Table 2 Importance of visible leadership with a focus on sense-making subthemes and exemplar quotes

A unique dichotomy between flexibility and structure needed in a dynamic environment

“It was very helpful as a team of COVID providers because we would all just still show up, sit at the conference room and sort of said, “How are your patients doing? Like what did you do? How – what have you been doing?” We all sort of – because day to day everything was changing so much, it was nice to just do like a little check-in and that’s how I feel like that sort of progressed, that it was more of a check-in with your teammates. You were working with an attending but then you still had three or four other COVID teams and we all got to sit around and just be like how are your patients doing? Oh, you sent two to MICU? We’re sorry.” (APP, Interview/FG 5)

“There was a small pool left that kind of ended up working a lot the first few weeks, and so I feel like we kind of all had this shared experience with trying to figure out how to take care of these patients and trying to talk with our patients and see if there were similarities or trends that we were seeing, and so I think clinically, it was like this kind of scary but bonding experience.” (APP Interview/FG 6)

“The nice thing is if there is any sort of issue or any sort of concern to just bring it to the-the appropriate level. So for instance, we would sometimes hear about something that had gone straight up, like through the command center to the C suite, and then also – and then it gets put back down to us. And had we just been able to have a direct conversation about it, I think it really could have easily been solved, because ultimately, it ends up coming back down to us to—to work on anyway. We just noticed that a few times where we're like, “well, we didn't even know this was a problem but, you know, we're happy to work on it.”” (Care Management, Interview/FG 9)

Communication was key to effective operational response (transparent, consistent, concise)

“There was a lot of communicating. It was good to hear from everyone and I liked the updates. It helped keep my anxiety at bay but at the same time, it may be made my anxiety worse sometimes because it was so much communicating.” (APP, Interview/FG 2)

“I think that tiering system [tiered surge plan] is great because one of the most unsettling things, is uncertainty, and not knowing when we may scale up, scale down, can be unsettling. So, knowing, “Okay, so these are the criteria that moves us to tier 2, these are criteria that moves as to tier 3…” (MD/DO, Interview/FG 25)

Sense of mission and increased collaborations

“I think one of the biggest positives was a sense of an overarching mission within the group and seeing my colleagues step up … And so it was, it felt like a pretty important shift and right from our first meetings, kind of those first emergency meetings, there was a real sense of solidarity and mission within the group that really meant a lot to me as the first year within the group. And so that was cool to see. And it made me feel good about coming to work and good about signing up for extra shifts and good about everything that might happen, because I trusted the people that I was working with. (MD/DO, Interview/FG 1)

“The sense of one team extending like well beyond anything I've seen before. The fact that we agreed to take obstetric COVID patients, that surgeons were interested in participating in the care planning, the fact that we were working with infectious diseases, that we had outpatient doctors who wanted to come and [help]. I mean, it was, it was, it was beautiful. That was a beautiful thing. So, I think it was probably the best crisis we could have, because we've established new relationships and approaches that never would have existed were it not for COVID.” (MD/DO, Interview/FG 20)

“I found working on the COVID services to be incredibly rewarding and one of the most rewarding clinical experiences that I've had in a really long time. And part of that was the people that you were working with, whether it was with nursing staff, respiratory therapists, specialists that you were consulting; everyone was sort of in this like, "Hey, this is a catastrophe that's happening, it's a disaster, no one knows what the right answers are, and we're just trying to figure it out day to day. So it's taking creativity and working together as a real team. I think it was the most robust team feeling that I've ever had in a hospital.” (MD/DO, Interview/FG 18)