In the time of Covid, Part 3: Triage for Crisis Management

I am getting better acquainted with my anxiety. I thought we were old friends by now and that I knew all of my signature symptoms: chest tightness, unease, jumpy and being on high alert. But this pandemic has upped the ante, and I am finding that my anxiety has more to teach me. Like you, I am sensitive to the anxiety of my clients, colleagues, family, and neighbors. Of course, the world news gets in, too. I get two newspapers a day and listen to NPR…so there is no shortage of worry in my daily experience.  

I find myself working with my own anxiety daily, to manage it and to remember to breathe. In my role as therapist, I have several methods of anxiety reduction I regularly recommend to clients. But in my role as a business coach, I notice that anxiety presents additional problems. It muddles the decision-making process needed to make good decisions about our practices and livelihood.

I have read neurological studies that show why this muddling happens: Anxiety floods the brain and the prefrontal cortex (the part of our brain that often acts as a traffic director, keeping our thoughts, ideas and solutions moving in a rational way) gets very confused; this cognitive area of the brain is easily upset and distracted when anxiety is present.

Normally resolvable business problems–both big and small–tend to collapse without the traffic cop part of our brain being on the job. This is why even simple worries seem so overwhelming to many people right now. Problems due to Covid-19 get combined with those of everyday life. Then our anxious brains deem all these issues equally (heavily) weighted. All demand our immediate attention right now. Its as though they all have a green light to rush in. We get flooded.

This is bad news for a small business owner. You need to consider business problems carefully, to weigh the risks and rewards prior to taking action. You need to think and plan without emotion clouding your judgement.

If you are dealing with worry and a sense of being overwhelmed, its time to have a mental strategy to stay clear and proactive. The mindset I like for dealing with business issues in a crisis is triage.

When Triage is Needed

Triage is a time-honored process that quickly and effectively prioritizes issues and problems during a time of crisis. You may use this process already, but when you are feeling overwhelmed, it helps to be reminded to slow down and be strategic. Here is an example.   

Joel, a therapist in private practice, is normally a cautious small business owner. But now he is overwhelmed and feeling frantic. Working from home using a telehealth platform, he complains that his internet connection is too slow and even cuts out. It’s frustrating. He meant to replace his router but never got around to it, pre-Covid. Now its essential to have a better way to connect with clients, but he is not sure how to proceed. He is having trouble with his billing software, too, a task he had hired someone to do and now tries to do himself. His young daughter is not doing well with the distance learning program the school offers, so he is worried about her. 

Of more concern, Joel says he doesn’t feel well. He still has clients and is using telehealth, but they are starting to worry about him as he coughs and sneezes through the session. Some of his clients have decided to stop therapy. He doesn’t know if he has the virus and has not been tested; he hopes to just tough it out.

“My wife is sneezing now too. She is blaming me for making her sick. So we’re arguing. And one more thing, Lynn, that is really on my mind,” he says. “Even though I have currently moved out of my office into my home to work, my landlord wants to renegotiate my office rent. My annual lease is up for renewal in two months. I am really irritated and upset about this and it keeps me up at night. I think about it constantly. It seems so greedy in this time of crisis that anyone would think about raising the rent. See why I am overwhelmed? What am I supposed to do next?”

I do see why Joel is distressed, and I empathize, but more importantly, I ask Joel if he can start to prioritize all of these concerns. Some are more critical than others. He says an emphatic, “No. All these issues feel immediate and equally important to me right now. They all need to be dealt with, I am just not sure what to do first.”

Joel needs to think clearly if he is going to make good decisions. It’s time for triage.

Using a Triage Process  

Triage is a medical term, used to sort out degrees of seriousness. Imagine a battlefield that is filled with wounded soldiers. You are the medic who walks among the wounded, quickly ranking the level of injury. Traditionally, triage uses 3 levels of prioritizing:

  • Emergent: Think emergency room, 911-quality critical issues that need first attention now.
  • Urgent: Pressing concerns that need care soon, but are not considered life or death right now.
  • Non-urgent: Conditions that are real, but can wait. 

For you, as the business owner of a private practice, triage can present like this:

Emergent issues:

  • I am ill or an immediate family member under my care is ill
  • I need to close the practice immediately
  • I am broke and can’t pay my bills
  • I am losing my license due to an ethical complaint or oversight

Urgent issues:

  • I am overwhelmed with too many clients (or I really need more clients)
  • I don’t know how to do billing or administrative tasks by myself
  • I have lost 50% of my clients due to teletherapy resistance
  • My cash flow is a very real problem

Non-urgent issues:

  • I am OK for now, but worry that my caseload may dry up in the future
  • I would like to add some online classes to my practice to have more to offer
  • I am not sold on telehealth and think more training could help
  • I want more clients in my area of specialty  

Steps to take:

  1. Make a list of all your problems, especially those keeping you awake at night or causing you to feel hopeless & helpless. Sort them into the three levels as best you can. Which are problems that you can impact (do something about) and which are out of your grasp? Stick with those you can achieve.
  2. Focus on resolving only the emergent and urgent issues on your list. This may take days or weeks.
  3. Then turn to the non-urgent issues.

This is what I helped Joel to do; it calmed him in that it gave him a focus of what to address first and what could wait. You can do this, too. Over time, keep updating and adjusting your triage list so you know what needs your first attention versus what can wait. This will provide you with a better sense of control; you can make thoughtful choices and decisions about issues that affect your practice, even during a crisis.

In the next email newsletter, I will look at the non-urgent issues that may be on your list and need resolution, by showing you how to position your business for strength in a time of crisis.

Some readers have asked for resources right now. The source book for much of what I am discussing in my newsletters is my earlier book:

Crisis Proof your Practice: How to Survive and Thrive in an Uncertain Economy (W.W. Norton, 2009)
It’s available on Amazon and at the publisher.
See inside the book at the website.