The unapologetic leadership of Dr. Marc Boom

Marc Boom, MD, revisits the decisions he's made as CEO of Houston Methodist throughout the pandemic with a sense of conviction that can almost leave one under the impression it's been an easy 22 months.

It's the Monday before Thanksgiving. Dr. Boom is technically "not working" today, but he's nonetheless in his office to catch up on some work, including nearly an hour fielding questions from me. To be clear: I'm hardly special. Dr. Boom decided early on in the pandemic that Houston Methodist would never say no to the press. 

"And we haven't," he says. "I have a cadre of 30 to 40 people around the institution who have spent more time with the press now than in their entire careers. I certainly have. We saw that as critically important for keeping the flow of good information out there, and we later realized how important it was to fight the flow of misinformation out there." 

To keep lines of communication open is a smart position to take given how much national attention Houston Methodist has received over the past 22 months. A few highlights: It was the first hospital in the nation to treat COVID-19 patients with convalescent plasma therapy. It was one of the first five clinical trial sites in the country to offer antiviral drug Remdesivir as an investigational therapy for COVID-19 patients. And, of course, it was the first system in the country to mandate COVID-19 vaccination for its workforce

The wider public learned of the decision in March, but Houston Methodist employees saw it coming months beforehand. As early as June 2020, Houston Methodist leaders were discussing vaccines in-depth during town hall meetings, including the status of vaccines and timelines from drugmakers, safety and immune responses. "We laid that groundwork week after week, and shared studies for transparency and education," says Dr. Boom, a dually trained physician board certified in internal and geriatric medicine who earned an MBA from the Wharton School of the University of Pennsylvania.  

By mid-September 2020, three months before the vaccines received emergency use authorization from the FDA, Dr. Boom began to build expectations for a vaccinated workforce. "We were saying to people, 'Once they're authorized, shown to be safe, used in enough people and widely available, you should anticipate that we will mandate these just like we mandate flu vaccination,'" says Dr. Boom. Houston Methodist was among the first hospitals in the nation to require flu shots for employees in 2009. 

Dr. Boom says making COVID-19 vaccinations mandatory for staff was the right thing to do, but did create noise, especially externally. "Never underestimate how much noise a small group of individuals can make. But in a strange sort of way, they actually served our cause even greater: They highlighted the fact nationally that we were doing the right thing," he says. "I think those individuals helped bring along more vaccine mandates by the noise they made." 

By its vaccination deadline of June 7, 178 full-time or part-time employees out of 24,947 workers did not get fully vaccinated or were not granted an exemption or deferral. Three weeks later, a federal judge dismissed a lawsuit brought by employees of Houston Methodist over the mandate. 

"We already have a values-based culture and now this builds on that culture — one that is even more patient-centric and one where people know when it comes to what it takes to protect patients, we are unwavering and unyielding. We will not bow to external pressure when we know the right thing to do," says Dr. Boom.

If there was one misjudgment made throughout the process of creating and enforcing the mandate, Dr. Boom says it's the pace at which he expected other hospitals to follow. "I was sure there were a bunch of other organizations literally about to do this along with us, because it was so logical. Vaccines were widely available at that point. It surprised us that it took as long as it did." 

(Note: Becker's has created a listing of health systems mandating COVID-19 vaccination for their employees, beginning with Houston Methodist and going in chronological order so readers can see which systems followed and when.) 


The game-changers at Houston Methodist  

The vaccination policy and position of never-say-no to press inquiries are byproducts of seemingly contradictory principles Dr. Boom and his leadership team adopted early on that came to inform countless day-to-day decisions. Here are those principles, in his words, along with other decisions and factors that have helped buoy Houston Methodist throughout the pandemic. 

