Health care leaders reflect on lessons the pandemic is teaching

screen capture of the 8 panelists during the webinar

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op executives from Connecticut’s four largest health care providers candidly shared the lessons they’ve learned during the COVID-19 pandemic and how they are planning for the uncertainties of tomorrow in a virtual forum on October 1 titled “Beyond the Coronavirus Crisis: Change, Innovation, Leadership and Success.”

Connecticut Gov. Ned Lamont joined Quinnipiac President Judy Olian and the following panelists: Marna P. Borgstrom, CEO of Yale New Haven Health; Jeffrey Flaks, president and CEO of Hartford HealthCare; Dr. Reginald Eadie, president and CEO of Trinity Health Of New England; and Dr. John M. Murphy, president and CEO of Nuvance Health. Janelle Chiasera, dean of the School of Health Sciences, served as moderator.

The event kicked off the inaugural Denise J. Fiore ’78, MBA ’91 Thought Leaders in Health Care Speaker Series, made possible by a generous gift from Fiore, who earned both a bachelor’s degree and an MBA in health care management at Quinnipiac.

Olian thanked Lamont and the health care executives for their leadership during the pandemic and credited them with the state’s continuing recovery. “My bet is that none of these leaders would say they have ever been through the breadth and depth of challenges they had to deal with in the last few months, the widespread assault on every aspect of how they delivered services, secured supplies, called on staff to work in risky conditions, and managed budget and cash flow despite the total upending of business as usual,” she said.

“Nothing in their playbooks or past experiences could have prepared them for this extreme reality,” she noted.

Despite the challenge, Olian said they brilliantly faced and dealt with the “here and now” while approaching the future with what she called gutsiness and the realization that they must innovate in order to survive and thrive. She emphasized that they were forced to accelerate things they thought were in the future, such as telehealth, much like the university did when it pivoted to remote education in March. Since then, 225 classrooms were outfitted with the ability to concurrently deliver courses live and remotely.

The state also moved quickly. “The first thing we did,” Lamont said, “was to reach out to our amazing health care providers. We were on the phone every day, and you guys were invaluable.”

“We don’t wear individual uniforms at a time like this, we wear the same uniform, we are on the same team,” Flaks said. He noted that while people harbor an understandable desire to return to normal, he hopes the health care system never does. “We are going to be better than normal,” he said, citing advances in infection control knowledge and in leveraging telehealth.

“We went from 400 telehealth visits a month to well north of 300,000,” Flaks explained, adding that people in remote parts of the state now have access to specialists. Hartford HealthCare also added a 24/7 hotline that has logged more than 166,000 calls since March.

“Why did it take this crisis to allow us to recognize that at 3 in the morning, sometimes we need to get advice from a clinician, but maybe we don’t need to go to the ER?” he asked.

Flaks also acknowledged that the pandemic amplified the issue of health care equity and disparity. “Massive change has to occur. The statistics during this crisis are startling,” he said.

Murphy talked about the emotional burden on hospital staff — the shortage of PPE and the fear of becoming sick themselves and infecting family members. In response to these concerns, his team instituted peer counseling that he said proved remarkably effective as they recognized the need to help each other get through the crisis. It’s an initiative he plans to carry forward.

Borgstrom concurred. At one point, she said, Yale Health had upward of 800 COVID patients. She recalled one nurse saying that staff will live with the emotional effects of what they witnessed for a long time.

Chiasera asked Olian and the health care executives to reflect on their initial decision-making when the crisis emerged.  

Quinnipiac, for its part, decided to protect the greater community by not letting students to return from their homes to retrieve possessions left behind when the university transitioned to online learning, Olian said. “If we had allowed an influx of 10,000 kids from everywhere, that would have put a burden on health care systems,” she said.

The strict measures employed, including having students test for the virus before they arrived in August and again while here, have yielded good results. Only two COVID-19 cases have been reported, and the campus community is enthusiastically protecting the “Bobcat Bubble.”

For Murphy, the question of what he would do over “is more important than the answer.” Back in March and April, he said life and death decisions were made in real time. “We thought hydroxychloroquine and azithromycin were fabulously effective — they were not; we thought masks were just an option, and guess what, they are not; we thought with warm weather the virus would disappear — it didn’t; we thought kids didn’t get sick — they do.” Yes, much was learned, but he noted, “We are not as smart as we are going to be two months from now.”

From learning that intubating patients early is really not the right thing to do, to discovering the “crushing” emotional toll when patients die without family able to visit them and only medical staff as witnesses, Murphy and his team have built an ongoing and evolving playbook.

“It sets forth things we are going to do differently when the next big wave arrives, and I hope it doesn’t,” he said, commenting that he is proudly stockpiling PPE and jamming warehouses full of it, to the displeasure of OSHA. Nuvance also has begun to cross-credential physicians across its hospitals to remove barriers to care.

Flaks said leaders demonstrate agility and courage during a crisis and make the best decisions they can at the time with the facts available — and adjusting when presented with new information. For Eadie, it was all about what he described as “inclusive and transformational leadership,” with command centers at each hospital to ensure optimum communications.

The forum also addressed the topic of vaccinations. Eadie, as co-chair of the state’s COVID-19 vaccine advisory committee, said the members are working to ensure the safety of a vaccine as well as its appropriate and equitable distribution. He said the “million-dollar question” is when it will be available. His best guess is Spring 2021. Although some have expressed a reluctance to take it, Eadie said he will trust the advice of the scientific experts and plans to publicly take the vaccine to convince the public of its safety.

On the political front, Borgstrom fielded a question about whether she thought the Supreme Court might overturn the Affordable Care Act in light of the death of Justice Ruth Bader Ginsburg. She answered that she most worries about the elimination of the individual mandate to buy insurance.

“If that were overturned, it would … destabilize the entire funding plan for the Affordable Care Act because without everybody participating in insurance, there would not be enough financial resources, and it would destabilize a lot of the financials of the safety net organizations that care for people who have gotten some insurance but would be able to drop it at that point,” she said, noting that it would widen the divide between the health care haves and have-nots.

Another question concerned the leadership role nurses played in the pandemic. Flaks called them “heroic,” saying he had the opportunity to speak with hundreds of nurses and is in awe of the planning they put into place and their agility in adapting to new circumstances.

“We knew nurses were critical, but it’s never been more evident than during this crisis,” he said. “The leadership and courage they showed when others quarantined at home and they ran to the front lines. We all owe an incredible debt of gratitude to our nurses.”

Dwindling time — but not discussion questions — ended the forum. Fiore said she could not have imagined a more appropriate topic than COVID-19 when she began working with QU to bring thought leaders together for an inspiring and annual discussion.

She thanked all the participants, saying: “This collective sharing of innovation, leadership execution and collaboration during the pandemic was very informative. As leaders you continue to demonstrate what it really takes, and all your efforts have resulted in the transformation of health care in keeping us well and safe in this state.”