On Ebola, preparation no substitute for experience

In September, Barclay Berdan became CEO of Texas Health Resources, the largest healthcare system in North Texas with over $4.3 billion in revenue last year.

Berdan, who previously served as THR’s COO, took over just before a crisis erupted in October at the system’s flagship hospital, Texas Health Presbyterian Hospital Dallas, when a patient named Thomas Eric Duncan, who had recently arrived from Liberia, arrived at the emergency department showing symptoms consistent with Ebola. Duncan was released and later returned to the hospital and was diagnosed with Ebola. He died, and two nurses at the hospital were infected, setting off a national uproar. Modern Healthcare editor Merrill Goozner recently spoke with Berdan about the crisis, whether patient counts have returned to normal at the hospital, how he managed staff morale and his long-term strategy for THR. This is an edited transcript.

Modern Healthcare: Are patient counts and revenue at Texas Health Presbyterian Dallas back to where they were before the Ebola crisis?

Barclay Berdan: We saw our average inpatient daily census drop about 20% to 22%, and it was similar with some surgeries. Our emergency department volume went down, but that’s because for 10 days in October we shut down and diverted ambulance traffic. I’m happy to report that compared to the year-to-date average that we were running for the nine months through September before all this started, my average daily census now is three patients higher. My surgeries are about five per day today higher than they were on average before that. My deliveries are about on par. So while we did go through a dip, it wasn’t a stark drop. The only thing that’s not fully back to normal now is ED volume. It’s been growing steadily back up, but it is not quite at the level that it was before we started this in October.

MH: Are you rethinking whether you’re going to continue outsourcing your ED to Emergency Medical Consultants as a result of what happened?

Berdan: Most hospitals contract for physician services for a number of hospital-based services. We’ve had a long relationship with this particular group, and we’re not looking at making any changes. We’ll be reviewing the whole care process that took place.

MH: Has this Ebola crisis caused you to take a broader look at hospital-acquired infections?

Berdan: Every system looks at things they may want to improve upon. But I wouldn’t say we’ve expanded that look based on our experience in this case. We were the first hospital in the U.S. to diagnose an Ebola patient, and that was a unique experience. Practice is helpful, but as my chief medical officer said recently, there’s really no substitute for combat. There’s a big difference between preparation and experience. As a result of our experience, hospitals across this country are better prepared. We remain committed to sharing the lessons we’ve learned with others so that we can all work together in this new and unique situation, to be prepared not only for Ebola, but for other rare diseases that could be crossing into our borders and entering our emergency rooms.

MH: How were you able to maintain high staff morale throughout this crisis?

Berdan: I and a couple of my key staff members spent literally a month—every day and every weekend—in Dallas listening to people both inside and outside the organization. That meant communicating to patients, board members and employees. It was really important to make sure that we had a high level of communication and that we maintained trust inside the organization while we were in many cases being attacked from the outside, as the world moved from science to political science to social science to superstition and fear. That helped us keep the morale of the organization up and to keep people focused on the fact that we had a lot of patients to take care of.

Even though our patient census dropped by 20%, we told everybody we weren’t going to reduce staffing. We were going to keep people working at their regular rates and times. We kept everybody really focused on this challenge, that we had to stay strong and get through this period of time.

“As a result of our experience, hospitals across the country are better prepared. We remained committed to the lessons we’ve learned.”

MH: Why did you feel a need to hire crisis management firm Burson-Marsteller? And are they still with you?

Berdan: We were not staffed and prepared for managing that level of external communication during the crisis. We brought them in primarily to help us monitor the media and manage messages. They did a great job. They did a lot of listening with us, a lot of interpreting, and helped us create messages that were timely responses to what we were hearing both internally and externally. They’re still with us in a much reduced presence.

MH: What was the nature of the negotiations with the Duncan family prior to reaching a settlement with them?

Berdan: I’m not going to go into any details. We extended our apologies to the family and shared our regret that during the initial ED visit we were unable to diagnose the Ebola virus in Mr. Duncan. We wanted to make sure we were searching for and achieving a point of reconciliation and healing for all involved.

MH: How did the crisis affect your original plan for when you took over as CEO?

Berdan: My original plan lasted for about the first 25 days. After that, it went out the window. One of the advantages—if you can call it that—of being in a crisis is it helped me to create some new relationships that I didn’t have before. I quickly got to know Dallas Mayor Mike Rawlings, Clay Jenkins, the county judge, and some other Dallas leaders with whom I was not as familiar. While my new COO and my chief clinical officer and I spent most of our time focusing on the crisis in Dallas, my CFO and chief strategy officer kept the fires burning at home. So we really didn’t miss a beat in terms of strategic initiatives to lead some changes in the marketplace, make us more affordable, create more innovation and improve the overall reliability of our services. We also had been executing strategies to develop relationships with post-acute-care services and link physicians’ offices and other outpatient services together to become more patientcentric.

MH: What is your long-term strategy for THR?

Berdan: We have had a great history of being a very successful acute-care hospital company, and we’re in the process now of changing our organization to be a great healthcare company. To do that we have to be innovative. We have to make our services more affordable and improve the overall safety and reliability of everything we offer.

MH: What’s the one takeaway you would offer about what you learned from the Ebola crisis?

Berdan: I learned that my style of listening intently, asking questions and converting that to action worked, but it had to be compressed into a much tighter timeframe.