When the one-year anniversary of the start of Covid-19 rolled around, it may have seemed like an opportune time to reflect on how affected so many aspects of healthcare, from the dramatic uptick in telehealth to the massive vaccination rollouts.
In reality, however, it simply isn’t the case. For those who are in trenches — including the ones providing support and leadership — there simply isn’t enough time for reflection, said Rick Evans, chief experience officer at NewYork-Presbyterian.
“We can’t rush to fully understand it,” he said during a recent interview. “It’s going to take a long time to put ourselves back together, put our health system back together, and put our country back together.” For Evans’ team, that has meant creating best practices for communicating through barriers such as PPE, and keeping a close eye on providers who are understandably exhausted.
But that’s just part of the picture. During the discussion, Evans talk about the “basic blocking and tackling” organizations must do to improve the experience for all patients; the need for healthcare to change its “suck it up” culture; how NYP is taking a stand against racism; and why his relationship with CIO Dan Barchi is so vital.
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- Health systems – especially those in Covid-19 hot spots – put forth a “Herculean effort” to ensure frontline workers were supported and patients were cared for.
- One of the biggest challenges for leaders was when “the adrenaline wore off” from the initial pandemic surges, and exhaustion started to set in for physicians, nurses, and other staff.
- Patient experience is about much more than food or parking; it’s about helping people “communicate efficiently and effectively,” which can benefit patients, caregivers, and providers.
- Physical barriers such as PPE can make it more difficult for providers and patients to connect. But something as simple as acknowledging those barriers can help overcome them.
- Understanding the full impact of Covid-19 is a critical piece in learning from the experience and developing better processes going forward – but it’s going to take time.
Q&A with Rick Evans
Gamble: I definitely want to talk about biggest areas of focus are right now, but I feel it’s only appropriate to talk first about the pandemic. We recently marked the one-year anniversary, which is hard to believe, and so I wanted to get your perspective on what the past year has been like. What were you most proud of in terms of what your team was able to accomplish?
Evans: Honestly, it’s bringing back a lot of thoughts, feelings, and memories. We were talking the other day about how we went from having 5 or 6 patients with Covid to 500 within a few weeks. We peaked at over 2,800 in our beds, hundreds of them in the ICU. I think what I’m most proud of is how we came together as a team and really figured things out and rapidly adapted to the situation.
Healthcare can be known as an industry that moves very slowly, and some of that’s justified in terms of reputation. But in the spring of last year, we didn’t know what we’re dealing with. People forget that now. We weren’t even sure about masks. We never ran out of beds, equipment or PPE. But it was a day-by-day effort — a Herculean effort — to make sure our front line was supported. I just feel enormously proud of how we mobilized and stayed ahead of the tidal wave that that hit our city.
I’m also proud of the way that our health systems stepped up to support our front line. At the beginning of the crisis, we didn’t know what we were dealing with. We were all at risk. We were asking people to literally put themselves in harm’s way, and not just once a 9/11-type situation where you’re dealing with something episodic. This went on for weeks and weeks.
And now we’re in another surge. We’re not out of it yet here in New York. And so we’ve made sure our staff didn’t have to think about food or scrubs or going home when they didn’t feel safe. We provided hotel rooms, childcare, eldercare, spiritual support, and emotional psychological support. We stood up an enormous array of things to help support the people who were right at the front lines. And this was at a time when the mortality rates was much higher. It was a time when we were working hard and it didn’t always feel very effective.
Gamble: Sure. I can imagine one of the challenges was being able to pivot so quickly as we moved into different phases of this.
Evans: I think for us, the adrenaline wore off over the summer. NewYork-Presbyterian distinguished itself and will be remembered in history. We’re in one of the biggest places to have this tsunami hit, and we made it through and we took care of our patients. That, I think, will be remembered for generations.
But now it’s more than year later, and we’re just coming through the surge that started over the holidays and continues in New York to some degree. It feels very different. We’re all exhausted. Our patients are exhausted. In some ways this isn’t as intense in terms of numbers, but it is equally intense in terms of the reserves we have inside of us to get through this.
It feels different because here we are again. We come in every day. We’re getting it done but it’s hard. The fact that the vaccine is accelerating brings hope. Spring brings a little hope. We’re hoping we’re in the last quarter of this game.
Gamble: You wrote a piece discussing the best practices for helping care teams communicate and connect with patients, and how those had to be reimagined during Covid. Can you speak about that?
