Banding Together

Banding Together

Leaders from across South Jersey health care systems provide an inside look at managing the COVID-19 pandemic.

Since the days in March when the coronavirus first began to change life around us as we knew it, the COVID-19 pandemic’s ripple effect has been far and wide reaching. Perhaps no one knows that better than the health care industry which has been trying to balance providing care for patients while also learning on the fly all they can about this novel infectious disease. Faced with unprecedented challenges and rapidly changing circumstances, the men and women who make up our local health care landscape have been lauded as heroes for their efforts, and rightfully so.
 
While it’s evident that dealing with this crisis has been no easy task, we wanted to go behind the scenes and get an inside look at South Jersey’s response and the role it played to help the state flatten its curve. Last month, as part of our ongoing pandemic coverage series, we put a spotlight on some of the local doctors and researchers that have played an integral part in helping to combat the virus. This time around, we wanted to delve further into how the local health care system rose to the occasion and so we spoke with leadership from the area hospitals to gain a sense of what it’s been like trying to navigate through these murky waters.
 
Though they are still very much dealing with this pandemic day in and day out, these executives were able to share a bit about their experiences thus far and provide a snapshot of what it’s been like trying to manage a crisis of this magnitude. They also told us why they remain cautious yet optimistic should we face a resurgence of the virus and how the measures put into place during the pandemic will bolster their efforts to provide the best care possible to the residents of South Jersey.
 
Q&A

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Given the unprecedented nature of this pandemic, how has your role as a leader evolved during these past few months?

ANTHONY J. MAZZARELLI, CO-CEO, COOPER UNIVERSITY HEALTH CARE
: “
I think the traditional role of a leader is one of having a vision and trying to move people toward that vision. And during the pandemic, or during a crisis, you not only have that traditional role, but you start to have one of what psychologists call ‘holding’—you are trying to make sure the people in your organization feel safe and feel heard and feel protected. And so you need to be able to give people hope and make sure people understand that there is light at the end of the tunnel and things are going to be OK, but also be realistic about the unknowns.”
 
JOSEPH CHIRICHELLA, PRESIDENT AND CEO, DEBORAH HEART AND LUNG CENTERMy role, and that of our leadership team, was turned upside down. Under normal circumstances, 80 percent of your time is focused internally on your organization, with 20 percent devoted to external matters. Due to the fact that COVID-19 is so highly infective and there was no magic bullet in our arsenal to eradicate or manage it, that shifted to an 80 percent external focus. Endless hours were spent sorting through data and research in pursuit of best practices that were evolving minute-by-minute.”
 
BRIAN SWEENEY, PRESIDENT AND COO, JEFFERSON HEALTH NEW JERSEY: “For me, it was probably different circumstances than for my colleagues that have been in their roles for years. [ED NOTE: Sweeney became the interim president in March before being named to the position in June]. I came from Center City division and I had to learn New Jersey pretty quickly. I had to get to know the culture and the leaders and the processes and policies because we were in a crisis situation. It was good to bring my previous experience here, but to also balance it with the culture of the New Jersey hospitals. It allowed me to meet a lot of people quickly—physicians, nurses—I got to see the teamwork early on. That has helped me in subsequent months and now I am building off of that. During the crisis, I built new relationships and as we think about our future initiatives, that will help me.”
 
JOHN DIANGELO, PRESIDENT AND CEO, INSPIRA HEALTH:“Communication is a vital skill for all leaders. It becomes even more important during a crisis. I have spent a great deal of time communicating with our staff, our community, our trustees, government officials and other health care CEOs. We have devoted tremendous resources to making sure our employees and community understand what we are doing to keep them safe. I have participated in more videos and live-streamed town hall meetings since March than in my prior seven years as CEO.”
 
DENNIS W. PULLIN, PRESIDENT AND CEO, VIRTUA HEALTH: “From a completely pragmatic standpoint, the pandemic emphasized the need for a leader to be a champion of fiscal solvency. … On a more personal note, this pandemic has reminded me that good leaders must be good communicators. In times of uncertainty, if you don’t communicate, people will write their own narratives to fill in the gaps. Communication needs to be transparent, clear and provide answers. If you don’t yet know the answers, at least share your process and help employees understand how their role contributes to the whole.”

At the peak of admissions, what was your biggest challenge? And what remains your biggest challenge moving forward?

SWEENEY: “The biggest challenge was surge planning. When we saw what was happening in New York and North Jersey, we were fortunate in South Jersey because we had some time. We had good communication channels in place … information was coming out from the federal government, the Centers for Disease Control and the New Jersey Department of Health at such a fast pace and to get people to absorb that while caring for patients was a big challenge.
 
