What we did after we started working with the medical staff, we started monitoring more in February.
And I think one thing I wanted to convey is that people in health care — and I think particularly at a Level 1 trauma — we’re constantly doing prep for disasters. That’s just the nature of what’s required.
And when you overlay that with the fact we had been through the tornadoes, we’ve been through the shootings, I’m not saying we’re not learning and we’re not having to change with more information, but I think there’s a bias for action with people and planning.
When I say ‘a bias to action,’ the couple things we had to do was: we always focus on our mission. So our mission is to care for people. We’re not going to abdicate our mission. So then the challenge became everything we had to do would be around “How do you provide care safely to keep your staff safe and the patients and the visitors?”
We, for example, started right away saying we can’t be traveling. We have to have visitor restrictions. “Where should we cohort patients or not?” The other thing surrounding the push for safety, which is still going on, is: communicate, communicate, communicate.
We started partnering, of course, right away. And I do think we had some excellent collaboration with GDAHA (Greater Dayton Area Hospital Association). And I think Gov. DeWine was all over this in terms of best practices, as advised by Dr. Acton.
We we were all collaborative. I think that was a plus for Ohio. But as relates to care for patients, we did a lot of unique partnerships locally. And I think this is back to this “bias for action.”
We moved quickly around issues like PPE and testing, which are at the core of safety and problem resolution around COVID. That was very impactful, to me in this role.
The government has so much going on a state level … and I think you have an obligation to your local community to say “How can we solve this issue in the short term?” Because otherwise you’re just in a giant queue. And our job is this community.
Q: You have done emergency preparedness, but there wasn’t really a blueprint to this.
Boosalis: I think that's why it feels so different. It was such an unknown.
And that makes it more daunting and more challenging, no doubt about it. And we still have a lot of unknowns, as we still don’t know the end of the who has COVID. And that’ll just continue to evolve. I think now we’re moving into ‘how do we live with this until there’s a vaccine and how do we maximize safety and still treat people?’
An oncologist mentioned to me early on in this, we’re not seeing any biopsies for cancer. He said that doesn’t mean cancer stops, it’s going undetected. So you get into these discussions of “How do you open up?” Because people need treatment, and then there’s the whole economic decision, but yet you don’t want to spread the disease. I think that makes this incredibly challenging, and that’s why the safety umbrella is so important in every decision.
Q: I don’t know if folks really understand the dynamics of how there’s so much more hospitals have to do, but it’s also been impacting revenue. Could you talk a little bit about how is that playing out with Premier?
Boosalis: We did get stimulus dollars but then the perception is it was one-for-one. And I'll just tell you it's not by the time when you add up what the PPP ongoing cost, the ancillary other revenues from no one being in the organization, and the huge loss of elective procedures, you're not going to make that up.
I think you have to have, again, a bias for action and explain it and be very honest with people.
So we took the downtown operation and we furloughed almost half the people. Because we’re walking this tightrope, particularly with clinicians where when the volume comes back you need them.
We asked all our executives and they took a pay cut. You have to be part of the solution. I think what really helped our staff is that we’re not just asking them to be on the front line and giving them platitudes about we’re behind you, we actually did something to preserve jobs for the future.
We have a huge employed-physician network, and once the physicians heard the execs were taking a pay cut, we had almost $1 million dollars in physicians voluntarily taking a pay cut and that’s pretty remarkable.
Thirty years, I have never seen financials like this. I could be up all night, every night, if I allowed it to get to me in that way. But what we do is keep moving forward and forecasting.
I don’t think any of us know you know, some people are now saying this will be 24 months, 36 months. But we’ve just started with electives and we’re watching very closely “Does the public feel safe? What are they putting off?”
We are getting a little concerned, put the revenue aside, that some people may be sitting on things like symptoms of a stroke, or heart attack too long, because they they’re either afraid or they want to self treat, and that is not a good thing.
We appreciate the fast federal stimulus, but we’re not there. I think it will be through the end of the year and we’ll just have to see what the new year brings as this evolves.
Q: Are you able to look ahead and see what you could see happening and six months from now or a year from now?
Boosalis: In general leadership, and as a board, you have to in a supportive way push people to be oriented for the future, even when it's hard. And it's harder in this because you don't you don't know.
How do we do better as a country in diversifying our supply chain in terms of where and how we source our medical needs? With the whole discussion around lab testing, I think personally it’s a travesty that the richest country in the world didn’t have adequate testing. And we’re working every day. That’s not a it’s not about blaming this group or that, it’s just the fragmentation between public health, private manufacturers. How do we do better in the future as we plan for whatever the next crisis is?
I think the other thing — and that’s not unique to us — is we’re looking at is the whole transformation from working at home. There’s a lot of people that really like that. Obviously, with kids at home, that’s also kind of a necessity in many cases.
