“Strategy went out the window, frankly.”
In healthcare IT, where anything from a hurricane to an expected outage can disrupt operations, disaster preparedness is critical. Leaders want to know what to expect, and how they can best react. It’s precisely why Virginia Hospital Center works with groups like FEMA to run drills — so that everyone from network engineers to nurses know what to do in the event of, say, a terrorist attack.
What VHC — along with every other organization in the country — has learned, however, is that when a global pandemic hits, strategy goes out the window. “Nothing can prepare you for something of this magnitude and duration,” said Mike Mistretta, who has served as CIO since 2015. Luckily, his team did have the ability and willingness to pivot quickly, and immediately took steps to be able to accommodate the surge in patients while protecting caregivers.
In a recent interview, Mistretta talked about how VHC pieced together a Covid-19 response (including setting up the area’s first drive-through testing center), what he believes will be the biggest challenge as facilities reopen, and what he would’ve done differently, given the opportunity.
- Covid-19’s impact on VHC
- “Nothing can prepare you for something of this magnitude.”
- From strategy to “reacting on a daily basis.”
- Taking on new or different roles – “You figure out how to get it done, and you do it.”
- Admin counsel focused on how to move forward
- “Staffing is going to be one of the biggest challenges”
- Telecommuting for the foreseeable future – “99 percent of what we’re doing now is remote.”
- Cross-training to fill essential roles
- “Right now it’s about doing whatever is needed.”
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You try to prepare for these things — and we’re fortunate enough here in D.C. that we have some disaster preparedness-type scenarios we’ve been practicing — but nothing can prepare you for something of this magnitude and duration.
Strategy went out the window, frankly. It’s reacting on a daily basis. We have calls with our leadership team twice a day — in the morning and evening — just to figure out the direction we’re going. Whatever needs to be done, we just have to figure out the bandwidth required, and do it as a team.
We’re not only seeing Covid-19 patients; we’re also seeing med/surg cases where people have postponed conditions for a month or two, and now they’re at the point where they can’t wait anymore. It’s a dual-edged sword.
When surgeries start to come back, we’re going to have to backfill for those screening stations. Those are the types of things we’re challenged with right now.
We’re doing whatever we need to make sure we’ve got people retrained and productive in some manner. They’re certainly not working at the top of their licensure, but right now it’s about doing whatever is needed.
Gamble: At a high level, can you talk about how the pandemic has impacted your strategy as CIO?
Mistretta: What’s interesting is you try to prepare for these things — and we’re fortunate enough here in D.C. that we have some disaster preparedness-type scenarios that we’ve been practicing and drilling with FEMA — but nothing can prepare you for something of this magnitude and duration. But while a lot of people were scrambling for remote working, we had implemented those policies a year or two ago. My staff’s ability to do 100 percent of their job from home was already in place, and so we were fortunate in that regard. For the rest of the health system, it was easy to take our policies, procedures, and practices and roll them out throughout the organization to the billing department, for example. It was just a capacity issue; we had to make sure we could handle the bandwidth and things like that. We were fortunate in that regard, and that saved us quite a bit.
As far as my role, strategy went out the window, frankly. It’s reacting on a daily basis. We have calls with our leadership team twice a day — in the morning and evening — just to figure out the direction we’re going. Whatever needs to be done, we just have to figure out the bandwidth required, and do it as a team. It’s also taking on different roles that maybe you had experience with before, or maybe you didn’t, like with the drive-through testing scenario. Who’s done that before? When we set that up, my CNO took care of the clinical side and did all the infrastructure — you figure out how to get it done, and you do it the best you can. That’s how you make things happen.
Gamble: Right. When it started to become clear that this was a largescale problem, what were the first steps? Did you have to put a response team together?
Mistretta: We didn’t. Our leadership team — my CEO’s direct reports, has an admin counsel that meets twice a week, once at the beginning of the week and once at the end. We’re a pretty close group. These meetings have become Covid-19 meetings, frankly, focused on what we are going to do strategically moving forward.
First, it was caring for patients. We’re about two months into this now, but at that point, it was how are we going to handle surges? Do we have enough capacity in vents and equipment? It’s also doing procurement if we need to with different builds.
