‘You have to throw out the book’
Hartford HealthCare CEO talks leadership through a pandemic
Jeff Flaks was a young executive working at the hospital closest to the World Trade Center on Sept. 11, 2001, when the twin towers came under attack. He never thought he would see anything like that again.
Flaks, now chief executive of Hartford HealthCare, the parent of Hartford Hospital and six others in Connecticut, is at the forefront of another unprecedented crisis — a global pandemic — that challenges the magnitude of 9/11. The COVID-19 outbreak has taken a heavy toll on patients, doctors, nurses and hospital finances.
The pandemic, Flaks said, is different from 9/11, but it presents some of the same daunting challenges: responding quickly to a situation that is fraught with the unknown.
As COVID-19 patient hospitalizations steadily decrease and Connecticut is taking bolder steps toward reopening business, restaurants and other gatherings, Flaks believes there is reason to be optimistic that the worst is behind Connecticut.
But he isn’t letting his guard down. There is always the prospect of another surge in the fall.
What follows is a condensed conversation with Flaks edited for clarity on leading one of
Connecticut’s two major health care s y st e ms through the pandemic.
Did management of Hartford HealthCare change with the onset of COVID-19 in Connecticut?
One decision that we made was we’re never going to look at the economics. This is our purpose. This is why we’re here. It’s a fundamental aspect of why Hartford HealthCare exists. So during this historic moment, at the end of day, we’re just going to do what’s necessary, whether it was buying PPE and scouring the globe and paying tremendous mark-ups on this stuff, we did it and we were always well situated. We always had a high degree of confidence that the agility within Hartford HealthCare would allow us to redistribute people, medical technology and equipment where it would be necessary.
What didn’t you anticipate?
What we didn’t anticipate was the issue around PPE. We do maintain a fairly significant inventory – somewhere between 30 and 45 days – but the difference here is you are off your typical usage. In those early days of March, when the usage went up five or tenfold, your days go down dramatically. That was one of the pieces that was almost impossible to anticipate and one of the great lessons we learned. Much of our sourcing comes from China ironically and, interestingly, Italy, the two places perhaps most impacted in the early stages of the pandemic.
How did you solve the dwindling supplies?
We ended up with some very significant early buys, and we set up a 24-hour, 7-day-a-week supply chain that allowed us to work within every time zone so that in real time, we could be transferring money, making buys. At that point, we were competing globally for PPE, and we were competing against the state and federal governments and all the other countries.
Why did you decide to hold daily media briefings?
The reason we did that is that, we said, the community needs to be educated, needs to be informed – and you can’t get that information from MSNBC about what is happening in the state of Connecticut and what’s relevant to the people who live here. So we said, we’re going to be completely transparent. We are going to provide every day the most current information, all of our statistics, we are going to bring people in front of the media who are providing this care so they can speak firsthand, particularly when we made decisions to restrict visitors, things like that where there was this unknown.
A recent TV campaign urges viewers to seek out care. Did you find people were scared to come to the hospital?
It’s one of the tragedies in this process is that there are a lot of people who died at home unnecessarily who don’t have COVID-19. I was in the emergency department two weeks ago, and a nurse stopped me and she goes, “You have to do a better job of telling people they need to come to the hospital if they need care.” She said, “Yesterday I had a stroke patient come in and this stroke patient was very sick. Had he come in the first day with the onset of stroke symptoms, he would have left with full functionality. He left the hospital with significant permanent disability. This is happening every day. People are scared to come to the hospital.”
What does management of a hospital in a pandemic look like?
In a crisis, you have to throw out the book on how you run the operations normally. You don’t have the luxury of time to make decisions. And you don’t have the benefit of being perfect. You have to make decisions that you feel are best that can be based on the information that you have. But being faster is often being better. And you have to adapt and change when you have newer and better information. That’s what we would do.
At the peak of admissions, what was your biggest challenge?
Ventilators were a very, very significant concern for us. When we looked at PPE, the concerns were migrating at times. Initially, it was N95 masks, at some point, it became gowns. But the lead time to create more ventilators was 60-90 days. Ford Motor Co, converted one of their plants and GE converted a plant and each made commitments to build 50,000 ventilators in 60 some odd days. But when we were sitting here during that time period, we knew we were going to have to wait. We had to prepare as if we wouldn’t have enough, which fortunately didn’t happen.
In the aftermath, are you concerned about the mental health of your employees?
We have built a 24-houra-day, 7-day-a-week behavioral care capability. Anyone of our staff members could call and be patched though to a behavioral care professional at any time. So, if they felt they needed to talk, if they were struggling, if they were having anxiety, if they’d seen something or that had impacted them. They could call and get help. It will be available indefinitely. I saw this during Sept. 11. The events of Sept. 11 – for a year in lower Manhattan, we had behavioral health centers set up. And that became a critical part of the recovery in restoring life to normalcy in New York. Today, we have a similar set of circumstances.
Where does this leave Hartford HealthCare financially?
Fortunately, Hartford HealthCare came into this pandemic in a position of some financial strength. We potentially could be off budget right now, part way through the pandemic of several hundred million dollars. On the back end, we’ve gotten some federal aid – $120 million through the CARES Act, and there is more money being released, but it is far less than our losses. We are waiting potentially for state aid.
So far, you’ve managed to avoid layoffs and furloughs. Will that continue?
I’ve done everything in my power not to have layoffs or furloughs. And we continue to do everything we can to not impact the people who are providing these essential services, and I hope to continue to hold that position for as long as possible and ideally, indefinitely.
Has elective surgery, curtailed during the height of pandemic, resumed?
It has. We’re up between 60 and 75 percent, depending on what facilities we look at of our [elective] surgeries. We’re doing it safely, and it’s working very well.
Looking back, is there anything you would do differently?
Here’s why that’s a hard question to answer. I’m incredibly proud of what we’ve done in testing and the fact that, at one point, we were providing 80 percent of the testing for the state for a good measure of the crisis. Now, we’re testing people who are asymptomatic, and we’re testing anyone – free of charge – under any circumstance. In the earliest days, when testing was being restricted to people who needed to pass a criteria – that was the right thing to do at the time because there was such a limited number of test kits being created. So, in retrospect, if I knew then what I know now that the supply of test kits was going to become more available, and we were going to build a partnership with Quest [Diagnostics] and have that capability, yeah, I would have managed our inventory and testing differently early on. But based on the facts of the time, we did the right thing.
Are you preparing for a potential surge in the fall?
We’re preparing for the worst case. I think we have to, and we will. We’re preparing as if there will be a second wave, and the wave could come quickly. But we’re doing everything possible to ensure that there isn’t, at the same time. And that’s the tension we are working with at the end of the day. We’re still on high alert. COVID-19 is still in our community. We have to be even more prepared to the extent this happens again within our community.
Contact Kenneth R. Gosselin at kgosselin@courant.com.