“Now that we are getting back to business as normal, how do we do things parallel and coordinate? The risk from now until we get a vaccine or a novel treatment—we need to live in that world managing normal clinical operations side by side with COVID and be ready. It’s hard to manage two things at once of that magnitude.”
 
PULLIN: “I think uncertainty was the biggest challenge for everyone. Frankly, we are still grappling with uncertainly as we bring services back on line while simultaneously planning for the possibility of second wave of the virus.
 
Anticipating the unknowable requires you to prepare not only a Plan B, but a Plan C and every other letter in the alphabet too. It takes our collective best efforts to ensure we are poised and positioned to meet whatever challenges tomorrow may bring.”
 
CHIRICHELLA: “No doubt the biggest challenge was availability of personal protective equipment (PPE) and testing supplies. Without ample supply of these resources, our ability to identify COVID-positive patients and protect staff was tried. Moving forward, the biggest challenge will be keeping everyone vigilant with regard to wearing masks. We are nowhere near out of danger relative to a resurgence.”
 
How fearful were you that those large numbers we were seeing in North Jersey would migrate south and potentially overwhelm the health care system?

KEVIN O’DOWDCO- CEO, COOPER UNIVERSITY HEALTH CARE: “We were confident and supportive of the mitigation efforts that the state government put in place to try and curve the rapid spread of the virus throughout the state. But, in short, we were very concerned about the continued spread once this impacted Northern and Central New Jersey as aggressively and as quickly as it did.
 
“But, I think within that there’s a story that has not really been focused on, which is that the New Jersey health care system, top to bottom, really served as a firewall from the coronavirus exploding out of New York throughout the rest of the country. New Jersey’s health system stood up and really stopped this in its tracks. Unfortunately, over the course of the past few weeks, we are starting to see spikes in other parts of the country that had the benefit of time and the benefit of planning that no one in New York had and that very few of us in New Jersey had. … As we sit here coming to the end of June, it’s concerning to see all the ground we are giving back in other parts of the country.”
 
DIANGELO“We decided early on that we needed to prepare for the worst-case scenario. We are fortunate that the stay-at-home order and other prevention measures were in place for a longer period of time before the virus began to impact our region. This mitigated the spread and kept our surge down to a manageable level. In the southern part of the state we effectively flattened the curve.”
 
What has surprised you the most while trying to manage this crisis?

SWEENEY“The surprising thing would be the collaboration across the industry. As a new person in New Jersey, I don’t have the relationships yet, but I got a lot of phone calls offering to help from our competitors. There were lots of calls from each health system to discuss what we are seeing and how we are managing volume across the region. In a time of crisis that’s what the community needs. We all really chipped in and provided thought and guidance and had a plan that was best to serve South Jersey, not just our facility.”
 
O’DOWD“One of the biggest surprises/disappointments for me was, and continues to be, the lack of advanced notice, the lack of warning, the lack of visibility into the severity of this virus and what its impact ultimately ended up being here in the United States. It’s concerning that our public health community, generally speaking—whether that’s on the academic side or the governmental side—didn’t hit the warning bell loud enough so that the health care system universally in America fully understood just how devastating this virus could be. The international public health surveillance and having that translate back into actionable, meaningful, direct guidance for the U.S. health system, that’s been a surprising disappointment.”
 
DIANGELO“The community’s involvement and their desire to help. Donations of PPE, meal and food deliveries, gifts, goodie bags and financial support—the donations just kept coming. People did whatever they could to help our employees and physicians. We started a Blue Hearts campaign to recognize our health care heroes. It took off. People in five counties placed blue hearts in their windows or on their doors. The generosity and words of encouragement from our community lifted the spirits of our Inspira family. And we are grateful.
 
“What didn’t surprise me was the way our team stepped up and came together to face this unprecedented challenge. I am very proud of how our employees remained focused on providing safe care to our patients while supporting one another. They also went above and beyond to address the emotional needs of patients who were isolated from their loved ones.”
 
What lessons have you learned along the way that you feel will make your health system stronger?

PULLIN“I think our shared sense of purpose has never been clearer, and we have newfound appreciation for how essential trust and teamwork are in this line of work. Last year at Virtua, we established something called the “Culture of We,” which is all about cohesion, camaraderie and recognizing the infinite ways we are interconnected. This spirit of teamwork was evident under the most difficult circumstances, and we are stronger for it.”
 
O’DOWD: “The lesson from my vantage point is how the Southern New Jersey health care community, when it works in a collaborative fashion, the ways in which we can collectively elevate our level of care. While there are elements of our business that is competitive, what we saw throughout this process was just amazing collaboration. That makes all of us better and gives us the ability to serve our community more effectively. I really do think that will be embedded in the mindsets and in the cultures of the organizations.”
 
