Turned Upside Down: The Role of New York Patient Experience Leaders During COVID-19

Abstract

At the epicenter of the COVID-19 crisis, New York’s largest health system, Northwell Health, leveraged leadership and innovation to ensure the health and well-being of patients, families, and employees. During this unprecedented time, the role of patient experience leader constantly morphed and transformed to meet the ever-changing needs of the community and organization. This dedicated group of leaders, supported by the Northwell Corporate Office of Patient & Customer Experience, focused primarily on remotely connecting patients and families, harnessing the power of positivity as a crisis strategy and supporting the emotional health of the frontline staff.

They say New York City is the city that never sleeps. That New Yorkers talk fast, walk fast, are tough, and get straight to the point. Having lived through previous natural disasters and terrorist attacks, New York is known for its unwavering resilience. This strength has been tested again, now as a major epicenter of the global COVID-19 pandemic. As the largest integrated health system in New York, Northwell Health quickly became a national leader for its diagnostic testing, emergency service responses, triage and acute care protocols, community health, and medical research. This is our story…

Northwell Health is comprised of 23 hospitals, 750+ medical practice locations, Research Institute, and medical and nursing schools. With a workforce of 70 000+ employees, system services are geographically spread throughout Westchester County, New York City boroughs and across Long Island, serving millions of patients annually. The first confirmed COVID-19 case in New York was reported on March 1, 2020. From that point forward, New York experienced unprecedented numbers of positive test results, hospitalizations, and mortality, more than any other state. The rapid viral spread stressed every aspect of the health care industry ecosystem. At the direction of state and local officials, hospitals were mandated to increase bed capacity by 50%, intensive care units (ICUs) were created within hours, field tents were assembled in parks and parking lots, lobbies and conference rooms were transformed into point-of-care testing centers. The Jacob Javits Center and US navy hospital ship, Comfort, provided surge volume relief.

At the height of the crisis, April 8, 2020, the state reported its highest single-day mortality rate of 799 deaths. During this time, Northwell was treating more than 3400 COVID-positive hospitalized patients. Between March 1, 2020, and April 28, 2020, Northwell Health has treated a cumulative total of 40, 402 patients in which 13, 198 required inpatient care, 8,398 were Emergency Department Treat and Release cases, and 18, 806 were seen in ambulatory or urgent care settings. In a large study examining the presenting characteristics, comorbidities and outcomes of 5700 hospitalized patients within the Northwell system, 14.2% were treated in the ICU, 12.2% required mechanical ventilation, and 21% died (1). From the onset of the COVID-19 crisis, senior leaders clearly laid out grounding priorities—ensuring the health and well-being of our patients, families, and employees. With thousands of COVID+ patients in our care each day, we relied on leadership, innovation, humanism, and flexibility to meet the demanding challenges of unprecedented patient volume, acuity, and public health concerns.

The Northwell System Office of Patient & Customer Experience (OPCE) led by the Chief Experience Officer and VP of patient experience directs the overarching experience strategic pillars of culture, care delivery, hospitality, and accountability. Due to the depth and breadth of the organization, the OPCE works closely with 63 patient experience leaders, internally called culture leaders. They are integral leaders present at each of our hospitals, post-acute facilities, clinical service lines, and major corporate shared service locations. As change agents, culture leaders are responsible for overseeing their local patient experience strategic plan, programming, and overall performance. Like many patient experience leaders, due to COVID-19, their role completely transformed to meet the unique and ever-changing priorities and needs during this crisis.

After 5 years focusing on establishing a shared culture grounded in the art and science of patient and family experience, our proactive, methodical, evidence-based approaches were completely flipped on its head overnight. Culture leaders were immediately integrated into command centers and action-based teams due to their previous experience and success with connecting our employees to human-centered processes and professional purpose. Over the course of days, weeks, and months, there was an extreme shift in their role—from developing experience scores and trends, logging into real-time feedback dashboards, and strategic planning, to more focused priorities of patient, family, and employee engagement.

