Background

The Ohio State University Wexner Medical Center is an academic, quaternary health system with ∼1,600 beds, comprising University Hospital (Level 1 trauma/burn center/liver & kidney transplant), the James Cancer Hospital (bone marrow transplant unit), Ross Heart Hospital (heart and lung transplant), East Hospital (orthopedic surgery) as well as ∼200 clinics including 4 ambulatory surgery centers.

Creation of co–medical-director model

The hospital epidemiology department historically had 1 medical director until 2012, when an AMD was added to provide oversight to the James Cancer Hospital. In 2014, another AMD was recruited with oversight at East Hospital. The medical director fielded emergency calls from IPs and leadership 24/7, presented at leadership forums, and approved all decisions. The enormous job scope left minimal opportunity for preparedness or clinical work.

In January 2018, the longtime medical director retired, providing the opportunity to reassess the traditional top–down leadership model. The AMDs worked as a team to identify operational needs, for example, starting the Influenza Workgroup. For the next 18 months, we continued with our primary epidemiology responsibilities and split the remaining responsibilities based on clinical obligations; the hospital leadership responded with supplemental pay. An added benefit was seamless coverage for each other while on leave (vacation or medical). Efficiency improved because approval and guidance was only needed from 1 physician, which allowed real-time decision making. The dyad leadership success built upon interpersonal trust, constant communication, meticulous organizational skills, and task delegation to the IPs. Our IPs grew in their roles as experts as we empowered them to make decisions. We created protocols for common exposures such as Norwegian scabies, led outbreak investigations for pathogens including group A Streptococcus, and created institutional guidance for emerging pathogens such as Ebola. The benefits of excellent team communication, increased availability for collaboration, and preplanning were quickly realized and acknowledged with increased institutional support. In August 2019, the Ross Heart Hospital funded a third AMD.

Experience during the COVID-19 pandemic

As hospital epidemiologists, we were at the center of the medical center’s response to the global crisis. We collectively led the COVID-19 Clinical Care Workgroup (CCWG), a multidisciplinary team responsible for protocol and guideline creation. In the setting of a new virus, compounded by panic from the press, family and coworkers, this amount of work was clearly untenable for 1 person. Our prior transition to a shared leadership model facilitated quick group decision making. Individual strengths and differences (ie, personalities, experiences, and risk tolerances) allowed us to challenge each other on policies prior to roll out. This model allowed us to remain active on the infectious diseases (ID) consultation services, providing us frontline experience to ensure practical polices as we literally went from the bedside to the boardroom for daily meetings with leadership. Importantly, we took scheduled breaks, including vacations and medical and maternity leave to avoid burnout. Our team has come out of the pandemic stronger, more cohesive, and with the respect of hospital leadership. The 3 AMD titles have been transitioned to medical director titles, underscoring the triumvirate leadership mode.

Current organization

The current department is composed of 3 medical directors; 1 associate medical director; 1 administrative director; and 20 IPs with diverse subject-matter expertise, including 5.5 IPs dedicated to ambulatory, 1 data manager, 1 planning analyst, and 5 high-level disinfection analysts (Fig. 1). We built a collaborative, dynamic department that functions at its peak performance regardless of which medical director is available. The medical directors each have salary support of ∼0.5 full-time equivalent (FTE), with the associate medical director at 0.35 FTE.

Figure 1.

Epidemiology department.