On Friday, March 6, 2020, I was having dinner with my family. We were eating at a local restaurant. It was busy, the mood was positive, and there was laughter all around. I received an urgent text and took a follow-up call. Our health system’s first COVID-19 positive patient had just passed away and we were having a leadership call within the hour. As I went back to the table, I looked around the restaurant and at my family. I was hit with a surge of emotion knowing this was just the beginning of what was coming to our region and our nation. The next day, our health system opened our incident command center. A month later 90 percent of the country and many countries around the world would be sheltering at home.

As the chief officer for hospital operations, I am responsible for our four acute care hospitals and system ancillary and support services. My role morphed and transcended in new ways. My experiences to date are reflective of the collaboration across our health system, community, and nation. Six observations and lessons have stood out:

1. organization culture: unified, trusted, collaborative, kind and transparent

2. health outcomes: ensuring the quality and safety of our staff and patients

3. staff wellbeing: empowering and supporting staff through mental and physical fatigue

4. financial viability: develop crisis-specific, short-term, and long-term financial plans

5. operating model: data-driven action and open communication plans

6. future of healthcare delivery, payment models, economic incentives, leadership, and community engagement.

Organization Culture: Unified, Trusted, Collaborative, Kind, and Transparent

The strength or weakness of the organization’s culture is magnified during a crisis. The culture serves as the “glue” that enables teamwork, empowers staff, and encourages creativity and innovation. When we were struggling with personal protective equipment (PPE) supplies, our staff got creative in how they protected themselves. They maintained an esprit de corps, and leadership responded in providing daily updates on equipment, patient volumes, and other pertinent information. A weaker culture will turn on itself, looking for blame and focusing on the negative.

Health Outcomes: Ensuring the Quality and Safety of Our Staff and Patients

Years ago I had a boss who reminded me that the team you have in front of you is the team you have to work with; so, put your differences aside and help bring out the best in each other. We have seen this in full force across our health system, with community leaders, governmental officials, and even competitors. It is surreal to experience what can be accomplished with so many people putting differences aside and staying focused on the same thing: the safety, health, and well-being of our patients, staff, and community.

Almost daily we send updated protocols based on the Centers for Disease Control and Prevention guidelines (CDC). These changes affect how we manage our PPE, reduce our visitor numbers and elective non-urgent surgical cases, screen our staff and visitors, and interact and distance ourselves from others.

Staff Well-Being: Empowering and Supporting Staff Through Mental and Physical Fatigue

At the beginning of the COVID-19 crisis, fear and anxiety ran high and many felt vulnerable. How will this pandemic affect our health, our livelihood, our families? Healthcare workers are deeply concerned if they personally will get infected or if they will spread it to their families, friends, and colleagues. They have to deal with the pain of patients not being with their loved ones in the hospitals and learning to add new ways to communicate.

We recognized quickly the need to focus on staff well-being in helping them cope through the crisis. We added iPads donated to the health system so patients could interact with their loved ones. Our wellness team created a special website, added on-line classes, support groups, wellness podcasts, and healthy treats for staff. Hundreds of companies and community members have reached out to provide thank-you cards, flowers, and food.

Financial Viability: Develop Crisis-Specific, Short-Term, and Long-Term Financial Plans

Between the pandemic scare, CDC recommendations, executive shelter-at-home orders, and reduction of non-urgent elective surgical cases, there were significant drops in patient visits. Many health systems, including ours, had revenue reduced by 50 percent compared to pre-pandemic volumes. Our system provided limited incentive pay to minimize the number of staff focused on COVID-positive patients. We had staff available to be redeployed if their areas had temporary closed or reduced hours.

Operating Model: Data-Driven Action and Open Communication Plans

To ensure we stay organized, focused, and unified as a system, we have daily calls with hospital leadership that focus on:

• infection prevention and incident command updates (for example, new CDC guidelines)

• supply needs

• surge planning and reopening plans

• screening and testing

• overall performance, including key performance metrics, performance gaps, data-driven action plans to address gaps, open communication plans—internal and external.

Future of Healthcare Delivery, Payment Models, Economic Incentives, Leadership and Community Engagement

Our daily efforts, observations, and learnings will allow us to develop new strategies or plans to help future care delivery. For years, the healthcare industry has discussed moving from “volume to value.” Each day through this complex pandemic we are providing significant “value” to patients and communities while losing millions of dollars.

Early data from COVID-NET suggest that COVID-19–associated hospitalizations in the United States are highest among older adults, and nearly 90 percent of persons hospitalized have one or more underlying medical condition. These conditions include hypertension, obesity, cardiovascular diseases, diabetes, and chronic lung disease. These are similar chronic health issues we’ve known about for years but as a nation have invested much less on prevention or supporting underserved populations on healthier lifestyles.

This is a strong indication that we need our future care delivery to be more intentional in aligning payment models and economic incentives with a balanced approach to needed medical care, prevention, community support, and private-public partnerships.