Optimizing a Network of Frontline Medical Leaders to Fight COVID-19: The Fusion Cell Approach

  • June 17, 2020

Background

In March 2020, as hospitals in the United States began to prepare for significant COVID-19 volume, Arena Labs stayed in close contact with our partners, and heard a growing desire for:

  • The tools, best-practices and lessons-learned from Italy, the United Kingdom, Seattle and NYC — all of which had already been on the frontlines of major COVID-19 spikes.
  • Practical and tactical support in crisis response.
  • Strategic approach to challenges requiring unorthodox solutions such as PPE, staffing, and daily hospital operations.
  • A means of regularly meeting and congregating virtually to share knowledge and insights across global geographies and siloed relationships.

Solution

Combining our ecosystem of healthcare partners around the country with our team’s experience in crisis response and “fusion cells” for national security and military operations, we established the Arena Labs Fusion Cell for COVID-19 Crisis Response in Frontline Medical Teams.

A fusion cell provides a structure for teams to approach a complex problem as a network across regions, so as to facilitate rapid learning and shared context in an ever-evolving environment. As recently described in New England Journal of Medicine, fusion cells are an example of how “learning leaders” can empower a network to yield actionable insights quickly. Rather than approaching crisis with a mindset to “get through it,” a fusion cell engages systems in developing the routines, capacities, agility, and structures to quickly adapt to each new dynamic in the face of crisis.

Aimed at connecting frontline staff globally to facilitate rapid learning and share critical insights, the Arena Labs Fusion Cell recognized the need for frontline leaders to pause from the intensity of their “heads-down clinical engagement” so as to exchange such innovations and advance together in the fight against COVID-19 as a collective across regions. It consisted of:

  • Weekly Zoom call including brief regional updates, a featured speaker (topic selected by poll in the previous call), and
  • Access to a private Slack Channel, with topics curated by participant interest
  • Basic code of conduct: Frontline leaders only, confidentiality, no attribution, and mutual respect, so as to facilitate honest sharing of lessons learned through error as well as innovation.

Video of select presentations shared in the Arena Labs Fusion Cell are available here.

Preliminary Findings

Leveraging the expertise of our teams’ pattern recognition developed through crises in other special operations and humanitarian contexts, we synthesized the findings shared through the exchanges of the fusion cell’s ten-week run. They are summarized in the table below, with gratitude to the Arena Labs Fusion Cell participants and partners.

Please note this is neither an exhaustive list nor formal research. More detailed dissemination of this work will follow, to be developed in collaboration with our partners.

Fusion Cell Table Final

We share these initial findings in this preliminary state believing that when the history of the COVID-19 pandemic is written, it will be innovations discovered on medicine’s frontline that will have moved our society forward.

Acknowledments

It was our privilege to learn with such a dynamic ecosystem so fiercely committed to frontline care during the COVID pandemic. Our special thanks to our presenters, collaborators, and partners:

Dr. Al’ia Alvarez, Stanford University School of Medicine; Dr. Bradley Taylor, University of Maryland Medical Center; Dr. Colin Buck, Mayo Clinic, Dr. Conor Delaney, Cleveland Clinic; Dr. David Callaway, Carolinas Medical Center; Major DJ Skelton (Ret), US Army, Founder + President of Karios Alliance Group and Paradox Sports; Dr. Douglas Johnson, Cleveland Clinic; Dr. Eric Lehr, Swedish Health Services; Dr. Hardy Kagimoto, President and CEO of Healios KK and Aqumen; Dr. James Leo, MemorialCare; Jessi Webb, Founder, Aizle Analytics; Dr. Juan Umana, FCI-Institute of Cardiology, Bogota, Colombia; Dr. Mark Taylor, Cleveland Clinic; Mr. Matthew Desmond, Chief Administrative Officer; St. Roper Hospital, Matthew Sitter, Partner, Adventary, LLC, and Advisor, Medlever, Inc.; Admiral Michael Lefever (Retired), CEO, Concentric Advisors; Dr. Nick Fletcher, St. Georges Hospital, London; Dr. Prateesh Patel, Cleveland Clinic; Dr. Preston Cline, Founder, Mission Critical Teams Institute; General Robert Neller (Retired), 37th Commandant of the United States Marine Corps; Dr. Robin Varghese, Mount Sinai, Dr. Stephanie Mick, New York-Presbyterian; Ms. Tammie Brailsford, RN, Executive Vice President/COO, MemorialCare; Dr. Tom Nguyen, McGovern Medical School at UTHealth.

 

Fusion Cell Timeline, Agendas, and Speakers

March 23 – Crisis Response: Leadership and Operations Insights for Frontline Staff

  • Doug Johnston, Admiral Mike LeFever (Ret.), US Navy, and Captain Jurgen Heitman (Ret.), US Navy

March 30 – Regional Updates and National Guard + Civilian Collaboration

  • Regional updates provided by: Dr. Eric Lehr, Dr. Stephanie Mick, Ms. Tammie Braislford, RN, Dr. Mark Taylor, Dr. Tom Nguyen, and Dr. Hardy Kagimoto
  • National Guard + Civilian Collaboration: Dr. David Callaway

April 2 – Predictive Modeling Tools and PPE Supply Chain

  • Updated Learning Model for Local COVID-19 Volume Predictions: Dr. Doug Johnston
  • Sharing a Model for PPE Burn Rates: Dr. Conor Delaney
  • PPE Supply Chain Access + Near-Term Considerations: DJ Skelton

April 6 – Trends + Environmental Update: What Has Changed in the Last 7 Days

  • Trends: Matt Sitter and Jess Webb
  • Robin Varghese of Mt. Sinai and Dr. Nick Fletcher of St. Georges Hospital, London

April 13 – Trends + Frontline Perspectives on Reopening Hospital Systems Post-Surge

  • Trends: Matt Sitter and Jess Webb
  • Reopening: Dr. Jim Leo, Dr. Juan Umana, and Dr. Prateesh Patel

May 11 – Resetting the Team After Crisis

  • General Bob Neller (Retired), 37th Commandant of the US Marine Corps