COVID-19 has, and continues to, wreak havoc worldwide, and the healthcare system has been particularly challenged with personnel shortages, resource insecurity, mixed messages, and fear to name a few. At the outset, it was thought the pandemic would be short-lived, resulting in the enactment of disaster plans in hospitals. Such autocratic approaches are not always effective in the long-term; a servant leadership approach is more conducive to engaging teams, and this dyad structure supports effective leadership during challenging times. While there is not one right approach to leading through a pandemic, lessons learned from this pandemic are applicable when, not if, the next pandemic occurs.

Stroke is the fifth leading cause of death and the leading cause of long-term disability in the United States, and timely administration of tissue plasminogen activator (alteplase) is a key predictor of post-stroke survival and disability. The authors explain how a process improvement team utilized LEAN methodology to decrease alteplase administration (“door to needle”) time by almost 50% at a busy, high-acuity hospital emergency room in Houston, Texas. The authors will explain the process that was followed, the post-implementation results, and lessons learned.