Robert Matheny, a Ph.D. candidate in communication at Wayne State University and an organizational effectiveness consultant for the Henry Ford Health System (HFHS) midtown Detroit and Wyandotte campuses, is used to managing organizational conflict, but nothing could have prepared him for the coronavirus (COVID-19).

He vividly remembers the day the Henry Ford Hospital in Wyandotte saw its first patients exhibiting COVID-19 symptoms. In the morning, one in seven patients were presenting symptoms, he said. By the evening, that ratio had flipped to seven to one.

"It was a bit like standing on the shore watching a tidal wave roll in," Matheny said. "A lot of people were scared. We didn't really know what to expect or how bad it was going to get."

In times of crisis, HFHS-like any other health care organization-sets up an incident command system (ICS), an incident commander is named and becomes the ranking member of the organization to guide the response, Matheny said. Henry Ford Hospital in Wyandotte set up an ICS when it experienced flood damages a few years ago. The West Bloomfield campusdid the same when a water main break cut it off from the city water supply. The only system-wide ICS prior to COVID-19 was briefly put into place after September 11^th, but nothing compared to what the pandemic demanded, he said.

"We simply didn't have the processes or resources in place to face a situation like this."

But HFHS adapted. Fast.

A central ICS was set up as well as local offices at each and every campus. HFHS started talking to health care leaders around the world who had already faced the virus and was quick to implement any guidance coming out of the CDC. Surgical and step-down units were converted to ICUs to increase bed capacity, ambulatory sites were converted to overflow units, and screening put into place. Then, Matheny had 48 hours to create and deliver an orientation to ensure those who would be deployed to cover these sites, felt informed and confident enough to start receiving patients.

"We transitioned an organization 31,000 strong from a peace-time to a war-time posture within mere days," he said.

Matheny said he began personally administering psychological first-aid to employees, which included"spreading important information face-to-face because many had no time to keep up with their emails, managing the rumor-mill, relaying what I was learning back to our executives, and making recommendations where I could."

In the beginning, developments occurred by the hour, Matheny said. It was all they could do to keep up.

"I never thought I'd bear witness to something like this. While our leaders continue to exhibit incredible strength, there have been lots of tears shed by all. We've all lost people we know. We've all had to take a break and scream into the void every now and again. Then, we get back to work."

Prior to the pandemic, Matheny focused on employee engagement, coaching, conflict management, and partnering with executives to drive adoption of the culture HFHS aspires to. Now, much of his time is spent checking in on those on the front lines, asking how they are, about their coping mechanisms, and what he might be able to do to help.

"I think a lot about one particular conversation with an employee who reported having auditory hallucinations at home. She hears the sounds of the ventilators and of the alarms when a patient codes. They were making it very difficult for her to fall asleep."

Then, he circles back and shares their stories and immediate needs with the executive team and completes the referral process for employees that require more direct care.

"We have a lot of hurting and traumatized people now."

Today, HFHS has settled into a new normal, Matheny said. When an employee arrives, a nurse checks their temperature, asks about possible symptoms, then places a sticker on their ID badge so everyone knows they've been cleared. Each day starts with an incident command call that updates everyone on the current numbers of admits, discharges, ventilators in use, PPE levels, and updates to treatment protocols.

Matheny has adopted some semblance of a new normal at home, too.

When COVID-19 first arrived at HFHS, he and his partner, who also works for HFHS, each worked 10-14 hours a day, seven days a week. They briefly contemplated self-isolating, but decided against it, since they were both exposed to the same risky situations. Each day, they came home, ate, then went straight back to answering emails and making phone calls.

"I started to notice the burnout and secondary victimization signs in both of us," Matheny said. "It wasn't sustainable."

So, they went back to taking weekends off when they could. His partner spends his free time in the yard. They ordered a greenhouse and have started a vegetable garden. Matheny likes to cook and has spent quarantine refining recipes. He's taking chef Tim Keller's MasterClass online and recently made a gluten-free lasagna from scratch for chef Samin Nostrat's "Big Lasagna" event.

"It took me two days! Then we jumped on a live chat with Samin and thousands of other people who did the same thing while we ate it. It seems silly, but it was nice to do something else and to see that thousands of people around the world also did that thing with you."

Of course, the crisis is far from over. Matheny said there's a sort of "emotional whiplash" when it comes to interacting with those outside health care who don't see firsthand what's going on.

"Suddenly everyone's an armchair epidemiologist."

But being a part of a core group of health care leaders who meet regularly for virtual happy hours has helped keep him grounded.

"We vent, we laugh, we cry with each other, make fun of each other, but mostly we do some kind of collective sense-making and perspective-taking," he said. "We uphold each other and keep each other sane."

By Kristy Case, web editor/writer for the Wayne State University Graduate School.