Personally, I was kind of old school going into this about working at home. I thought, “Well, are you really that productive?” But I think there’s many who feel they’ve been more productive because you’re not traveling from pillar to post, which is an additional expense for companies.
I think the technology is there. I think COVID-19 has forced our industry and others across the digital divide, because before we had Teams and we had Zoom, but were we really using it? We just preferred to meet in person. I’m not saying don’t ever have meetings, but I think it’s kind of flipped the whole thing. And what are the efficiencies gained? And how do you monitor appropriate productivity? And I don’t think we’re going to go back to business as usual. I think we’re trying to figure out what’s the new norm.
If you go back to our mission — and our Diversity Committee already wants this as a topic — you’re seeing some of the data come out about the disparity in care. If you don’t have access to broadband … you’re now at a disadvantage and that’s going to affect access and care.
The other huge huge transformation I think is actually think is pretty interesting to watch was around telemedicine.
The customer wasn’t always wanting it or maybe the physician. But our televisits are up 2,000%. They went from hundreds to thousands. So now we’re trying to see, it’s not going to go back to hundreds, but I think at a minimum, you’re going to offer an array: Do you want to come in? Do you need to come in depending on what it is you’re coming to the doctor for?
But I think it’s just going to continue to explode.
Q: Do you talk about a fall surge? Is that a conversation at Premier?
Boosalis: It has to be. That's honestly just our job. And I think so much of the planning that was done for the original surge … that is still very relevant.
We have a very solid plan, kind of algorithmic “if this, then that” all the way through what other facilities would we use? Where would we cohort patients? And why? How do we partner with other hospitals in the community and the National Guard?
I do know that this region was considered pretty quick to be organized. I think that’s something the community should be proud of that was interdisciplinary. And we are planning for hotspots including if there’s any more patients this fall. That’s our obligation to do that.
Q: How do you work on staff retention and keeping staff safe and making staff feel assured that they’re safe?
Boosalis: It's multi factorial. You can never over communicate and even if you think it's redundant, you know that seven ways seven times and I think you have to, you just have to do that that otherwise, people don't feel supported.
We’ve done things like accommodate staff, I think this is a tangible for you. If someone says ‘I’m in a high risk category … I’m diabetic, I have asthma. I’m older. We have worked very hard and encouraged them to let us know and nd we will try to accommodate, put them in another area, not just say ‘too bad you signed up,’ We are working to identify those people.
We’ve been very strict on the social distancing. We’ve been very aggressive in the testing and PPE space, which is critical to staff. If staff don’t have the equipment, they don’t feel safe and they’re not going to stay. So we have actively communicated and responded to that.
In any crisis there’s perhaps what were unsung heroes, and there’s been so many people like that I can’t tell you. The sourcing people, whether they’re driving in the middle of the night to go get something, I mean this is the brass tacks reality. Our lab people have been incredible. Incredible.
We just announced last week we were really limited and we appealed to the state. We could not get enough testing and the testing is the key to so much of this.
So a very concrete example as you open up surgery, if you don’t have enough testing that makes people very anxious, not only the patient, but the staff taking care.
The testing site at UD Arena, operated by Premier.
They’re going to use more PPE than is required because they’re going to assume they don’t know they’re going to think the worst. And so now you’ve exacerbated the PPE problem because you haven’t done the testing. So that’s why we just pushed and pushed and pushed and finally got this machine and enough reagent.
We went from 125 tests to 1,500. And that’s the other thing I would really like.
One of the things that was really hard for me on an emotional level when we started is because many years ago I was in critical care. It really bothered me to sort of be encouraging people in this role and not being out there. I’m probably so rusty, I’m not very much help. But that’s hard if you’ve been a caregiver. It’s hard to tell people “I’m right with you” and not be there. But I just had to sort of emotionally work through that and say, “What’s my job? And how can I leverage my office to get what we need?”
We have a lot of leaders who were clinical at one point and it’s very hard. First of all, you don’t have a current license, but it just makes you feel a little inadequate. Probably a more positive would be: you feel such gratitude.
Q: Is there anything else important for people who are trying to understand what’s going on at Premier and what’s it been like for you in leadership at Premier at this time?
Boosalis: I think when you go through something like this, if you haven't cultivated some sense of gratitude, I don't know where you've been, but mine is in so many people. Toward the courage and the dedication of really the front line people, anyone taking care of patients, I think they're really the real heroes in this. And any time we can applaud or convey our appreciation, we need to.
I also want the community to know how much we heard and saw their support. We have not felt alone in this journey, and I don’t know how you convey in words that appreciation.
And then the only thing that I didn't work in there that I think it's part of our role to encourage people to wear masks. I think with this whole discussion on your individual rights … Why would you not have a bias airing towards something that could protect you and others? I think that is very important for not just the providers, but all of us.