Cleveland Clinic and NewYork-Presbyterian on healthcare in a pandemic
Healthcare organizations around the world are facing new challenges and opportunities during this pandemic, pushing them to reimagine the healthcare experience for patients, providers, and payers. What comes next in human-centered care?
As part of our Experience Visionaries series, we sat down with healthcare experience professionals Dr. Adrienne Boissy Chief Experience Officer, Cleveland Clinic, and Rick Evans Chief Experience Officer, NewYork-Presbyterian to discuss how:
- Change has helped to drive innovation and creativity during the COVID-19 pandemic
- Policy, funding and models-of-care wise must change to fight racism and inequality
- The future of healthcare is human-centered
On the incredible pace of change that had to happen
“We changed in ways we never thought possible,” says Rick. When the pandemic hit, NewYork-Presbyterian had to take action quickly. “We didn't have 900 ICU beds. We built them overnight.”
As well as the immediate disruption, there was a rolling series of challenges, such as needing more ventilators, ICU beds, staffing for the ICU beds, PPE, and dialysis to name but a few. “There were days when it was scary,” says Rick. “I'm very proud to say my organization stayed ahead of these challenges, but that was not a given – we made it happen.”
It was the same situation for the Cleveland Clinic. They had to rise to steep challenges with breakneck speed. “We built a hospital out of the medical school,” says Adrienne. “That was up with 1,000 beds in a matter of weeks.”
On spurring innovation and change
The hospital was looking into virtual visits, or telehealth, but had no formal structure in place. ”We had teams of people for whom it wasn't safe, practical, or reasonable to ask them to come to work – or even get on a subway,” says Rick.
In the height of this, they moved to virtual care with the speed that Rick says they wouldn’t have been able to prior to COVID. “Chaos definitely led to enormous creativity,” explains Rick. “We broke through some barriers that looking back now seem absurd.”
Adrienne agrees, and says Cleveland Clinic had to cope with an extreme spike in virtual visits – unsurprising, but impossible to predict just a few months ago:
We’d been offering virtual visits for a while – at a pace of ~1,000 a month. And then it jumped to 200,000 a month.
Like many others, Cleveland Clinic also had to make some hard decisions when it came to restricting visitors. “That was a very difficult decision for the organization to do. But within days we had set up iPads for families to connect with each other, with patients on the inpatient side.”
Previous red tape that would have been a barrier to getting this done – such as bandwidth and security issues that were national and regulatory – all came down. “That felt really, really good,” says Adrienne. “It freed us up to do much more important work – to focus on patient care.”
On inequality and social injustice
“One of the reasons that I love living in New York, that I choose to be a New Yorker is because when you walk out of your front door, the whole world is there,” says Rick. “It’s our community. And just when you think it can't get more challenging, it did. “We saw horrific, deplorable, and revolting incidences of racism – everything from murder to harassment in Central Park.”
Rick says that compounding this is the horrendous inequality of the disease. “Let's get to the really tough stuff:
When you look at who dies from COVID, the disparity smacks you in the face.
Rick says it is clear that something has to change. “Policy-wise, funding-wise, models-of-care wise etc etc. And then with racism itself. Thoughts and prayers just are not going to cut it. They never have.”
“Our organization has made a very strong commitment to change,” he says.
We’re taking steps to address those things in a very meaningful, real way here. Our community demands it – as they should.
Adrienne agrees: “The city of Cleveland has declared racism a public health issue,” she explains. “The healthcare relationship has to work both ways. Not only what kinds of commitments should we be asking of our caregivers moving forward, but also of our patients.
“So when our caregivers, our heroes, are subject to racism, derogatory and disgusting behaviors, we have to take a stand. We have to say that we will provide care, that is respectful, high quality and inclusive, we expect the same level of respect in return.”
Adrienne says that it is also about working together. “We must always include caregivers, patients and families in everything we decide.”
We're never going to get the person-centered care if we don't understand culturally competent care
On the future of healthcare
Right now healthcare is at a crossroads – both Rick and Adrienne agree that we have an incredible opportunity now to close the gaps that we've known have existed for quite some time. “A lot of things that we’ve now implemented are things that patients had long been asking for,” says Rick.
“For example, patients having to physically come in for appointments,” he says. “They had other options in every other part of their life, except healthcare. No one likes sitting in a waiting room, plus waiting rooms are dangerous now, so we've done away with them or re-thought them dramatically.”
Adrienne says that she doesn’t want to go back to the same patient satisfaction survey strategy. “It’s usually college-educated, elderly Caucasian people returning HCAHPS surveys. Healthcare organizations need to take a hard, honest look at how we elevate all voices across the entire journey – we don't want to just fall back into what we were doing before.”
COVID-19 has given healthcare organizations the opportunity to listen more to patients’ preferences about their healthcare. “We’ve been able to focus more on how to care for [patients] as human beings,” she says. “As well as how best to keep them safe – all things that are not classically included on surveys. The same is true for our own people.
We’ve been through trauma. Part of how healing occurs after trauma is growth. We are not the same people and organizations as we were going in.
Rick says both COVID and racial injustice is a once-in-a-generation wake-up call. “It's been so brutal,” he says. “But it’s a catalyst for truly making some progress on issues that we've had in healthcare for years and years, and that we've had in our country.”
Despite there needing to be a lot more work done, Adrienne says that she is hopeful for the future. “There's an opportunity on the landscape to bake empathy into how we operate,” she says.
“There is no easy antidote for the hate in the world. But empathy and love will drive real change,” she says.
And above all, we need to listen better. And from that listening, we must take action.
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