_{The Tean Alignment Map along with many other tools will be featured in the Strategyzer series book, High-Impact Tools for Teams co-authored by Alex Osterwalder, Stefano Mastrogiacomo and Alan Smith.}

During March 2020 the epidemic statistics in Italy increased dramatically. Hospitals in Ticino, a region of Switzerland next to the Italian border, were being overwhelmed by COVID-19 patients. Simulations on the potential number of patients in the Geneva-Lake region were very concerning. Where currently available intensive care beds could run out in just a few days.

We helped the Operations Department of Geneva University Hospital - in charge of surgical units and patient flow - plan the hospital’s transformation into a dedicated Covid-19 center.  Identifying and implementing measures to provide the best possible care for COVID-19 patients. While protecting the non-COVID-19 patients, the medical and the non-medical staff. Here's what happened and what we learned.

How Team Alignment Map (TAM) helped to transform a hospital with 1900 beds and more than 11’000 employees to handle the COVID-19 crisis in 5 days

The TAM is a quick and simple visual tool to align around common goals, gain team buy-in, build trust, reduce risks and deliver concrete results. We used it to help the hospital teams plan their transformation during an intensive one-day session. For the Head of Operation and her deputy, the Surgical bloc manager and his deputy, the Patient flow Manager and the projects department, they were able to:

1. Identify, discuss and challenge the key objectives for each unit
2. Translate objectives in joint commitments
3. Identify the resources to mobilise.
4. Confirm the plan as a team and take action

Faced with the urgency of the situation, we dived straight into the content by using whatever materials were at hand:

• A whiteboard and paper post-it notes to align the teams
• An online tool to list and track identified tasks (Trello) 

During the exercise, the team rapidly identified 3 main challenges: 

1. Transfer non-Covid-19 patients to outside locations, 
2. Transform non-essential operating theatres into intensive care units, and
3. Establish a new patient flow to segregate Covid-19 patients.
   

After the objectives and commitments were transferred to a task management tool (Trello), daily progress meetings were held and in five days, the following objectives had been met:

1. The transfer of non-COVID-19 patients to COVID-19 free clinics  
2. Transforming the largest hospital in Geneva into a dedicated platform to help fight the pandemic.
   

3 questions to Sophie Christen Creffield, Head of Operations at Geneva’s University Hospital

We asked Sophie to share her thoughts of the hospital transformation project

1. How did you and your teams feel when getting organized to fight the Covid?

Well, the staff is familiar with emergencies situations but this was a novel and unknown situation for all of us, both in our professional and personal lives. However, we all quickly realized that the priority was to identify the main challenges and ensure that processes were put in place to deal with them in a very short timeframe. All the while leaving enough flexibility in these processes to deal with a rapidly changing environment that could change both actions and their timing. We were also aware that coordination with all the relevant departments and services would be key to the success of any measures put in place. 

2. What was the contribution of the tools (TAM and Trello) to the successful organization of your teams?

Having identified our priorities, we also realised that we needed tools to be able to handle them. We needed a process and a support that ensured traceability and consistency. To that end, and having myself used TAM in different contexts, I was convinced that using a TAM framework would be the most effective way to rapidly bring all stakeholders together in a non-confrontational way, while affording all of us a forum for debate and enabling an identified and agreed way forward. I knew a TAM could transform a complex situation in a clear map, building the necessary common ground to bring our team to its best performance. We then decided to use Trello as a platform to support and follows the goals identified during our TAM sessions. We chose Trello because it is easy to deploy and has a user-friendly interface. We did not want to participants to have to spend much time and effort learning how to use software, on top of having to deal with the stress already generated by the COVID-19 crisis!

3. What will be different at the hospital after the COVID-19 crisis?

Nothing and Everything! The opportunity to share such a clear common objective was a very special situation. I believe there will always be a before and after COVID-19. We faced an unknown challenge and succeeded in taking the necessary measures to counter it. This is something all the staff of the hospital can and should be proud of. It was also a humbling experience in that we saw first-hand how close we could have been to a much worse outcome. 

I am sure that all departments will be identifying what went well and what went less well during the crisis. As for the Operations department we will be focusing on the tools needed to face similar crisis’s and defining what resources are necessary during “normal” times and what resources need to be mobilised in extraordinary circumstances, and how these extra resources can be mobilised in various scenarios and timelines.  However, we were all convinced that TAM is an amazing tool to manage any situation that involves getting each implicated person on board with clearly defined goals! 

Timeline‍

Timeline. Actions

March 13

 Decision are made to:

1. stop the elective surgery in order to increase number of intensive care in beds and staff accordingly. 
2. launch collaboration with local clinics to host non-COVID patients and allow surgeons to follow their patients and perform emergency operations

March 22

Decision to transform the hospital into a dedicated COVID-19 hospital.

March 22

 Operations Department meets to organize the transition and implement changes as quickly and efficiently as possible.

March 23 

Transfer non-Covid patients

• (1) identify all the patients to be moved to the clinics
• (2) plan and organize transfers and
• (3) bring missing surgical equipment to the clinics
• (4) schedule all surgical procedures for the whole Canton of Geneva
  ‍

Transform the surgical units 

• It is also necessary to plan the transformation of the operating theater units in intensive care rooms and reallocate the qualified personnel to operate this new capacity. 

March 25

On Wednesday evening the 25th, the non-COVID patients were all transferred to the clinics, the HUG became a hospital dedicated to the pandemic.

March 27

The capacity of intensive care increased from 32 to 110 beds. 

Define a new flow for patients

A follow-up TAM session has taken place during the week, dedicated to the definition of the patient flow of a COVID-19 dedicated hospital.

5 lessons learned to organize effectively in an emergency situation

An incredible job was done in record time and under maximum pressure. We knew it, but we never had an experience of this magnitude: when the key stakeholders are aligned, major institutional changes can happen at lightning speed. To be more specific , we learned five key lessons working with the hospital staff: 

1. Mission: Ensure the mission is meaningful and crystal clear. THE PATIENT IS THE PRIORITY. To this end, the Operations team provided support for the patients, both directly in the case of admissions and indirectly by providing support to the medical staff)
2. Conditions: Validate that the right people are in the room, have an experienced facilitator to pick the right tools, frame the conversation and dive straight into the content
3. Mindset: Put aside current rules and processes that are not relevant to a crisis of this magnitude, the situation is new and requires a collaborative spirit and a creative mindset
4. Communication: Hold frequent alignment meetings to monitor progress and share new information
5. Uncertainty: Keep moving forward even if some non-essential steps cannot be completed in time (but ensure that everyone understands what’s missing to be successful and make the problem a future activity). In the face of a complex reality, it’s obviously impossible to plan everything in advance. Keep going with the (sometimes messy) information at hand frequent alignment rounds advance towards the mission a semi-clear approach with short alignment loops even if some aspects remain uncertain.

Everyone's knowledge and skills were key factors for the success of this transformation, as well as collaboration and cooperation at all levels. For the Operations Department, the use of a TAM made it possible to quickly arrive at a mutual understanding of the challenges of each entity, a visualization of the operations to be carried out, the roles of each and the resources to be mobilized.

About

Alain Giannattasio – is an experienced team coach and facilitator, he helps teams in the health and IT sector overcome difficult situations and move towards high-performance collaboration.

Stefano Mastrogiacomo – is the designer of the Team Alignment Map, the Team Contract, the Language Compass and the other tools of the team alignment toolkit. Find out more about Stefano's work on www.teamalignment.co/

Pierre Sindelar – is a physician and psychiatrist with extensive practice in crisis management and medical teams coaching.