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In part two of a two-part series, AMA Chief Experience Officer Todd Unger talks with three New York health care experts about efforts to provide mental health assistance to physicians on the front line.
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- Eric Wei, MD, senior vice president and chief quality officer, NYC Health + Hospitals
- Ramon Rodriguez, president and CEO, Wyckoff Heights Medical Center
- Mark Jarrett, MD, senior vice president, chief quality officer, deputy CMO, Northwell
Unger: Hello, this is the American Medical Association's COVID-19 update. Today we're continuing with part two of our two-part series where three health care leaders in New York share lessons that they've learned in one of our nation's first hotspots. Dr. Wei, what specific lessons have you learned about taking care of mental well-being of physicians and your health care teams?
Dr. Wei: Yeah, I think very early on we realized that this was something unprecedented, that it would be hard to measure what our staff and our front-line health care workers would go through in this pandemic. We felt fortunate going into the pandemic that we had two strong teams. One was the Helping Healers Heal team, which addresses emotional, psychological trauma and health care. We had 18 teams across our facilities and service lines with over a thousand trained peer support champions. So teaming that up with our behavioral health services, which provides over 60% of behavioral health in New York City, together create emotional, psychological support around COVID for our staff. So, that meant wellness respite rooms; that meant one-on-one support or debriefs. Wellness rounds, proactively going through our emergency departments, our ICUs, looking for signs of burnout, anxiety, compassion fatigue, second victimization, and linking them to support immediately.
We also were fortunate to receive the generosity of donors across New York City and the country to be able to set, send comforts to the front-line staff, to provide them with hotels if they needed to isolate away from their families, transportation so they wouldn't have to ride the subways, food and meals while they're working their shifts, or even after their shifts. All of these things help to support.
But I think something that's novel and I think is really cool is that when the DOD was here, they were the ones who said, right, "This is the closest to combat that I've seen in a civilian setting." Unfortunately, the United States has been at war for almost 19 years straight, and we've learned a lot of hard lessons; what combat does to the soldier's mind. And they said, "would you like us to share some of the lessons learned from the Department of Defense around combat stress management and resilience?" Working with multiple agencies across New York City, we've created The Hero in New York initiative and it's to incorporate and adapt the Department of Defense's Combat Stress Management and Resilience Training and Curriculum into civilian health care as well, especially with an eye towards COVID. And so we're training all of our Helping Healers Heal, peer support champions, as well as we have help from psychiatrists and psychologists with this combat stress training so that when they're providing supports to the front-line staff, it's even better.
And 100% agree with Dr. Jarrett about celebrating the win. Reminding you why we're running towards the fire. And so like many other hospitals and systems that in New York City, we started playing a song in each of our hospitals every time someone got un-intubated from COVID. And I'll just share an example at Jacobi in North Central Bronx Hospital, it was the Rachel Platten "Fight Song." And when I told my three and five-year-old daughters that every time the Fight song plays, it means that somebody got better from the virus. So they wore Alexa out playing the Fight Song on loop because they felt like every time they played the song, somebody was getting better. And so it just felt like that that symbolized, that was outside of health care, cheering, cheering on the patients.
Unger: I'm going to turn that for the last question to think about the fall. I'm reminded listening to you that we had a physician, an emergency medicine physician, Dr. Bradley Dreifuss, on the program last week. He's a co-founder of HCW Hosted, which helps prepare infrastructure for physicians to support them during the pandemic. As you look toward the fall and you think about building capacity for another surge in New York, what are the things that you're putting into place to support physicians, to be able to let them do their jobs well, and maybe learn from the lessons of the last round? Dr. Jarrett?
Dr. Jarrett: Well, I think, first of all, we need to provide them with the most support we can in terms of, again, being quicker on the draw, using data to help tell them what's happening and keep them abreast of and continue the communication. Something we've done with both physicians and our other staff is the front-line staff has gotten extra PTO time. We're forcing them to take it. They need to take some time during the summer to be with their families and to have downtime. So they will be ready for the fall, if there is a resurgence. Number three is we will follow up with more support systems as much as said by HHC, that we need to do all these things in continuum. Even if this surge doesn't occur until November, that doesn't mean that the effect on our staff and our physicians in any way has lessened.
In fact, sometimes it gets worse when the pressure is off and your adrenaline is running. So we will continue that as well. And finally, we're working with them in terms of learning from them, what they think worked well and what didn't. Because sometimes in leadership, we all think, "Oh, this was great." And then the staff says, "What are you kidding me?" Physicians will come back. "We should have done this." "We should have done that." So I think having them work with us and be part of the solution for the next time, instead of rapidly trying to fix things as we went on the first time, may be very helpful for their well-being and their participation, because then they think they're an integral part of the solution, rather than just being somebody who's carrying it out. It's actually what they thought should be done.
Unger: Mr. Rodriguez?
Rodriguez: I think to tag onto what Dr. Jarrett said, we didn't do enough to help our physicians. And this time around, we're doing many of the things that are being talked about. They really know in the emergency department, which is like a fishbowl. We see 92,000 people a year at Wyckoff. And we're a small hospital. So, at one point when it was at its worst, we had 60 people who had COVID in the emergency department trying to find a place for them up in the floors. And they handled it extraordinarily well. A lot of people got sick. We lost five people to COVID-19. One of our leading union representatives, one of our carpenters, a couple of our nurses were on ventilators and getting ECMO at Northwell. And they came back from that. So this time around getting them to go on vacation, that's really critical. Adding food every place. Making sure that they are able to not worry about having food and having the various materials that they need and to be supportive and to always communicate with them.
I have a weekly communication process where I do these kinds of videos on Tuesdays with all of my managers; on Wednesdays with the entire staff. And I'm just about to start the same thing with groups of doctors, so we can get ready and communicate together, and work together on this because it's inevitable that we're going to get something like this again.
Unger: Dr. Wei?
Dr. Wei: Yeah. I think as Dr. Jarrett mentioned, we got through the worst of it with adrenaline. I think I could say that for sure. With my shifts, you show up and it is just do whatever you can to save as many lives as possible. And the most vulnerable a time was as that adrenaline was wearing off, people were having this rush of emotions and grief, and what did I just go through? And so our emotional-psychological support was even more critical after the fire hose was turned off with new patients coming in. The EDs were first and then the ICUs and now post-acute care staff. And so definitely supporting staff, making sure that they find their resilience within. Time off is critically important to recharge and be ready. I think another thing that we're realizing is wanting to get back to our normal functions, right?
Dr. Wei: Some normalcy. Let's get back to the quality improvement work. Let's get back to the root cause analysis. Let's do our hot washes and figure out what we did wrong and what we could do better. And we definitely need to do that. But without supporting your staff, that might come off as punitive.
Unger: Well, thank you so much, Dr. Jarrett, Mr. Rodriguez, and Dr. Wei For being here today and sharing your perspectives with us. That completes our two-part series. If you missed part one of our update, you can find it on AMA's YouTube channel. We'll be back tomorrow with another COVID-19 update. For resources on COVID-19, go to ama-assn.org/COVID-19. Thanks for joining us today and please take care.