FEATURES: Overcoming Pandemic Challenges

FEATURES Moving Forward in a Pandemic

M Dentistry magazine reported in the spring/summer online edition about how the arrival of the pandemic in March was met with fast action, long hours and creative solutions that kept students engaged in online learning and patients receiving emergency treatment. Over the last eight months, students and patients have returned to the school, though the daily routines are still far from the previous norms. M Dentistry asked six people with widely varying jobs – and with half a year of hindsight – to briefly reflect on how the school has kept moving forward.

Brandonn Perry: Safety first

As Infection Prevention and Compliance Officer at the dental school, Brandonn Perry was accustomed to developing, communicating and enforcing infection control procedures. But the challenge in the first days of the pandemic was that no one – not even state and national health agencies – knew how to best defend against this new coronavirus for the general public, let alone a dental school. Perry and school leadership had to immediately take steps that would keep students, faculty, staff and patients safe so that solving myriad other problems could go forward. Perry worked with the school’s COVID-19 Response Group that was quickly formed, as well as the existing Infection Prevention and Safety Committee he chairs. He joined a constant stream of meetings – daily, weekly, impromptu – with administrators, faculty, department chairs and staff leaders of various offices whenever input and consensus was needed. He constantly monitored outside sources, including the Centers for Disease Control and Prevention; the Michigan Department of Health; the U-M Environmental Health and Safety Department; state and federal occupational safety and health agencies; other dental schools, including six he met with weekly; and the U-M health system, including its Occupational Health Services. Perry navigated through countless online bulletins, advisories and webinars from state and national health agencies, including the Organization for Safety Asepsis and Prevention (OSAP), an industry group that advocates for the safe and infection-free delivery of oral healthcare. “In the beginning, there was little scientific evidence on anything for COVID-19 because it was new, so you were just going off of best guesses and what seemed about right,” Perry said. “And you may err on the side of being too strict because we need to stay safe. And sometimes, people thought, ‘Well, this is ridiculous.’ And it may be, but we’ll just see how it goes and we may be able to make an adjustment if necessary.” “Dentists had never worn N95 masks and typically face shields or surgical gowns were not required. So we had to figure out what was reasonable.” The strictest Personal Protection Equipment (PPE) requirement was implemented for faculty and students treating patients with high-speed instruments that generate airborne particles.

They must wear head covers, N95 masks, safety glasses, face shields, surgical gowns and foot covers. Early on, and even today, PPE was not widely available, which was another issue. Perry also participated in decisions about restricting access to the building, temperature checks for everyone who entered the building, disinfecting commonly touched surfaces throughout the building, legal compliance and human resources issues that arose, and how to communicate constantly to the wider school community about the

Dr. Berna Saglik: Always learning

Faculty member Dr. Berna Saglik says the pandemic has been difficult, particularly in the first few weeks, but over time a significant number of positive developments have emerged that will strengthen the dental school moving forward. Saglik, a Clinical Associate Professor of Dentistry in the Department of Biologic and Materials Sciences & Prosthodontics, cited the extensive collaboration within the school when the curriculum needed to be moved online after students left campus. Faculty, curriculum administrators and educational services staff worked closely to reconfigure coursework virtually to replace in-person lectures. “I feel like we are more connected than ever,” she said. Saglik is a prosthodontist who teaches residents in the graduate pros clinic and co-directs the Dental Post-Graduate Program, where internationally-trained dentists observe faculty and grad students in clinic. She also directs the removable partial dentures course for second-year DDS students. To replace the in-clinic, hands-on experience that the pandemic interrupted for the graduate and post-graduate dentists, Saglik and her prosthodontics faculty colleagues participated in a series of seminars that quickly became popular. “Most, if not all, of the prosthodontic programs across the country participated in the seminars, sometimes two a day from different program faculty. It was almost like the national pros community having an annual

Dr. Saglik

Bliss Ledford: Empathy for patients

Bliss Ledford, a Patient Business Associate in the Graduate General Dentistry Clinic, normally talks with patients about their dental needs, cost of services, insurance coverage, scheduling and other general concerns. Once the dental school reduced patient care to only emergencies, her duties quickly morphed into calling patients to relay the news that their upcoming appointment was canceled because of the pandemic. latest and constantly changing regulations. Perry applauds the team effort from everyone, including patients, who were at times frustrated by new safety protocols. “It was this constant education and re-education of people, including patients who often didn’t understand the reason for the changes. I liked to tell them: This is the safest visit for you,” he said. “I love my job, I really do. I love helping keep people safe. You do what you have to do. It’s a sense of duty, but it’s just the right thing to do.”

