Observations from Inside the C-Suite: COVID-19’s Impact on Hospitals

An interview with Ron Dreskin, Interim CEO of St. Christopher’s Hospital for Children and Principal-in-Charge of EisnerAmper’s Health Care Services Group

We are two months in from the first reported U.S. COVID-19 case, and hospitals are working feverishly to treat patients, while protecting employees and confronting a dire shortage of personal protective equipment. EisnerAmper has a unique insider’s view thanks to Ron Dreskin, Interim CEO for St. Christopher’s Hospital for Children. Since April 2019, he has been Interim CEO for a two-hospital system comprised of Hahnemann University Hospital and St. Christopher’s, providing strategic and operational support during a bankruptcy proceeding for both hospitals and the successful sale of St. Christopher’s. Subsequent to the sale, Ron has continued in the role of Interim CEO, providing a runway for the acquiring institution to conduct a thorough search for a permanent team. The COVID-19 crisis has only added to the many challenges of an ownership change. EisnerAmper asked Ron, who has 30 years of experience in hospital leadership, for his insights on managing a health care facility during a pandemic.

Question:How does managing in the time of COVID-19 differ from your typical interim management role?

answer:My entire mindset had to change abruptly as the pandemic worsened. Concerns about revenue growth and profitability were temporarily supplanted by the more urgent concern for the health of the greater community, and my focus shifted away from the transition to a permanent team and short-term decision making. That’s not what my hospital needed; they were looking for someone to lead them through this difficult period—one that is unprecedented save for disasters such as Katrina or 9/11. My primary role now is to help clinical staff make good decisions and help my executive team get the right answers.

question:Can you share an example of the kinds of challenges you have addressed?

answer:Due to patient confidentiality, I cannot share specific details. What I can say is that we had to rise to the challenge of providing necessary care for patients, even though coronavirus exposures and quarantines reduced our staffing pool, which led to stressful decisions.

question:What has hospital life been like in the last two weeks?

answer:There has been a constant influx of news and information where guidelines, rules of engagement and even the laws are changing quickly, sometimes hourly, as the crisis worsens. For example, in the beginning, testing for potential exposures of COVID-19 focused on those who had traveled internationally or had direct exposure to a known COVID-19 case. With the increase in community-acquired cases, those imported cases are less of a trigger now. Another example is the guidance from the Centers for Disease Control and Prevention (CDC) and other governmental bodies. Our epidemiologists and infectious disease prevention team members remain in close contact with these agencies, and updated guidance generally precipitates a flurry of new communications, procedures and a change of direction for our COVID-19 command center’s handling of issues. In health care, we are used to following protocols that change slowly. Variables are now changing dramatically and dynamically, and we are trying to put processes in place to maintain standards. You can’t rely on experience alone, because no one has been in this situation before. Instead, trusting and relying on my executive team and making them part of the decision process allows us to narrow down what information we need, determine who we can trust, and how we can get to the right decision. 

question:What are the most critical initiatives the hospital is addressing?

answer:It’s all focused on flattening the transmission curve and modifying procedures to increase capacity. In one recent brainstorming session, I asked what would happen if our pediatric beds are needed for adults, what could we do? At first, the answer was we’re not equipped for adults. But then you break it down and ask granular questions like is a pediatric ventilator different than an adult one? And so on. We also have explored accepting pediatric patients from other hospitals to free-up beds for adults and moving non-urgent or emergent pediatric patients out of the hospital to reduce the potential exposure of acquiring the disease. There are also logistics dilemmas around testing potentially exposed patients while waiting for approvals from overwhelmed departments of health. All of these difficult decisions will have a long-term financial impact that we are attempting to forecast; however, that is challenging because we are focused on maintaining a high level of care. Long-term, we are planning for how best to resume providing routine care and non-essential procedures once the pandemic is over.

question:How do you manage the fear around COVID-19 in the organization?

answer:People are generally resilient, but they need to know there is a way forward. They have to have faith in the organization—and the leadership team—to have the ability and agility to pivot as new challenges appear. It is essential to rally employees around a common mission, direct their attention to working together, communicate quickly, and always be truthful whether the news is good or bad. Part of the unique situation at St. Christopher’s is that several members of our clinical leadership team are also serving in interim roles, because the virus hit in the midst of the hospital’s transition to a permanent C-suite. With my health care background, one of my strengths is in getting clinicians to work together toward a common goal, even though they are unsure of what the end-game will look like.

question:How is this crisis affecting you personally?

answer:The last two days especially have been exceedingly difficult and stressful for my family, with the shelter-in-place orders and my concern that I might bring the virus home. That concern is shared by many health care professionals who have to make extraordinarily difficult decisions daily. By doing what I think is best for the client and the people for whom I am responsible, I take a lot away from my family and I can’t undo that. But I can’t abandon my post, either, as leader of the hospital. You can’t ask employees to make sacrifices you are unwilling to make yourself.

question:Being a consultant, do you think you offer something different than an insider?

answer:I am here at St. Christopher’s to leverage my experience to the best effect. As a consultant, I can bring up the tough topics no one else wants to voice and push for solutions. We read about what’s happening in Italy with rationing care and equipment based on the age of patients—and that’s not consistent with the U.S. health care mindset; we don't want to think it can happen here. For example, I posited what would happen if the entire leadership team should come down with COVID-19? It prompted my team to develop solutions in a direction I hadn’t anticipated, such as changing our structure to one patient per room. This spreads out patients and nurses, and it enables us to mobilize more quickly should we need to close a unit. Regardless of whether you are a permanent employee or an interim leader, you have to prioritize your goals and be proactive.

question: Are you drawing on external resources?

answer:Yes, especially in this crisis where you might not be getting clear direction. I need to know what other Philadelphia hospitals are doing. I’m taking initiative, drawing on my colleagues locally, gathering relevant data, and making informed decisions in coordination with our parent system on how to best protect the hospital. That’s leadership. With more than 30 years in health care, I have developed relationships with health care executives all across the country. Part of what I can bring to the table is the ability to leverage relationships, enter those conversations, talk through the issues, and maybe together we can come up with a solution that helps everyone.

question: How can EisnerAmper help health care organizations through this pandemic?

answer:Every health care organization is short-handed right now, and CEOs should have resources at the ready to fill in. EisnerAmper has an entire team that has broad health care industry experience, detailed knowledge of operations and strategy, and the ability to be deployed on a moment’s notice. If your organization was financially or operationally challenged before the crisis, this additional stressor might call for the resources and expertise of our Bankruptcy and Restructuring Services Group. Our practice groups work together seamlessly and bring all the firm resources to bear when needed.