Health system leaders are facing a series of urgent issues in as the COVID-19 pandemic continues, including redeploying staff, managing employee morale in a time of worry, and ensuring their supply chains can handle a massive surge in demand.
In today’s interview, Kenneth A. Samet, President and CEO of MedStar Health, the largest healthcare provider in Maryland and the Washington, D.C., region, explores his approach to leadership in unprecedented times, from communicating personally with employees to keeping a close eye on key indicators of hospital capacity. This interview was conducted on March 25, 2020.
Q: What are you seeing in your system in terms of patients who have either tested positive for COVID-19, or who you suspect might test positive?
A: As of March 24, we had 49 positive COVID-19 patients in our hospitals. We've tested about 2,500 patients. In the Washington, D.C.–Maryland region, we are definitely seeing an uptick; our numbers are double from three days ago.
The inability to have testing at scale with quick turnaround has been a major issue. We were able to add rapid cycle in-house testing capability several days ago. Before that point, we had 200 patients a day as inpatients who were persons under investigation for COVID-19. We had to treat all of those patients as if they were positive for COVID-19. As a result, we were consuming huge amounts of personal protective equipment.
Knowing what we’re dealing with is important for quantifying the situation, and it’s powerful for our people. They’re assuming the worst, and with some of the exposures, we had a number of our staff we had to send to home quarantine. We simply didn't know what the situation was, and until you know that, you can’t bring them back.
Q: How are you preparing for the expected surge?
A: We’re working with the other health systems in our area and with governmental leaders, including Maryland Governor Larry Hogan and D.C. Mayor Muriel Bowser. The collaboration with our colleagues across the region, and nationally, has been meaningful on every level.
Last week, we began a hard stop on elective cases, which includes outpatient cases that are elective, non-urgent. Our system activity levels are literally down by half, although it varies by location. We have some community hospitals that are two-thirds empty today. MedStar Georgetown University Hospital and MedStar Washington Hospital Center, which handle more quaternary cases, are still relatively busy, but down by one-third.
The next question is understanding the implications for staffing. We committed to redeploying our people in whatever way we could. As an example, we were seeing approximately 10-20 patients a day on our telehealth platform prior to the COVID-19 pandemic. Right now, we’re flying past 500 patients a day, and we're on our way to 1,000 patients a day. Our team evolved our platform in a comprehensive way with connection to our EHR and billing systems, and trained more than 50 providers on telehealth. These providers are both physicians and nurse practitioners who might have been previously working on elective cases in their area. We're redeploying these providers where we can, to both keep people busy and use their capabilities on our eVisit platform.
Q: How are you communicating with your staff during this time?
A: Communication is a full team effort. It takes all our leaders to actively share information and our unified system thinking. To support that, I sent out an all-associate communication the other day. It gave me an opportunity to connect to our associates from the heart and to communicate about the difficulties ahead. I believed that was a moment only the CEO could own.
We have a number of support staff who can’t perform their jobs today because they can’t be in the facilities. We wanted to be clear with them how we were going to take care of them, but also certainly have them understand that this could go on for a while. The pandemic is going to be the single biggest financial challenge in the history of American hospitals in my 38-year career. I can’t stress that enough. But that is not our first concern—our people and our patients are. But as leaders, we know this will be a material issue waiting for all healthcare organizations.
In times of crisis, you realize who the selfless heroes are in our healthcare system. They are standing willingly in harm's way, and they want to come to work. We've talked to physicians who are over 60 years old about the current risks, and they’re insulted. They want to be there to help. I'm always energized by that.
Our job is to make sure we can help our providers and other staff be as prepared as possible. Our supply chain team has been nothing short of amazing. We have our people fully protected and prepared with PPE. We’re trying to keep the psyche of our people solid, so they feel comfortable coming in. The challenge is sustaining at scale when the surge comes to our region.
I was here for 9/11 and the 2008 financial crisis, and the mood is different today. Right now, there’s a psyche of worry. Staff are seeing their neighbors, their friends, and maybe their spouses who work in companies that are now shut down. The magnitude of personal anxiety that I'm seeing and feeling from our people is significant. Hospitals and health systems have to do everything we can do to help steady them, support them, but not sugarcoat what’s going on. Our staff knows what the world is like right now, and yet they still come in, and they're still here for our patients. Sure makes me proud to be part of their team.
Q: What are the pressure points in your supply chain at the moment?
A: Let’s start from the top with masks. Everyone knows the purpose of an N95 mask, as opposed to a Level 1 surgical mask or, say, a procedure mask. But because of the current psyche of our staff, and because a lot of the professional societies have come out calling for universal use of N95 masks, which no one’s supply chain couldn't keep up with, our infectious disease, medical and nursing leaders spend lots of time with staff so they have confidence in our commitment to their safety.
We have moved to providing masks to everyone in our care environment as an extra level of support. For our system, that currently adds up to over 25,000 masks a day. Projecting that for a few weeks, that might be 500,000 masks that weren't accounted for in a normal supply chain calculation. I’m really proud of our heroes in our supply chain department who are doing so many creative things to try and make sure we can do that. It also speaks to the importance of maintaining good long-term relationships with our vendors. In addition, we’re benefitting from a “systemness” approach to our entire system and to our supply chain. For example, there’s a small community hospital in our system that has been really hit hard. We were able to bring ventilators and staff from another hospital in the middle of the night to that location. “One MedStar” truly matters.
Q: How are you approaching the issue of capacity?
A: There are three key areas we’re watching in terms of capacity: ICU beds, negative pressure rooms, and ventilators.
The negative pressure rooms were a problem before we could do our own in-house rapid testing. We had 200 PUIs [persons under investigation] without test results in-house as recently as four days ago, and that number was growing. The in-house testing has been a game changer. Being able to clear these patients has been critical. We're also using creative approaches to convert other spaces into negative pressure rooms. It isn't perfect, but it works.
With all that being said, we have not seen the surge yet in our region. We have less capacity than we did because our patient numbers are escalating, and that's the worry for everybody. We don't actually know what's coming, but from a modeling standpoint, we have to err on the side of assuming we have a major surge coming. That's our most responsible thing we must do for our mission to our communities and our patients.