NewYork-Presbyterian CXO Rick Evans: Leading through a spring like no other

It's definitely spring in New York City. All the signs are there. Days are longer and trees have bloomed. Central Park is arrayed in all its glory. But, it's also a spring like no other. 

Normally bustling streets are empty. Schools and places of worship are closed. Everyone is wearing masks — and we avoid being near each other on the street. Businesses that are open have "socially distanced" lines to get in. We are in a new reality as the seasons change.

Since the crisis started, my hospital — NewYork-Presbyterian — has admitted thousands of COVID-19 patients. At the height of this wave, we had to double our ICU capacity in a matter of days to stay ahead of our community's needs. Our ICU patient census peaked at almost 800 — nearly all of the patients in ICU were intubated. Mortality was significant and devastating to both our community and our care teams. 

If anyone doubts the seriousness or the danger that the coronavirus brings, let them look at what we have come through in New York. Every community needs to take this seriously, and vigilance must be maintained. 

Thankfully, the numbers are declining each day from our peak. The situation is easing. However, many other questions now arise. How will we safely transition back to more normal operations, even as the virus continues to circulate? In a time before a vaccine is developed, how do we continue to serve our community and create an environment built on safety and trust? Much work lies ahead! If this were a football game, we are probably just near the end of the first quarter. 

The numbers above reflect a terrible toll. But, there is another toll that is still playing out within our walls among our staff and teams.

We have faced crises in New York City before. We lived through 9/11 and Hurricane Sandy. But, these crises were totally different. There was a brief but harrowing period, followed very quickly by prolonged recovery. In both instances, we knew when the immediate emergency was over and we shifted to "returning to normal." The COVID-19 emergency is not like this — at all. 

First, the emergency — the period in which we all feel vulnerable — has lasted for weeks, and will likely last for months and years to come. While we treat COVID-19 patients, there is always the possibility of becoming one ourselves. We face this crisis at work, and then head home to face it there as well. Our ability to support one another has also shifted since we can’t be together or even offer a hug. And, perhaps worst of all, it's impossible to know when this will end. 

In New York and at our hospital, we have had to think very differently about how we deal with this totally unique crisis.

For our patients and families, in a time of extreme limitations on visitation, it has meant being especially creative in facilitating virtual connections while people are hospitalized — using technology like iPads and other devices. It has meant helping patients (and providers!) to become comfortable with virtual visits and telemedicine. And now, as the crisis eases, how do we connect with our patients and help them understand how we can work together to provide healthcare that remains safe? This is a work in progress as we figure out issues like logistics and ways to protect privacy and confidentiality.

It has also meant thinking very differently about how to attend to our team members' basic needs. While our hospital has been busy, many of our staff have significant others who have lost jobs. Staff with children have struggled with home schooling. Many have had sick family members or, even worse, have lost family members. We must address employees' needs — childcare, housing for staff who need to isolate from family, bereavement support, parking to allow people to physically distance while commuting, and other programs. We have built and implemented all of these and many more. 

We have had to deal with loss in a very direct way. We have lost many patients in this emergency. Our hospital has never seen this level of mortality. This weighs very heavily on all of us. We had a tragic suicide of a cherished staff member and have lost colleagues to COVID-19. Nearly everyone who works at our hospital or who lives in New York knows someone who has died. Death has been all around us. 

That's why New Yorkers get very sensitive when we hear others say COVID is like the flu. It's not. Responding to this reality has meant creating and deploying mental health services — counseling, support groups and other resources — for our teams. This has meant providing spiritual resources and support. We have broadcast interfaith prayer services every other week through the crisis which have been thoroughly embraced. We have had to create these resources and then bring them directly to patient units and departments. Healthcare workers are used to "sucking it up" and not asking for help. That does not work in this emergency. We are going out and bringing these services directly to staff where they work.

We have also had to find ways to support resilience. Like many hospitals, we have provided food to our teams and we have coordinated that to support local businesses. We started playing music over the PA systems (like "Don't Stop Believin'") when we discharge COVID-19 patients. We've used chalk art on the sidewalks of our entrances to deliver encouraging messages for employees entering and leaving the hospital. We have also given two pay bonuses to our front line staff. And, we've also given them outlets to tell their stories. We have created a campaign called "My COVID-19 Story" where our team members can share their feelings and what they have been through. 

During this spring like no other, we have had to be creative in ways like never before. We've had to let go of many of our former ways of doing business. We've had to pivot to caring for our employees beyond what we have ever done before. We are acknowledging and reconciling ourselves to the fact that there is no going back — this is the journey we are on now. All that change we've been talking about for years — it's arrived.  

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