NewYork-Presbyterian CXO Rick Evans: How will we rebuild trust with patients now and after COVID-19?

In New York City, the summer has brought a strange and unfamiliar mix of both relief and anxiety. 

Locally, we have seen a dramatic decrease in COVID-19 infections and admissions. As a city and state, we have achieved a manageable level of COVID-19 patients. It's a hard-won moment of peace, born from stay-at-home orders, careful reopening and mostly vigilant mask wearing. 

But, this sense of relief is tempered with anxiety as we've watched much of the rest of the country explode with cases. Having been through an extreme surge, we know firsthand – viscerally - what it feels like. We worry for our colleagues. And, at NewYork-Presbyterian, we now find ourselves sending out teams of clinicians to help other hospitals who are at the center of the storm, just as others did for us in the spring. Of course, we worry about a resurgence of the virus here. But the dominant sentiment is empathy for our colleagues.

While we carefully watch the rest of the country and work to maintain vigilance here, we have turned to creating environments where our patients feel safe returning to care. We still don't know the full cost of all the care that was deferred during the crisis. While we have a stable system, we want to restore our services. That involves careful planning and frequent, detailed communication with our patients.

In our communities, there is still deep gratitude for our teams for what they did during the spring. Patients still readily recognize the heroism of our staff and organization. There is a deep reservoir of respect for our organization. This, however, is coupled with fear and skepticism about coming back to our emergency departments, surgery centers, practices and hospitals. We have respect and gratitude, but we need to rebuild trust. 

What have we learned so far about restoring trust and helping patients feel safe returning for care? A few things:

  • Patients trust their hospitals, but more than anything, they trust their physicians. Doctors are the best messengers about safety in returning for care. Of course, these clinicians have to feel comfortable with what is being done to maintain safety for all. But, when this is achieved, our patients want to hear from their doctors.
  • Basics matter most right now to patients. Is there effective screening in place for staff, patients and visitors? Will masks be required? How will social distancing be maintained? How will environments be sanitized? 
  • Telemedicine remains an important part of the mix. But some data is already showing that many patients do want to return to in-person visits with their providers, at least some of the time. And, there is some care that can never be virtual. 
  • There are age-old elements of the patient experience that should forever die with the pandemic — crowded waiting rooms, clip boards and forms, lack of coordination with care. We should try and fix these, now.

We have been communicating about all of the above in multiple settings through marketing messages, over patient portals and in other ways. 

What else are we learning? As I read patient surveys and comments on those surveys, we see how tenuous this trust is. If a patient sees one staff member not wearing a mask, they comment. If they see an absence of vigilance in any of the above measures, they let us know. In addition, word of mouth also seems more powerful than ever in this time. Trust means everyone has to observe these measures, all the time. There is too much at stake.

This has led us to yet another opportunity to evolve our hospital's culture. How do we not only always remember to wear our masks, but also create an environment where we all feel comfortable monitoring the environment and reminding each other when needed? How do you remind a colleague to don a mask, or to wear it correctly? How do you ask colleagues to step off an elevator when it is too crowded to maintain distancing? This can be very hard, especially when there is a large power differential between the person reminding and the person receiving the reminder. 

By extension, how does this same effort extend to patients and visitors when they are not observing these measures? We've all seen the videos of disputes over masks and related issues from around the country. It makes us all reticent. But, for the safety of all, we MUST learn to do this — consistently and respectfully. We are hard at work at this at NewYork-Presbyterian, where we speak often about our "culture of respect." We are finding this moment challenges us to take that to an even deeper level.

Actually, when you think about it, this time presents a challenge to evolve our culture nationally as well. The pandemic is a powerful reminder that selflessness and sacrifice must once again become part of who we are. Our history has plenty of examples — especially during wartime or deep crises like the Depression. I'd argue that the ultimate sign of patriotism, the strongest gesture of respect any of us can make right now, is to simply wear a mask and maintain distance. That is how we will beat the coronavirus and also how we will restore healthcare services here in NYC and across the country.

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