1. A tenured executive team. At the start of the pandemic, Dr. Boom had been CEO for more than eight years and at the institution for almost 22. His executive team is made up of nine leaders, including him. Collectively, they have more than 150 years of tenure with Houston Methodist. The team has worked together without any changes for about seven years, when the most recent person joined. This longevity lends itself to major systemwide decisions almost feeling instinctive due to their familiarity working together. "I had a team that was very tenured," he says. "To work with people who you've known for a long period of time — you know the ins and outs, the strengths and weaknesses. You have almost an understood language. You can talk in five-word sentences, move on and everyone goes and does their thing. There are a lot of advantages to that."

2. The commitment to be data-driven and apolitical. Houston Methodist aimed to stay as far away from politics as it could. Movement toward either end of the political spectrum, or even the appearance of such, can prove especially problematic given that Houston is politically split. In 2020, 56 percent of Harris County voted for President Joe Biden and 43 percent for former President Donald Trump, making it an outlier in the red state. But Dr. Boom took the position not so much to avoid political rancor (he points to both parties for politicizing the pandemic, in fact), but to stick with science. "My view was we will work with every elected official — regardless of red, blue, whatever — who we can help in helping the public or they can help us in helping the public," he says. "We'd always stick with the data, wherever it led us. Little did we know how ridiculously politicized the data would become." 

3. The decision to take a stand where and when it matters. Dr. Boom emphasizes that "apolitical" is not synonymous with "apathetic." At times, following the science brought Houston Methodist to positions that neither Democrats or Republicans clamored to endorse. "Sometimes, when you take a stand, you have to do things that while apolitical may be perceived as political or one party may not be happy with what you did," he says. "In summer 2020, we spent about a million bucks wrapping the Houston Chronicle [with advertisements] urging the citizens of Houston to wear masks over Fourth of July weekend because we had no mask mandate. On the flip side, we had other political forces at play that really wanted us to throw up our hands and say, 'Shut the whole world down again.' We pushed back on that, because we had seen all of the harm that had happened to patients in that first surge." 

4. Conviction in one truth physicians know well, but the public does not: Science is messy in real time. Dr. Boom and his team communicated this truth at every opportunity. Looking back, it cannot be said enough and he's unsure the greater public trusts it. "It's really complicated to get population-based, large group answers to a biological question. It's not like you can just do a trial. Doctors are used to that. It's frustrating for physicians. The general public is really not used to it," says Dr. Boom. "We scientifically, medically, the press — we did not do a good job explaining that early on. Data will evolve, new data will emerge, and we need to change our mind with the data. If you lack that nuance, you start losing trust because you see it as flip-flopping. We'll follow the data wherever it goes." 

5. The decision to put Houston Methodist's fiscal strength to use. By April 2020, elective, non-urgent procedures at Houston Methodist had been halted for weeks and the system was losing $30 million a week. Dr. Boom and his team took note as health systems around the country issued furloughs or made workforce reductions. "We decided if we are ever going to use our balance sheet, now's the time to use it," says Dr. Boom. In what he calls the decision that felt most instinctive, the system has not issued a single furlough, layoff or pay cut throughout the pandemic. "With the benefit of hindsight, and given the staffing issues we're seeing nationally, that was absolutely the right thing to do," he says. "It showed loyalty to our employees, it showed we are there to protect them, and they were there at higher numbers than they would have been otherwise when we got to a more difficult point [with COVID-19 hospitalizations]."  

6. Resistance to binary thinking. In a world seemingly hell-bent on binary oppositions, Dr. Boom is a champion for what he calls "the sacred 'and.'" Nuance is rare today, but he encourages people to embrace it in decision-making when appropriate and when time allows for it. "We have a sacred responsibility to care for patients with COVID, and patients who don't have COVID, and keep our employees safe," says Dr. Boom. "Politicians had their 'sacred and,' which was to protect people from COVID, and minimize suffering and death, and protect our economy and safely educate our children. Had we had a political realm where people from both parties reached across and said, 'Clearly we have to make some best judgments' and acted like scientists, I think we would have been in a much better place. Instead, we didn't get the 'sacred and.' We oftentimes got the 'or.'" 


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