On Ebola, prepa­ra­tion no sub­sti­tute for ex­pe­ri­ence

Modern Healthcare - - Q & A -

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.

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