Montefiore CEO Dr. Philip Ozuah on why he refused to ration a 1-day supply of N95 masks

Philip Ozuah, MD, PhD, began as president and CEO of Montefiore Medicine in November 2019, just months before the COVID-19 pandemic slammed New York City.

He was tasked with leading the New York City-based health system of 13 hospitals, a medical school and 300 clinical locations, through the once-in-a-century global pandemic. 

The pandemic forced Dr. Ozuah and his executive team to quickly adapt and make difficult decisions. Despite the unprecedented challenges, Dr. Ozuah said he believes Montefiore's COVID-19 response was as good as it possibly could have been — a testament to his leadership.

Before becoming president and CEO of Montefiore Medicine, Dr. Ozuah was president of the Montefiore Health System, physician-in-chief of the Children's Hospital at Montefiore and professor and university chairman of pediatrics at the Albert Einstein College of Medicine, all based in New York City.

Here, Dr. Ozuah discusses how his experience as a physician shaped his leadership style and shares the most challenging decision he's had to make as CEO and accomplishment he's most proud of in his first year at the helm.

Editor's note: Responses have been lightly edited for length and clarity.

Question: How has your experience as a physician affected your leadership style? 

Dr. Philip Ozuah: Physicians are problem solvers. We diagnose the condition, figure out the cause or causes, and come up with a treatment plan. Often we must solve problems without having all of the information, and we don’t have the luxury of waiting for the final piece of confirmatory data — the patient may be dead by the time that becomes available. 

So, my approach to management is similar to my approach to medicine. Whenever I'm confronted with a problem, I first take a thorough history. When did it begin? How did it progress? When was it at its worst? And in the medical history we have what we call the review of systems. Even though a problem is presenting in the eye, you also inquire if other organ systems are affected. Is breathing affected, is the heart affected? Next comes the physical examination, when you get as much hands-on insight as possible.

Then, based on the first two steps, you order certain tests, which provide more data. From all of that you establish the top three most likely reasons for the symptoms you are seeing. And you rank and re-rank them based on new information. You treat for the most likely, but you keep in mind the second and third possibilities. You monitor closely whether the patient is improving or getting worse. You remain flexible, ready to alter your treatment plan if necessary. This is the same approach I bring to solving complex management problems. The real key to this approach, as a physician or as a CEO, is to build trust in your judgment and authority through open and honest communication with the people who are depending on you.  

Q: Can you describe the most challenging decision you've had to make as CEO. Why was it so challenging?

PO: I think the most challenging might have been in April of this year, at the peak of the coronavirus pandemic, when we only had a one-day supply of N95 masks left in our hospitals. Many on my senior management team recommended that we start to ration them, to save some, because if we ran out, we couldn't render care anymore. That was a reasoned recommendation. Yet if we did that, we would put some of our people in harm's way. If our staff started getting sick at an alarming rate and became unable to take care of patients, then our people could lose confidence in my ability to protect them. And you could lose your army from demoralization as well as physical illness. Remember, we were in the midst of fighting a furious war against this virus. On the other hand, if you hand out all the masks, and in two days there are no masks, then you can’t render care either. You may have to shut down a major part of your operation. And everyone suffers.

So, I made the decision to hand out all the masks, without any guarantee that we were going to get more. We were working hard to get more, of course, but they hadn't come in. That was a very lonely moment, because I had to make that call alone and assume the responsibility for the consequences of that decision. But I said to the team, and myself, that we must protect our people today, right now, and protect them maximally. And that we'll figure the rest out tomorrow.

It was a particularly tough decision, made in real time, when everybody was having difficulty getting these masks. We'd been scouring the globe trying to find them. As it happened, we managed to get a handful of masks a day later, and then another handful. And we got through that crisis.

Q: In terms of Montefiore Medicine's COVID-19 pandemic response, is there anything you would do differently or encourage colleagues to be mindful of, based on your experience? 

PO: Frankly, I think our response was as good as it possibly could have been. We went from two COVID-19 patients on March 11 to nearly 2,000 less than a month later. We built new facilities almost overnight. We went to nearly 100 percent telemedicine for our outpatient visits, created new platforms and patient resources, and greatly expanded our health information technology capabilities. Clinically, we had to immediately transform the way that we operated. We repurposed every space possible to double the number of beds and triple the number of critical care beds. We were spread incredibly thin. Everyone had to be flexible to meet the demand: Anesthesiologists worked as respiratory technicians; directors worked overnight shifts; nurse practitioners worked as intensive care unit nurses. The pace was relentless around the clock.

When the world shut down, our people stood up, summoned courage, overcame fear of the unknown, and went above and beyond their duty to save thousands of lives at great risk to themselves and their families. Confronted by an unimaginable disaster, they were as ready as any team could have been. The dedication and discipline, the professionalism that saved so many lives, was in place long before the first COVID-19 case arrived at our doors. Their performance in the face of a deadly pandemic was what I expected of them. More importantly, it's what they expected of themselves. I could not be prouder of them.

As for things to be mindful of, I'll say this: The only way to prepare for a once-in-a-century global pandemic is to strive for excellence every day, individually and as a healthcare system. If you do that, then you put yourself and your team in the best possible position to meet the challenges of the future.

Q: How do you recommend hospital executives handle negative feedback or criticism?

PO: You have to have some humility. Criticism comes with the job. We deal in life-and-death scenarios, there are no small issues. So, respect your critics and try to understand their point of view. CEOs, department heads, senior physicians, residents — everyone in the system has their own perspective, their own "world," if you will. If you find the criticism to be valid, adapt accordingly. If you decide it’s not, say why and move on. There's no substitute for a straight answer.

Q: What projects at Montefiore, either in the works or upcoming, excite you the most?

PO: We're in a period of active transformation. We've grown very rapidly over the last decade, and we've begun a process of integrating all of our values and assets across the system — our 13 hospitals, our medical school and our 300 clinical locations, including our vast primary and specialty care network. Montefiore is a culture of innovation and a history of firsts, including, for example, the first cardiac pacemaker. We value that heritage and are committed to building on it. We are always looking for new ways to serve our patients and our communities, new ways to do things better. As we look at our business model and work on creating an even stronger, more sustainable enterprise, we’re incorporating the many lessons we learned while meeting the challenges that COVID brought. 

Q: What accomplishment are you most proud of in your first year as CEO of Montefiore Medicine?

PO: I am most proud of, and humbled by, the extraordinary excellence and courage our staff displayed in the face of the deadliest public health crisis in more than 100 years. We lost 27 of our dear colleagues to COVID. Their memory inspires us. It is my good fortune to lead such skilled, brave and dedicated people. They embody the highest of ideals — the selfless care of those in need — and I am honored by the trust they place in me.


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