Leading Through a Crisis in Changing Field Conditions

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

With COVID-19 now officially community-transmitted and no end to social distancing orders in sight, federal and state governments continue to issue disaster declarations and shelter at home orders as the pandemic evolves. EisnerAmper’s Ron Dreskin continues to offer his perspective and lessons learned as Interim CEO for St. Christopher’s Hospital for Children in Philadelphia.

Question: How are conditions changing with the rapid advancement of COVID-19? And how is that affecting leadership decisions?

Answer:As the virus spreads, field conditions change that require a shift in thinking and in operational protocol. Directives that were right last week are now changing. Personal protective equipment, or PPE, is a good example. Both the World Health Organization and the Centers for Disease Control and Prevention initially said that all citizens didn’t need to wear masks unless they are sick and coughing but that may now be changing. Even our own clinical leaders – smart, skilled, well-intentioned people ­– have had divergent opinions on the best course of action. With limited PPE and conflicting information, which guidelines does a hospital CEO choose to follow? We had to weigh safety, labor pool and supply chain ramifications and make a difficult decision.

We made the decision several weeks ago that all employees must wear masks while at the hospital, and have temperature scans on their way into work, before many other hospitals. But, in the course of fighting a war like this, you solve one problem and another pops up. So even though we were protecting our employees, we hadn’t totally limited the spread of the disease because there were still patients and visitors coming into the hospital who were not required to wear a mask since they were asymptomatic. So, we had to change and limit visitors as much as possible and start to require masks on everyone in the hospital. All of this is happening when PPE supply is limited.  Ensuring the availability of PPE to ensure the safety of clinicians and staff, as well as patients and families, is critical.  As a leader you have to gather as many facts as you can as fast as you can, press your team for answers, reach some agreement, and sometimes serve as an arbiter.

Question:We’ve seen some confusion over state borders closing and travel restrictions. How did those impact the hospital?

Answer:It’s the same challenge of adapting to changing conditions on the ground. New (and rapidly changing) shelter-at-home orders and restrictions on travel between states that are hot spots presents a material challenge for us. Not only is Philadelphia close to New York City, we draw patients and staff from Delaware and New Jersey. So, a one-size-fits-all mandate does not work.  We employ common sense and construct rules that work for our institution given its geographic location.

For St. Christopher’s, such rules impact our patients and workers who are caring for family over the state lines in Southern New Jersey or Wilmington (DE), or even if they are sharing custody with a parent in the next state. How do you manage for things that are out of your control? These travel bans are helpful in terms of stopping the spread of the disease, but they may pose additional burden on employees, even when you’re acting in the best interest of your patients. There are ramifications for staff and patient families that you have to carefully think through, especially with a decreasing labor pool as more health care workers get sick.

Question:What advance plans are you putting in place to handle the anticipated patient surge? 

Answer:Again, it’s a balancing act. We’re taking in all the information and are in the process of actively crafting a plan that works for our hospital, system and community. The Association of Children’s Hospitals issued guidance to consider related to freeing up capacity for adult patients if demand continues to surge. Following that guidance involves risk issues, and you have to plan your strategy in advance and ensure your staff can do what you’re asking. Additionally, like many hospitals, we are part of a larger health system, so we must weigh a hard question: Is our obligation to our health system or to the other hospitals in our community? Chief medical officers from hospital across the City of Philadelphia are participating on conference calls coordinated by the Department of Health and working out plans – unprecedented in my 30 years in the industry.  We’re still working to figure out the best answers.  Another part of our surge planning contemplates the reconfiguration of physical spaces throughout the hospital in anticipation of a surge, which requires the support of leaders across the hospital.   

Question:As the situation continues to change so rapidly and with such dire consequences, do you have any advice for your fellow hospital CEOs? As the situation continues to change so rapidly and with such dire consequences – and with the surge crisis on the horizon -- do you have any advice for your fellow hospital CEOs?

Answer: Just make sure you’re communicating with your C-suite leaders as well as your medical professionals, and maintain contact with professional advisors who have broad health care industry experience, detailed knowledge of operations and strategy, and the ability to be deployed on a moment’s notice.