Bliss Ledford

meeting every single day and our residents got to see what’s happening in other programs. And other programs got to see what we were doing here.” Another major plus was advancing the use of digital imaging, which was a vital part of the virtual learning since students couldn’t have hands-on experience with full or partial dentures in clinic. Saglik credits Dr. Gustavo Mendonca and other faculty members who are part of a digital initiative that was already underway at the school. When three graduating DDS students still needed to finish their removable partial denture (RPD) requirements, but had no access to patients in-person, Saglik and her colleagues created a two-part virtual solution. Students first studied online learning modules, then demonstrated competency by successfully delivering 3D-printed RPDs to a typodont in a clinic setting. Saglik joined first author Dr. Sabrina Garcia Hammaker and colleagues in documenting the innovative educational method in the Journal of Dental Education. “Looking forward, what I’m trying to do is think of the things I would want to keep from what I’ve learned from this time, such as the collaboration across programs at other dental schools, our own collaboration at the school, and utilizing more digital dentistry,” Saglik said. “The need to try new learning methods really accelerated our digital progress. I think that should be our focus – training all of our faculty – its’s an area that we all have to learn, because these are new tools. We’re not going to be learning new foundational concepts, but we are going to be learning how to use these tools. That’s going to be a lot of learning for us all, and I think collaboration is going to be the key.”

The staff then devised a screening system to determine which patients could wait for care and which had serious problems that needed immediate care in one of the school’s clinics that were handling emergency cases. The next challenge was how to track all of the appointments that were canceled; it was March and the schedule was mostly filled out through June. It amounted to thousands of calls for the staff.

It was frustrating and disconcerting for patients. “I think the most important part is to remember that each of us has been in a situation where we were in pain or uncomfortable,” Ledford said. “If we can draw on our own feelings about what that’s like, then it’s a lot easier

to understand where patients are coming from. And each patient is a unique individual person that’s calling with pain or a problem, so we really need to listen and see what that problem is and try to help them understand that there may be a light at the end of the tunnel that is not a train. And that we will get to them and help them.” During the early days and even as patient care began to ramp up again in June, each day was filled with problems that the team needed to solve. Like the rest of the world, because the staff was working from home, Zoom meetings became the answer, not just for strictly business but also for staff camaraderie. “It was helpful because it at least put our faces next to each other when we can’t be face to face in contact with someone who is part of our team. We spend a lot more Admitting and Emergency Services Clinic, or PAES, was how to determine which patients had the most serious emergencies and which could be delayed. Instead of in-person screening, it was done mostly by phone by faculty and staff who were working from home as the dental school went into its pandemic protocols. time with the people we work with than we do at home. So these people have become very important to me and I really want to make sure they are OK. It’s hard to do that when we are not face to face. So we Zoom.”

Although the pandemic was disruptive, Ledford found many positives. “Anytime we have a challenge, we have the opportunity to grow and change and reach new parts of ourselves that we didn’t know existed,” she said. “I think a lot of us are working on that. Resilience, determination – all of those things. You’ve just got to push through because there’s not really a normal to go back to. There’s a forward where we have to innovate, work together and figure out how to meet

Dr. Patty Doerr: The neccessity of staying open

For Dr. Patty Doerr, the challenge of directing the Patient this challenge. That’s what we do. We’re humans.” “One of the biggest priorities the first week was how do I get my dentists in PAES set up at home so they can still manage patients. Normally, we would have scheduled patients to come in to the clinic, but we had to do more triage by phone, calling in prescriptions, working with their health providers to make sure that their symptoms were managed until we could get them in here. Initially, we had a much-reduced capacity for the number of patients that could be seen by PAES, oral surgery, endodontics and pediatrics, so we had to work with those clinics on how we were going to do this.” Technical support from Dental Informatics was crucial in helping staff work from home. Then Doerr had to make sure there were dentists and dental assistants scheduled in the clinic for patients who were coming in for treatment. Full-time faculty, adjuncts and other staffers, often from other clinics or who would have been working in pre-doc clinics with DDS students, volunteered to help in PAES. A sense of teamwork and camaraderie developed across the school. “The first two or three weeks, you never could really relax. It was always: Oh, I didn’t think of that. It was very fluid, but people were willing to help in any way possible. ‘What needs to be done?’ It was outside of their normal duties. With most folks you saw the best of them, even though it was the craziest time.” “I met a lot of people who I had never met before. I probably have half of the school in my cell phone contact list now. We communicated by text because you didn’t know where people were, so you couldn’t go to their office. You weren’t sure if they would check their email by the time when you needed the answer because things had to be decided very quickly.” “I’ve said a couple of times over the summer that necessity is the mother of invention. We’ve certainly reinvented a lot. It’s taught us that we are all very much interdependent on each other, maybe more than we realized. We need each other more now than we ever did. It brought out a lot of frustration in the circumstances, but for the most part you saw people really work together and keep the mission going of seeing the patients and getting the students back in here. We stayed open, we had to start over and we’ve only gone up from there.”

