The biggest pandemic lessons from BJC HealthCare's CEO

Richard Liekweg serves as president and CEO of St. Louis-based BJC HealthCare, an integrated delivery system that generates more than $6 billion in revenue and has 32,000 employees. 

In the last two years, Mr. Liekweg has led BJC HealthCare through five different surges of the COVID-19 pandemic, which brought different lessons and challenges.  

Here, Mr. Liekweg shares the biggest lessons learned during the pandemic, how the omicron-driven COVID-19 surge has affected the health system, his top priorities in 2022 and details about the health system's campus renewal project.

Editor's note: Responses were edited for length and clarity.

Question: What would you say has been the biggest lesson you've learned in this pandemic?

Richard Liekweg: I've been reminded that healthcare is still a "people taking care of people" business, regardless of which side you're on. And that every individual — nurses, physicians, housekeepers, transporters, etc. — are critical to us doing what we do best, and that's caring for others. 

I was also reminded that we have significant gaps in care delivery, healthcare disparities that the last two years have just magnified. And as healthcare providers, we will not close those gaps if we just stay focused on the delivery of acute care medicine. We need to be involved, and we need to work with community partners in those underserved neighborhoods to help with education, jobs and housing so that we can truly close those gaps that often begin at birth. 

Q: Becker's covered a report that mentioned BJC HealthCare postponed nonurgent procedures because of a high increase of COVID-19 cases in early January. Can you describe how else the omicron surge has affected BJC HealthCare?

RL: As we got to the end of December [2021] and omicron took hold within the region, we far surpassed the number of inpatient admissions than we experienced in any of the previous waves. For BJC, on Jan. 20, we peaked. In our hospitals, we had approximately 635 inpatients that we were treating for COVID-19, and that far exceeded any of the peaks we had previously. In December 2020, the peak of the inpatient volume for the BJC system was no more than 500. As we were heading to the 635-inpatient peak, that meant about 35 percent of our total inpatient beds were occupied by patients with COVID-19 and about 45 percent of our intensive care unit beds were COVID-19 patients. Additionally, because this virus was spreading so fast in the community, we had staff members that were also testing positive. Fortunately, [those staff cases were] not severe because we mandated vaccines back in June 2021. Fortunately, case numbers took a turn down on the 21st, and [as of Jan. 28] we've seen about a 25 percent drop in the volumes. That's a function of vaccines, masking and just the pace in which this particular variant is sort of burning out in communities. 

But, we began to postpone electives in the hospital because we wanted to free up capacity. We now are beginning to reschedule those patients that were postponed for the month of January. So we will start to bring those elective procedures back on the schedule in the month of February, so that's good news. Good news for our patients, particularly those who we have to postpone, and good news that things are beginning to slow down a bit. And just as the COVID cases are dropping, the number of employees who are testing positive is also dropping. So that means our staff were able to come back into the care environment.

Q: What are a few of your top priorities as CEO in 2022?

RL: Our workforce is priority one in 2022. We've lost individuals from the field either because they could retire or they've retired earlier than we had expected. We lost individuals in the field because it's really hard work, and they're exhausted. Fortunately, the overall majority have stuck with us, and we want to make sure that we're supporting their mental health, their physical health, their spiritual health so that they can continue to do what they do best. We also need to make sure that we continue to attract individuals into our field and make sure that we're playing our part with local schools, starting in the high schools, working with community colleges, and then working with our college of nursing to ensure they graduate and find a home here at BJC. We also have a great partnership with the School of Medicine at Washington University, and we want to attract residents. We want to make sure that those individuals have choices and that they want to choose BJC and Washington University to pursue their careers — because we need them.

Another priority that's been added because of the way the new year started is thinking through, how do we recover from this fifth wave that far exceeded any peaks that we'd experienced before? How do we recover in terms of our staff and their health and well-being? How do we recover economically? At least to date, there hasn't been a new infusion of federal funding to support the healthcare providers as we experienced in 2020 and parts of 2021. So there's an economic component.

I'm also looking at how we bring back the elective nonurgent cases that we postponed at least for 30 to 45 days, and where do we add that extra volume back in? That's the work we're beginning to do and will consume at least the rest of the first quarter and first part of the second quarter of 2022. 

Another priority is the major capital projects. Even though they won't come online until 2026, we've got to make sure those projects continue to move forward.

On the supply chain side, we know there continues to be a global disruption for supplies. We opened in the early part of January a new supply distribution center for all of BJC that we began planning at the end of 2020. So we just opened those doors, and we want to make sure that the center is functioning well so that we're able to mitigate any of the impacts to the global supply chain. 

Another priority is community health improvement; we called this out with our board in 2020 and 2021. We want to be a better partner in our local neighborhoods to really help address healthcare disparities. We're going to use the size of BJC as an anchor tenant to buy more locally to create more jobs that support those that have been underserved in our community. We're doing this with the other large healthcare systems and businesses in the region. 

Another priority I'd say is related to the quality of the care. It's been a challenging time, and we don't want to see the quality or outcomes that we are proud of to erode, so we're doubling down on looking at preventable harm to make sure that doesn't increase and we can bring those numbers down out of the pandemic. we can bring the preventable harm numbers down as we recover coming out of the pandemic. 

Q: BJC HealthCare recently broke ground on a new 16-story inpatient tower. What do you hope to accomplish with this new tower, and when will it open?

RL: Set to open in 2026, the new tower is both a replacement of a 1960s vintage inpatient tower and also an expansion. When completed, it will have 224 private patient rooms and 56 intensive care unit rooms. Our cardiovascular program will likely be the anchor tenant, but it will also allow us to bring more contemporary, state-of-the-art inpatient capability to this region. We will also be relocating all of our inpatient imaging, which is in an older building, into this new facility on the south end of the campus and expanding some of our surgical capability. The inpatient tower is part of Barnes-Jewish Hospital, which is about a 1,200-bed adult academic medical center in partnership with [St. Louis-based] Washington University School of Medicine. This inpatient tower is phases three and four of a four-phase campus renewal. A couple years ago, we opened a brand new tower on the north end of the campus, which is home to most of our oncology inpatient services. We also expanded the St. Louis Children's Hospital in the first two phases of this four-phase project. When all is said and done, it will be about a 10-year project to renew and refresh Barnes-Jewish Hospital.

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