What can you say about the resolve all the doctors, nurses, first responders and other staff members have shown during this time and in what ways have you been personally touched by it?
 
MAZZARELLI: “It’s pretty amazing to walk the halls and to spend time with our front line workers during the height of all this. They don’t think twice about it, this is what they are meant to be doing. We think of them as heroes well before all this happened, but it’s particularly amazing to see how they have really increased their appreciation for each other. The dedication of the doctors and nurses and first responders to each other was really enhanced during this time and that was really special to see.”
 
PULLIN“Every employee has leaned in to our safety principles and made tremendous sacrifices for the good of the communities we serve. They are extraordinary and I cannot thank them enough.
 
“Visiting with staff during rounding has helped me better understand the resources and support staff need. It has also inspired me. The most common thing I hear from staff members is a feeling of pride and recognition that they have made a meaningful difference.
“I recall a conversation I had with an environmental services colleague from one of our emergency departments. We talked about how the pandemic has made him realize just how essential his role is to infection control. Hearing from the health system’s heroes like him helps lift my spirits and motivates me.”
 
CHIRICHELLA: “I have to compliment my staff who remained calm and utilized their collective experience as a resource to get through a very stressful period. Deborah was born out of the tuberculosis epidemic. I believe this is why our organization has evolved a reputation for highly compassionate care. We, as all hospitals, were prohibited from allowing visitors during the pandemic. I have been greatly moved by our staff who went above and beyond to comfort and support patients during their isolation.”
 
You hear a lot about the dedication of health care workers—even during normal times—but mental health has been a real topic of discussion during this pandemic. Have you been concerned about the mental well-being of your employees?
 
CHIRICHELLA: “Without question, everyone is fatigued by the long hours and isolation that this pandemic has thrust upon us. I believe our team has done a great job supporting each other. Our leadership and employee team is on high alert to closely monitor fellow staff for signs of fatigue and stress.”
 
SWEENEY: “We talk about that regularly, we are concerned about that. When you talk to staff, you can feel that stress and anxiety. A lot of people are working at home these days; the clinical teams don’t have that luxury and it adds another layer of stress for them. They are conflicted like the rest of society—how do I stay safe? How do I make sure my kids are safe? How do I care for my elderly parents?
 
“One of the things they asked for is place to decompress. So we put together these quiet rooms to let them step out of the COVID environment and retreat for a few minutes and listen to music, read or get their emotions together.
 
“We have a team of behavioral health resources to make sure there was counseling available to support them. The challenge is we won’t know what the long-term outcomes are for a while. COVID is still here and has the potential to resurge. It will be interesting to see over time the impact it will have on health care workers. On 9/11, those involved with the response had many traumatic elements to deal with and it won’t surprise me if we see some things like that here.”
 
DIANGELO“This has been a true concern. To have your routine upended at home and at work is stressful enough. Add to that the fear of caring for patients with a previously unknown infectious disease and it’s no surprise that this has been a very difficult time for many front-line employees in health care and other fields. 
 
“We have implemented a number of services and initiatives to help our employees. Working with our Behavioral Health Department, we have made telehealth counseling available to our staff. We expanded the number of staff relaxation rooms in our hospitals, where staff can go for 10 or 15 minutes to decompress or meditate. We opened pop-up markets in our hospitals so that staff could pick up food staples and other common household needs without having to make an extra stop on their way to or from work. We have also been providing employees with one free meal voucher each week as a token of our appreciation.”
 
MAZZARELLI“We entered into a wellness study where we are particularly looking at this. We put together a “resilience team”—we have psychiatrists and psychologists rounding in the hospital seeing people that are taking care of COVID patients to make sure they know we are listening for their concerns and making sure they are heard and protected. It is something long term that we are certainly concerned about for a couple reasons. Not only because of the concern of secondary trauma of taking care of people who are really sick, but also because of the visitor restrictions to keep people safe. You have a lot of caregivers who are not only providing medical care, but who have also become the primary support for patients. That can be an extra burden as well. We know down the road, we have to think about the behavioral medicine aspect of all this.”
 
PULLIN“The reality is that many of our colleagues encounter human suffering on a daily basis, and the coronavirus has certainly heightened that. Burnout is a major consideration, not only for our clinicians, but for all the employees who have dedicated themselves to helping our neighbors through this public-health crisis.

“Coping with this virus is a marathon, not a sprint. Virtua leadership is committed to working with our teams to safeguard their mental and physical health.”
 
What has it been like to see the outpouring of support from the public?
 
SWEENEY“It’s been absolutely awesome. I’ve never seen so much support from the community and it’s so meaningful for the front-line staff. The food deliveries are nonstop. It’s very powerful in terms of the staff feeling like they are making a difference and that the community is behind them during difficult times.”
 