Dr. Doerr

Matt Vuocolo: Finding IT solutions

Probably the most commonly used word at the dental school since March is “remote” – as in “remote access” or “remote user.” Whether it is students accessing lectures, or staff accessing patient records, or faculty and students accessing digital radiology images, the ability to securely enter the school computer network “remotely” is imperative to navigating the pandemic protocols. The team behind those connections is led by Matt Vuocolo, Information Technology Operations Manager in Dental Informatics. He opens any discussion of the pandemic response by listing his team: Systems administrators Austin Bruck, Mike Crisovan and Phil Kennedy. “They are vital. None of this could have been done without them,” Vuocolo said. “All I ever did was help organize and orchestrate and identify problems. They solved them.” Reconfiguring parts of the school’s technology network and infrastructure was an immediate priority filled with problems. While a significant number of the dental school community, about 125 people, had remote access before the pandemic, most had been brought into the system over time with benefit of unrushed installation and training. When the pandemic arrived, seemingly everyone at the school – it turned out to be about 850 more people – needed to be outfitted with remote access, immediately.

Matt Vuocolo

Deanna Goddyn: A patient connection

For Deanna Goddyn, the move to working at home came on one of the first days the dental school sprang into action to combat the pandemic. The Patient Services Associate suddenly found herself on her way home with her computer and monitors in tow.

Deanna Goddyn

She quickly set up her equipment on a desk in the spare room of her home in Blissfield, two miles north of the Ohio border near Toledo. She forgot to bring an ethernet cable, so that evening she bought one at the local Meijer store. “I got everything hooked up for the next day, and I’ve been here ever since,” she said. Goddyn is a prime example of the hundreds of people at the dental school, and thousands at U-M, who are following the campus pandemic mandate of “if you can do your job from home, you must.” The transition was fairly easy for Goddyn because she spends most of her day on the phone, answering questions from patients, directing them to the correct clinics and scheduling appointments. Now the phone calls ring in on her computer in Blissfield instead of in the Many use Windows and others use Apple computers. Not every user’s software was the same or up-to-date. Employees range from tech-savvy, do-it-yourself users who could quickly follow connection directions to tech-challenged users who would need to be walked through changes step-by-step, even for basics like installing Zoom. Vuocolo credits Business Systems Analysts Lisa Newton and Usha Dronamraju who helped with scheduling and education for the users of the newly expanded remote system. Then there is the complicated network of computers and servers within the dental school that had to be configured to accept the remote queries. Two platforms in particular were crucial. Staff, students and faculty all need access to Axium, the patient portal that contains health records, appointment schedules and billing information. The other is called MiPacs, which provides students and faculty with access to digital imaging of patients. To support the new remote load, system administrators built out a new virtual computing environment and changed the roles of existing computers at the school, increasing the number of computers from 35 to 132. As the pandemic progressed, staff and faculty would present new problems, and Vuocolo and his team would solve them on short notice, even if they might have preferred to spend time devising a more comprehensive solution. “I think we could have been hung up by ‘paralysis by analysis’ but we had to solve the need. We’ve addressed everything and then some. I’m pleased, very pleased. I think everyone in IT is always looking for a solution. I think it’s just an IT thing – we want everything to be the best.”

Patient Services Office at the dental school. She handles about 100 calls a day, but it has fluctuated from a low of 55 up to 120. The calls are different now compared to the pre-pandemic days. Beginning in March, many appointments needed to be canceled as the school reduced care to emergency only. It has gradually increased the number and type of patient appointments, but protocols still limit the number available. So instead of quickly making appointments or referring callers to the correct clinic, Goddyn must now do more screening of calls and explain that things have changed. Patients who are used to immediate care or regularly scheduled appointments have often been disappointed, or angry, that they may have to wait longer to make an appointment. “It’s been difficult at times because they’re not sick, everything seems to be getting a little bit better, and they want in for an appointment now. So you just have to use a little bit of persuasion.” Working at home means Goddyn no longer shares a two-hour round-trip van pool commute to U-M with six Blissfield residents, but she misses the ability to run upstairs to a clinic to answer a question quickly. Still, she said she loves helping patients find a treatment solution at the dental school. “To do this job you need to be a people person. Even on the phone, they can tell the difference if you are not.”