleagues in nephrology?
I’m looking forward to our new strategic planning process in collaboration with Chief Strategy Officer Ron Amodeo and his team – they are kicking off the plan at the January faculty meeting, and we will expand from there. A strategic plan is all about not being the victim of fate and instead making informed choices to shape our own future. This inevitably includes establishing what we will do and just as importantly, what we will not do. The latter can be the most difficult choice for a leader -- I therefore count on and depend on the advice and participation of our department members to aid in these critical choices. It is truly an honor to get to serve for a third term as department chair and a privilege to work with the talented and dedicated members of our department – faculty, staff, and housestaff -- to shape our own future, find our new normal, and make every year an even happier new year.