Life and hard lessons leading a hospital during a pandemic
Lynn Guerriero was on the job for only two weeks when the virus struck
This was not how life was supposed to unfold.
When Lynn Guerriero assumed her job as the president of Niagara Health in late February, she was going to take her time to get to know the hospital system she had been hired to lead and to acclimate to Niagara, her new home.
Health care restructuring and building the new south Niagara hospital were the day’s pressing issues.
But within two weeks of her arrival, the world was consumed in the worst public health crisis in a century. Almost overnight, Guerriero was leading a COVID-19 front-line agency and was responsible for the safety of the hospital staff and their patients.
Sleepless nights of worry were not in Guerriero’s original playbook. But like the rest of the world in the grip of
the novel coronavirus, she had to adapt.
“I think as a leader when you’re going into a new job, particularly one where you’re moving cities and you don’t know the region, is to plan out your first 90 days or your first six months as really listening, learning, getting to know people, making those connections, those personal connections,” said Guerriero.
“And, all of a sudden, you’re sort of forced into a commandand-control situation, right? So your leadership has to change very quickly, at the time where that’s the last thing you should be doing.”
In the pressure cooker, Guerriero had to ask people she barely knew to trust her.
“I think No. 1, being very, very honest and direct, and showing as much transparency as possible and as much vulnerability as possible, without sort of having people not have confidence in you,” she said.
“So being able to say, ‘I won’t know all the answers. This is unprecedented. I don’t know all of you well, and things are not going to be perfect, be patient with me.’ So being able to sort of show vulnerability at the same time as being decisive.”
Among the things they didn’t know in March, as the virus swept across the planet and overwhelmed hospitals, was whether or not Niagara Health had enough masks, gowns, shields and other equipment to keep its staff safe when COVID-19 inevitably hit Niagara.
A global shortage of personal protective equipment at the time meant that the hospital system had to be careful with what it had.
“It was a scary time for all of us. The one thing that was keeping me up nights was the PPE issue. There wasn’t an answer to that. No hospital leader knew if they were going to have enough supplies to keep their staff safe.”
Niagara Health had a stockpile of PPE that got it through the initial storm, but the risk is real. At least 28 Niagara Health staff have contracted the virus.
Niagara Health’s overall plan was simple: All COVID-19 patients would be treated at the St. Catharines hospital, the region’s newest hospital with modern infection control infrastructure.
But a virus isn’t concerned with plans and policies.
A little over a month into the crisis, COVID-19 struck the Greater Niagara General Hospital, sickening so many staff and patients it wasn’t safe to move them to St. Catharines. A mini COVID-19 ward was created in the Niagara Falls hospital to contain the outbreak.
“It was extremely disappointing. We had reached a place where our in-patient numbers for COVID positives had come down. Our ICU numbers had come down, we were in a good place.” she said.
“It demonstrates how tricky this virus can be and how diligent we need to be. I think it taught us all a lesson that, when we see our numbers coming down, we cannot let our guard down.”
Guerriero’s task is not just to manage the present crisis — one that has seen 39 COVID-19 patients at Niagara Health die — but restore medical services that were shut down due to the pandemic.
“We’re going to have to start this recovery phase of getting back to some of our scheduled procedures as part of the care. And again, we are going to have outbreaks, there’s no question,” she said. “I think the more we see how adaptive we can be and how nimble we can be, the more confident we are that we can sort of deal with every single phase of the pandemic.”
But recovery doesn’t mean a return to the world as it was before COVID-19. Without a vaccine, the virus will remain a potent threat even as the overall case numbers fall.
“If the hospital has to maintain a level of capacity available for a (COVID-19) surge, it means that our community partners also have to be working to make sure that they can take our patients who are ready to be discharged. We have to keep that patient flow going to make sure that we do have that capacity because if our capacity backs off we’re going to have to be rescheduling procedures again.”
A key pillar of the new normal has to be an end to “hallway medicine” — the phenomenon that sees patients being treated in the hallways of overcrowded hospitals because there are no rooms to move them into. Although the provincial government pledged to solve hallway medicine, it remained a serious problem when the pandemic struck.
“We’re going to have to keep physical distancing of patients front and centre, so we can’t have overcrowded hospitals. We can’t have people in hallways as other people are walking by, we’re going to have to always be ready to contact trace,” she said. “So, how are we ever going to be able to do that if we let our hospitals be overcrowded?”
To make that happen, she said, the health system has to be more integrated so it can adapt faster. If COVID-19 has taught health-care leaders anything it is that they have to redefine what it means to be prepared.
“I think if you had asked us before this hit, we would have said, yes, we are prepared,” she said. “I think that the gravity of it and the extent of it was really unknown until we saw what was happening in Italy. So even though we saw what was happening in China, I really don’t think we understood how sort of pervasive it would be. So I don’t think we were fully prepared. I think that our lack of PPE supply chain is a perfect example of that.”
“I think the more we see how adaptive we can be and how nimble we can be, the more confident we are that we can sort of deal with every single phase of the pandemic.”
LYNN GUERRIERO PRESIDENT OF NIAGARA HEALTH