‘We needed to provide for emotional and mental health services for them’

Dr. Laura

After the first COVID-19 patient showed up at a New York-Presbyterian hospital,

Forese, the system’s executive vice president and chief operating officer, began what would be a weekslong effort of daily communications with staff. Listening to the concerns of front-line staff is important, she says, in developing a safe and sound response to the pandemic. She spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.

MH: You started daily live updates and broadcasts with your workforce at the beginning of the pandemic. How did that come about?

Forese: We had the first inpatient who had COVID in New York, and we were anticipating that there would be patients coming in. What we didn’t anticipate was exactly what was going to happen.

As soon as we had a positive patient, the CEO, Dr. Steve Corwin, and I got on a broadcast video to the entire organization saying, “Here’s what’s happened. Here’s where we’re going to go next. And we’re going to keep you informed.”

From that very first one, which was the first week in March on a Tuesday, we then did seven days a week for a number of weeks, and it really continued through several months. The goal really was to make sure that we were giving the broad team as much information as we possibly could. And

as we go back and look at some of those broadcasts, we can see that they evolved because, of course, the pandemic evolved.

We also use it as an opportunity to have twoway feedback. So we always solicited the opportunity for people to send us emails or to give us other feedback. “What else do you need to know? How can we, as the leadership, makes sure that we’re keeping you informed?”

MH: How did those conversations evolve?

Forese: When we first started out, we were literally saying, “Today the number of patients,” and it started out with one and then two, and it went on. And we wanted to give people information and say, “Here’s what’s happening. Here’s what will happen next.” So very factual.

Within a couple of days, it starts to be clear that we had to give our team a sense

of, “We’re not sure exactly what’s going to happen. Here’s what we’re doing to prepare. Here’s what we need from you, and here’s how we’re going to support you.”

As we started to get more and more patients, then we had to shift to, “Here’s what we’re going to provide for you.” There were a lot of (personal protective equipment) discussions.

Then we were talking about supports. So we wanted the people to be physically safe, but we also knew that people had things going on in their lives that they had to be thinking about. So childcare, once the schools shut down in New York City and the surrounding areas, we knew that we had to talk to them about childcare. Mass transit, people weren’t necessarily feeling safe. We were providing certain things in childcare. Parking, a lot of people wanted to park. It became those kinds of things. Food. People needed to eat. And we said, “Don’t worry about that. We’re going to provide food for you every day.”

I’d say the biggest change over time was really thinking about people’s emotional well-being. We encouraged people to have opportunities to speak about it and in all different forums. We would encourage them to send us information. We had a lot of different ways people could take what was happening to them; each person as an individual had experienced it a little bit differently.

And then we were also very concerned about the trauma that everyone was feeling, particularly those who were on the front lines and who were right in … the battle. We needed to provide for emotional and mental health services for them. And that changed over time as it became clear that this wasn’t a single event, this was going to extend. And it extends to this day.

MH:

New York-Presbyterian isn’t unique in this situation, but we’ve heard criticism from those on the front lines that their concerns haven’t been responded to. Are there things that you wish you had done differently?

Forese: What we did well was keep saying to everyone, “We’re here for you. We’re going to keep you informed. We need to keep hearing from you as to what will matter.” And as I was describing the supports that we put in place, those were coming out of people emailing to us, writing to us. We were doing virtual rounds because we couldn’t be everywhere.

We had 2,500 inpatients at the height of this. As we’re talking today in late May, we still have almost 900 patients in our hospitals. And about a third of these patients have been on ventilators this whole time. These patients are sick, and we really needed our team to come together in this incredible way to provide the support, to take about 400 and some ICU beds. And more than double that, we went to over 900 ICU beds.

That came out of this incredible spirit that people put together. And really our job was to make sure that we were doing everything we could to provide for everyone in this pandemic, because they were the ones who were going to be taking care of all of these patients.

“(Needs) changed over time as it became clear that this wasn’t a single event, this was going to extend. And it extends to this day.”

MH: What’s the message to your staff as you move toward bringing back procedures?

Forese: We’re calling it renew. Because of course we never really shut down. We were taking care of emergencies, non-COVID patients throughout. But we’ve been describing this as renew as we welcome more patients back into our midst. And part of what we have to keep doing is we have to take care of all of the patients. We still, as I said, have a number of patients who are COVID-positive. We think we’re going to have that for a while, but we’re going to have a lot of other patients and we’ve got to keep everyone moving forward. We have to make everyone understand that we’re making it as safe as possible for our team members, as well as our patients.

We had a lot of experience after 9/11 here in New York. That was one event, and it was traumatic. We learned a lot from that, but it was an event and then we were able to move on. This is ongoing. We’ve got to do a number of things all at the same time. We’ve learned that we do this because of all these incredible people throughout our organization.

So hearing from them, listening to them, having a lot of open channels where we can continue to say, “Now that we’re in this next phase as we welcome more patients back, what do you need so that you can care for

● our patients?”