Several months ago, I had the opportunity to give a TED talk about “How to lead a team through difficult times”, were I remembered my involvement as an Orthopedic Surgeon at Mostar on 1994 during the Balcanic War. It was one of the most valuable experience in my life, were I learn the importance of a good leadership to manage a difficult situation. And now, that in Spain we are living the Coronavirus pandemic, and we are facing a global health crisis unlike any in the last century, I would like to remember that talk as in many aspects that war was comparable with the situation that we are living now, and how we have used that principles in my Hospital in Madrid.

One of the biggest problems we had to face in Spain was the lack of information, or maybe, the misinformation. Most clinicians thought at the beginning of the year that the COVID problem in China was going to pass out like the SARS and MERS epidemics years ago, and we were going to be safe in Europe. I was one of them. However, since first cases started in Italy, we saw that things were going to be different. When I talk at mid-February with Dr. Pedro Berjano, an excellent Spine Surgeon based in Milan, and a very good friend, I started to recognize that things were going to be thought. We started to have problems in Hospital Infanta Elena of Valdemoro at the end of February, so a crisis plan was started.
I can say now that I am honored and proud to work close to such an excellent team, made by persons, which were able to face this dramatic situation even without the proper protective equipment and personnel. The chief of the Emergency Room, the chief of the ICU, the chief of Anesthesiology, the chief of Internal Medicine and the one of Infectious Disease, and many other. Everyone gave a step beyond. All of them demonstrate what a leader has to do in this situation. Much more than some others, especially in the Administration. They were expected, but they never appeared.
In this “war” situation, there are always some temptations. But we have to avoid them to keep the team together

1. Temptation: To spread your sense of urgency and panic. Instead, we were able to communicate transparently about the situation. Learn to break the news calmly, while making the seriousness of the situation clear. Take a breath and carefully assess the situation so you can work with the team to clearly set the appropriate priorities. Then you can be effective and efficient internally as you deal with the outer chaos.
In our case we continued with our normal activity in a different way. We stopped all the surgical activity, except for the emergencies, but we continued with a telemedicine consultation from a different building. We have been continued with the consultation until now. We were able to solve many problems, and in some critical problems the patient visits us in a special day. We kept our normal clinical session with discussion of cases, but by mail.
Currently 90% of the hospital’s beds are dedicated to the treatment of COVID-19 patients. Some of us were involved as 2nd 3rd line support for the COVIDs patients. Helping with calling families or as support at the ICU, were they were able to triple the capacity with beds and equipment, using all the OR´s ones, and buying new equipment, but when there were difficulties to triple the number of workers. Some of us also worked in hospitalized hotel created to facilitate the discharge of some patients that required minor care.

2. Temptation: To lay blame. Instead, we never point fingers at any staff members; working as a team is key to getting through tough times. Of course, the lack of equipment or the “anarchy” of our governors was always been there. But we try to keep working just focusing on our daily activities. At the same time was time to explore and improve new mechanisms to improve our work in the short future, so most of us improve different areas of our protocols

3. Temptation: To let your emotions drive your response. Instead we try to be strong and solid all of the time, and work as much as the others. Everyone has been working 7 days a week, without asking who it is going to be compensated.

4. Temptation: To withhold information. However, we always gave people as much good information as the situation allows. We try to keep people updated and keep them focused on the work they CAN do, rather than worrying about what they CAN’T. As I said, the major fear was the lack of protective equipment. But that was what he had. Recently the New York times publish an article. ‘Health Care Kamikazes’: How Spain’s Workers Are Battling Coronavirus, Unprotected They described how 12,000 health care workers have contracted Covid-19 in Spain amid grave shortages in personal protective equipment.

Somehow, this is a war situation. And like every war, the end is close. There are a number of possible futures, all dependent on how governments and society respond to coronavirus and its economic aftermath. Hopefully we will use this crisis to rebuild, produce something better and more humane. Of course, I will always remember the amazing attitude of everyone working in the Hospital. Makes it worth the effort