O’DOWD“It’s been incredibly gratifying to watch this explosion of support that the health care community has seen throughout New Jersey and throughout the country. From everyday Americans to celebrities and politicians and everybody in between focusing on the notion of health care workers as heroes has been great to see.
 
“This crisis really brought home the fact that the men and women in health care that are serving on the front lines are really at their core the ultimate public servants. They are there every day and organizations like ours exist for one purpose, which is to serve people. To see them held up was incredibly gratifying and I hope it’s something that sticks moving forward.”
 
PULLIN“The response Virtua has received from its community has been humbling. I believe there was one day during the height of the pandemic when one Virtua hospital was offered 500-plus donated pizzas in a single afternoon! It is clear that everyone wants to do their part to help.
“The type of people who work in health care are those who have a calling to serve others, and I think the public’s response to the pandemic has demonstrated their desire to ‘return the favor.’”
 
How are you better equipped to deal with a possible surge in the fall and what measures are you putting into place?
 
DIANGELO: “Hospitals used to operate on a ‘just in time’ inventory system. This experience has changed our view on that. We just expanded our warehouse space so that we can stockpile large amounts of PPE and other crucial supplies. We also spent about $2 million on HVAC upgrades so that we can keep all of our negative pressure rooms operational, even during the heat of summer. We could have backed off, but we want to be prepared if we experience a second surge. We are remaining vigilant and keeping enhanced safety measures in place, even as the number of patients with COVID-19 continues to go down.”
 
MAZZARELLI“I think we are better equipped and have more knowledge, but we want to have the correct amount of humbleness to know that we can always do better. We are doing the appropriate after-action reviews now of what we’ve been through, and still acquiring knowledge and still planning. We have better knowledge of this virus and its current situation and we have better line of sight in how to communicate with partners.”
 
SWEENEY: “I feel much better prepared, the surge plan [we put into place in March] was exhaustive. I feel more confident going into the fall because all that prep work we did was time well spent and we won’t need to do that again if there’s another surge. We’ve put a lot of data measuring in place so we can see what trends are happening across the state, in our region and in each one of our facilities. We did not have those things those first weeks or months. That’s all real time information we bring back every day and we are looking at that to see if we are doing OK or do we need to make adjustments. We now have that information at our fingertips and it makes me more confident that we have time to prepare for [a second wave].”
 
CHIRICHELLA: “We are not out of the woods yet relative to this pandemic. We have already witnessed surges in states like Florida and Arizona that were ahead of New Jersey in terms of reopening. Our strategy for the fall includes restoring appropriate levels of our pandemic supply of PPE, and maintaining vigilance to keep staff and patients safe. This includes masks, screening, social distancing and hand hygiene. It will be most important to attempt to help everyone adjust to the new normal. We all can adopt these practices and simultaneously have fun, restore social interaction and heal from the impact of social isolation.”
 
PULLIN“Talk of a potential future surge has been front-and-center in our planning meetings. One way to prepare for a surge is to try to prevent it from happening. Over the past few months, Virtua Health has implemented a number of additional safety measures, nearly all of which are still in place. Should there be a second wave of this virus, we could quickly reinstate or reinforce everything that has proven effective thus far. This includes everything from enhancing visitor restrictions, establishing pop-up testing sites and continuing to cultivate our supply of PPE.
 
“We want to set a clear expectation with our community that the average health care experience is going to feel far-from-average for the foreseeable future. … We will continue to adhere to these safety measures—and will likely adopt more—as we look to the future and what it may bring.”
 
Has the pandemic altered your long-term goals and vision for your health care system in any way?
 
CHIRICHELLA: “I do not believe that the pandemic will alter our long-term goals. From my perspective, there is a general recognition that what has been done for the last 30 to 40 years relative to costs and a healthier population is not sustainable. Pre-COVID, I believe we were on our way to factoring in social determinants of health and leveraging technology to improve outcomes. Health care providers will get back to that strategy in short order.”
 
DIANGELO: “We are all struggling to understand what the new normal will be like, at least until we have a vaccine. Many of the enhanced safety procedures will continue; the expanded use of telehealth will continue to give patients more flexibility.
 
“We are always looking for the best way to provide services to our community. For years, this has meant offering more services in a non-hospital setting. The pandemic has accelerated these efforts. … We will continue to emphasize all the safety measures we have in place so that our community feels comfortable coming to any of our locations for care.”

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Published and copyrighted in South Jersey Magazine, Volume 17, Issue 4 (July 2020).

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Author: Leaders from across South Jersey health care systems provide an inside look at managing the COVID-19 pandemic.

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