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Military Health System

COVID-19 amplifies importance of Trusted Care culture

Image of soldier holding up a badge that says "Trusted Care.". An Air Force airman holds up his Trusted Care badge at the Defense Health Headquarters in Falls Church, Virginia. (Photo by Josh Mahler.)

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Preparing for the unexpected has long been an essential part of the military ethos. While you can never fully prepare for something like a global pandemic, the best alternative is having a culture in place that empowers your team to adapt and respond to heightened uncertainty.

For Air Force Medicine, this is the Trusted Care culture.

The vision for Trusted Care has been around for a few years, with the aim of building and nurturing a culture of safety and high reliability throughout the Air Force Medical Service. But the importance of this culture shift has been amplified throughout the COVID-19 fight.

“When an aircraft is experiencing an emergency, the pilots refer to their emergency procedures checklist to narrow down what the cause is, where the smoke is coming from and how to alleviate it,” said Air Force Col. Michele Shelton, special assistant to the Air Force Surgeon General for Trusted Care. “While we didn’t have an emergency checklist for the magnitude of pandemic we were facing with a previously unknown virus, what we do have is an established culture to guide us.”

“In the midst of this unprecedented pandemic,” Shelton continued, “we’ve been able to build on past disease response and rely on the principles of high reliability as our culture checklist to guide us through these challenging times.”

The goal is to create a team of innovators focused on patient safety.

During this pandemic, the Trusted Care culture has been on display through problem solving and innovation from the front line. Specifically, in the development of processes or acquisition of resources to protect both patients and staff. These daily wins in the fight against the virus are attributable to the Air Force Medicine team as a whole.

Air Force Senior Airman Olivia LeBoeuf, a biomedical equipment technician, 15th Medical Support Squadron at Joint Base Pearl Harbor-Hickam, Hawaii, knows the importance of adapting to the situation. Her team, which is responsible for readying critical medical equipment, decided the best way to approach social distancing would be to work through the night in shifts. LeBoeuf rapidly certified and repaired an onslaught of non-contact thermometers and ventilators, even stepping in to train others on the equipment.

“Early on we were all concerned that if COVID-19 hit Hawaii hard, how we would be able to respond, and if we would have enough equipment available,” said LeBoeuf. “I was fortunate to know how to calibrate and repair the ventilators we had in storage, and I was given the opportunity to train Army counterparts on this process as well.”

“It was a great experience, because it enabled me to interact with a variety of units on base that I usually would not have and to be a part of their mission,” said LeBoeuf. “It’s always great to be able to share knowledge.”

Trusted Care’s problem-solving mentality also has a direct impact on patient care. Air Force Maj. Mark Gosling, a registered nurse, 81st Medical Group, Keesler Air Force Base, Mississippi, worked with the critical care team and his Simulation Laboratory team to step in and modify the design of their intensive care unit beds to optimize them for ventilated COVID-19 patients.

“The patient is always our number one focus, but this frame of thinking is even more important when you’re dealing with critical care from a COVID standpoint,” said Gosling. “When you’re using ventilator techniques on a patient, they can’t tell you what they’re feeling, or if they’re uncomfortable. They’re completely dependent on you and how in tune you are with their needs now and throughout their care. So we need to be thinking multiple steps ahead.”

“Much of the COVID-19 response has forced us all to do critical care medicine in a way we’ve never done it before. It’s about chronically adapting and learning as we go how to best treat this virus and save lives,” said Gosling.

Due to the importance of these implications, the AFMS has followed guidelines from the Centers for Disease Control and Prevention to establish policies and procedures to prevent the spread of the virus between the medical facility and the home.

“We’ve instituted the option for staff to change into freshly laundered scrubs at work and change back into uniform or civilian attire when leaving,” explained Ferdinand Blaine, infection preventionist, 96th Medical Group, Eglin Air Force Base, Florida. “The staff can bring home or spread this virus unknowingly, so cleanliness, hand hygiene, common surface area cleaning, staying home when sick, social distancing and wearing a mask or face covering are the keys to defeating this virus.”

The medical group even instituted a “Hy5” hand hygiene campaign, which adopts the practice of saying “High Five” to fellow staff members as an inspirational reminder to perform hand hygiene. The Hy5 campaign extends from the treatment facility into their homes. Medical Airmen understand the importance of maintaining the routine to keep themselves and their families healthy.

Medical airmen, like those with the 96th Medical Group, overcame challenges through creativity as the pandemic expanded. Teams developed ways to safely handle, clean and dispose of contaminated linens and trash while managing personal protective equipment supplies. Relying on guidance from leadership and CDC guidelines, they built self-assuredness in protecting against this new virus.

Trusted Care culture comes down to leadership at all levels of the AFMS, especially in a time when Air Force medical capabilities have become increasingly vital.

“We’ve seen time and time again, our clinicians and non-clinicians working through the complex challenges this virus has brought on the AFMS, let alone, the world,” explained Shelton. “As our Airmen have endured, they have exemplified resilience, in putting people first, taking care of their teams, doing the right thing and seeing the big picture.”

“When you think about Air Force operations, historically the primary operators have been pilots. They are the tip of the spear, the front line, what makes the Air Force the Air Force,” said Shelton. “While the medical community has always been a support function to front line operations, during this pandemic the focus shifted and the medical community has stepped in and become the operator, the tip of the spear.”

At the end of the day, when it comes to challenging situations, the AFMS was built to handle the pressure, and the Trusted Care culture will continue to provide the way.

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