Now it’s about planning for the transition. When surgeries come back online, we’re anticipating a pretty strong run on supplies — do we have enough stock to be able to do that? Physicians are going to be knocking on our door asking for additional block times, additional hours, and extended hours in the ORs, because they’re hurting on their revenue streams just like we are. How are we planning for those things? That’s where we are.
Not only that, but some of what I’ll call our normal capacity, which went away for about six weeks, is starting to come back as well. And so we’re not only seeing Covid-19 patients; we’re also seeing med/surg cases where people have postponed conditions for a month or two, and now they’re at the point where they can’t wait anymore. It’s a dual-edged sword right now. I’d say bed capacity is probably one of our biggest issues.
Gamble: I can imagine there are a lot of different components to that. Who are some of the people you’re working with on that front?
Mistretta: We have an AVP in surgical services; he’s working with a lot of the physician offices — and physicians themselves — to understand their plans, and what they want to do. The challenge we have is more on the staffing front than anything else, and trying to get a feel for what the schedule is going to look like.
One of the things we had to do to protect our patients and our employees was to put in screening stations at all points of entry, which are manned primarily by the surgical suite staff. And so, when surgeries start to come back and they have to tend to their patient care duties, we’re going to have to backfill for those screening stations. Those are the types of things we’re challenged with right now. Staffing, I think, is going to be one of the biggest challenges. We’re not going to stop the screenings anytime soon; in fact, I wouldn’t be surprised if it didn’t go through the third and fourth quarter at a minimum. We don’t know when we’ll turn that off.
Gamble: Right. As you said, that could be the case for a while where you have to staff these extra roles.
Mistretta: We’ve added functions, and in all honesty, a lot of my folks are probably the ones who will be called back in from teleworking to do those stations. I fully anticipate that.
Gamble: And you said you’ve had remote work capabilities in place for a while?
Mistretta: Yes. At this point, I would say the vast majority of my team; 90 or 95 percent.
Gamble: So was it a matter of making sure the capacity was there and working through any early bugs?
Mistretta: Yes. We implemented telework agreements with the staff about a year and a half ago. Almost everybody already had the capability to work. I would say that most of them were working from home three days a week before this, and so we just reworked the requirements and told them they can telework for the foreseeable future; for the duration of the pandemic.
When we need them — if something breaks where we need them here or have to get something done very quickly and pull people together face to face — we can put out the S.O.S. and bring them in. We do the design work, and they go back out and do the build and testing and everything they need to do. And so periodically people come in, but 99 percent of what they’re doing now is remote.
Gamble: Right. Do you foresee things staying that way and some jobs staying remote, or is it hard to predict at this time?
Mistretta: I think we will go back to our normal telecommuting agreements at some point, but like I said, most of them are already working remotely three days a week. It’s really a customer service/patient-centric reason why they come into the office, but I do think it’s difficult not to have any face time with people. We do have some analysts that work remotely. We have one in Kentucky and maybe two in the Kansas City area who are full-time remote. In the D.C. market, if you’re not doing some level of telecommuting, it’s going to be very difficult to retain people because the traffic’s so bad.
Gamble: You mentioned people taking on different roles — is that happening throughout the organization?
Mistretta: It is. We’ve done a lot of cross-training on the IT side. That’s probably one of the places where people are being stretched. Some of the surgical nurses, for example, have been retrained to do med/surg duties, and some providers were cross-trained to take on ICU responsibilities. Every week, we have different cross-training classes so that they know how to do their jobs, as well as other roles.
We’ve made a concerted effort not to furlough anybody, because we know what’s going to happen when surgeries come back. It’s been very difficult, because financially this has been stressful on everybody. But we’ve tried hard not to furlough anybody, unless they were an exposure candidate, and we hope to maintain that.
Outpatient therapy is pretty much shut down right now, so those individuals are working in the cafeteria. We’re doing whatever we need to make sure we’ve got people retrained and productive in some manner. They’re certainly not working at the top of their licensure, but right now it’s about doing whatever is needed. We have a command center that distributes PPE and mans the command center, and that lets us track pretty tightly what areas are getting what pieces of PPE. Those individuals do inventory, keep track, and distribute equipment. It’s another where people have been cross-trained to do different things.
Gamble: It’s not the top of the licensure, as you said, but it’s work, and I think that’s really big right now.
Mistretta: It’s work; it’s productive work that needs to be done for us to maintain operations. That’s key more than anything else.