Evans: One thing is that the pandemic itself puts a barrier between us. Patient experience, in our minds, is all about connection and communication. Sometimes people think patient experience is about the food or the parking; it’s not that those things are unimportant. But at the core of it, having read hundreds of thousands of surveys now in my career, it’s about feeling connected and understanding what’s going on, both individually and throughout the team. That’s the heart of patient experience, and that’s the heart of our best practices. What we’re trying to do is help people communicate efficiently and effectively; when that happens, it benefits the patient and their loved ones, but it also benefits the caregiver, the provider, the clinician.
One of the most elemental things about Covid is that it puts a physical barrier between us with things like gowns, masks, and shields. We have an initiative here called Commit to Sit where providers sit at the bedside for 5 minutes during every shift, to connect with the patient at eye level. No matter what you’re doing, even if it’s just passing meds, you have that eye-level, face-to-face communication. It’s very effective in creating connections between our patients and our staff.
The question became, how do you do that during Covid? First of all, you don’t want to be face to face with a patient. And then you have the actual barriers, so we’ve had to speak with people about how to connect across PPE. It’s simple things like body language, but it’s also how we help the patient understand who we are, and acknowledge there’s a barrier between us. Even just naming it helps to create a connection; saying something like, ‘I know it’s harder for us to talk right now because I’m covered in this stuff, but it’s what I’m doing to keep both of us safe and I’m going to do my best to communicate with you.’
And then there are practices that minimize time while you’re in the room. A lot of times clinicians are working under production pressures of one sort or another, and we tend to rush from room to room, patient to patient, because there’s so much to be done. So it’s important to pause at the door and do what we call agenda setting. ‘Okay, I’m going to go in this room — what do I need to accomplish here? I’ve got to pass meds and I’ve got to make sure the patient understands what these meds are for.’ By doing that, you sort of center yourself, and then you go in and get right to it, making sure that in the 2 minutes you have, instead of the 5 minutes you used to have, you get that core work done.
Those are types of things we’ve been talking about. And when we make that adjustment, we do two things. We increase our chances of actually connecting with the patient, and we also acknowledge to the frontline caregiver, that we know what they’re going through, and that we’re not expecting them to do everything the same way they’ve always done it, because it’s almost impossible. And that makes them feel heard and acknowledged.
Gamble: That’s really important. I also wanted to get your thoughts on the technologies being used to help patients stay in contact with family members and share information. It seems like there’s a fine line between wanting to use technology without taking away that face-to-face interaction.
Evans: I would say an unfolding pandemic of its own has been the pandemic around visitation. It’s been its own unique piece of this disaster, which has been very hard on our patients and families, sometimes devastating. It’s also hard on the staff, who want people to be connected and who in some cases have had to become surrogate family because the family can’t be at the bedside. It’s added to the burden on both sides, and it’s been really tough for everybody.
We’ve had necessary visitation restrictions, particularly in the spring when we didn’t know what we were dealing with. And while we were still making sure we had all the right PPE and equipment in place, we had to be very Draconian in implementing guidelines from the State Department of Health. If fairness, I can’t say we disagreed with them. We were trying to figure out how do we keep everybody safe and keep this thing from spreading further.
But as we’ve learned how to use PPE in different ways, we’ve been able to make some changes. We don’t want someone saying goodbye to a loved one over an iPad. We know it’s happened here and all over the country. And so we found ways to make safe circumstances where we know visitation needs to be allowed. For example, if someone’s giving birth to a child, if someone is at the end of their life, or if someone is physically or developmentally disabled and needs someone with them, we ought to be able to figure out how to get people properly protected and so that their loved one can be with them. I think we’ve had to learn and iterate that as we’ve gone through the crisis. That’s not even using technology, that’s just care.
The other piece is devices, whether it’s the patient’s own phone or iPad or devices we’ve provided for our patients. We’ve used a lot of iPads in the last year. We’ve tried to get creative with that and facilitate connection wherever we can, using whatever means we can.
When this whole thing is over, which hopefully will be soon, it’s time to think again about visitation and caregiver presence at the bedside or in the exam room, in terms of what we’ve learned from this and what would we change going forward.
Gamble: That’s a really interesting point. You think about the culture and how things are done and everybody wants to talk about going back to normal but it’s not going to be the same.
Evans: I think we’ve learned some things about visitation that we’re going to need to consolidate. However, like many other things with this pandemic, I think we can’t rush to fully understand it. I think it’s going to take a long time to put ourselves back together, put our health system back together, and put our country back together. And quite frankly, some of those lessons we’re going to learn with time to reflect.
Right now, I’ll be honest with you — there isn’t a lot of time for reflection, because we’re still taking care of patients. We’re still vaccinating people. Our noses are still to the grindstone taking care of patients and getting shots in people’s arms. So there’s not a lot of reflection time yet.