Connecting Patient and Families

On March 18, 2020, the New York State Department of Health issued a health advisory regarding hospital visitation restrictions. In accordance with evolving mandates, Northwell quickly implemented solutions to ensure patients and their loved ones could communicate during hospitalization. Private companies, community outreach, and philanthropy efforts generously donated an abundance of Pads in Motion, iPads, tablets, and Echo Shows. The Office of the Chief Information Officer, OPCE, Culture Leaders, and clinical teams partnered virtually and on-site to streamline connectivity, onboarding device imaging, network considerations, and bedside utilization protocols.

Virtual visitation technology was deployed to support end of life, remotely connecting patients and families during the imminent death and dying process to share final words, sentiments, and prayers. In maternity, devices were used to celebrate new life, enabling siblings and extended family to be part of life’s most memorable moments. For intensive care, extubated patients’ first requests were to see their family and we were able to fulfill that emotional request. In emergency departments, step down and medical–surgical units, technology provided visual reassurance of a patient’s medical condition and emotional state. At some of our sites, Virtual Support Groups connected patient caregivers in a facilitated session to express their deepest emotions and receive timely and professional support.

Although the solution was virtual, it required a manual process. Culture leaders, patient experience team members, reassigned clinical staff, and medical students were accountable for overseeing for coordinating virtual visitation. Donned in protective personal equipment at the patient’s bedside, their palpable expressions of empathy and compassion, often served as physical extensions of the patient’s loved ones—holding the patient’s hand, brushing back hair off their forehand, offering prayers, peace and comfort, and bearing witness to one’s last breath.

Power of Positivity

Throughout the COVID-19 pandemic, our President and CEO, Michael J. Dowling continually communicated with the Northwell workforce during in-person site visits, video messages, and text alerts. With a spirit of optimism, the organization at large rallied around his statement made during an interview on 60 minutes aired March 29, 2020, on CBS, “You don’t quit. You don’t retreat. You don’t put up the white flag. You are going to win.” Focusing on moments of positivity became an organic undercurrent that celebrated patient’s journey to recovery and lifted employees to continue their selfless work.

Executive Command Center daily meetings began by sharing a positive patient story, grounding the senior leader operationalization team on the ultimate goal. Through overhead hospital speakers, site leadership shared daily words of hope and inspirational quotes and performed gratitude rounding. By personally expressing deep appreciation for coming to work, providing quality compassionate care and hearing firsthand of barriers and/or innovative ideas, staff expressed feeling cared for and supported. Instead of solely focusing on mortality rates and code prevalence, “Win Boards” were placed at employee entrances, highlighting the number of patients’ extubated and breathing on their own, discharged to home, and enrolled in clinical trials. Music played a major role in spreading positivity with hospitals gravitating to symbolic songs such as “Here Comes the Sun” and “Don’t Stop Believing.” It became their rallying cry that good things are happening daily amidst immense hardship. Those songs or melodic chimes were routinely played overhead during positive patient milestones. These visual and auditory cues uplifted employees, reinvigorating them to core values and purpose.

At Northwell, patient clap-outs quickly became a beacon of hope. When ICU patients were discharged home, these critically ill, once ventilated patients who fought for their recovery, were given a proper and emotional send-off. All available team members lined the hallways and loudly applauded as the patient was escorted out of the hospital to be reunited with their family. A good moment indeed. The outpouring of cheers, well wishes, and fond farewells was incredibly moving and touching. Videos were posted to the internal Northwell Facebook page with thousands of reactions and comments of gratitude and optimism. Office of Patient & Customer Experience and culture leaders spearheaded many these programs because our organization recognizes the correlation between patient experience and employee engagement.

Supporting Our Frontline Staff

Office of Patient & Customer Experience realized the importance of keeping our high-performing culture leader group intact and connected. Twice a week, touch-base calls provided a forum to share patient stories, executive updates, best practices, site report-outs, guest speakers, and peer support. Topics ranged from technology logistics, handling of deceased patient belongings, virtual visitation clinical liaisons, and positivity programs. Since culture leaders are responsible for empathetically caring for so many—patients, families, and employees—they in turn, needed support and reassurance from their peers. This virtual forum fostered connectedness and streamlined communication in a clear cascade approach.

With the gravity of the prolonged COVID-19 situation, employee well-being remained an absolute priority. Human Resources, Employee Wellness, Employee Assistance Program (EAP), OPCE, System Chaplaincy, and site leadership partnered to develop holistic programs to supporting the hardest affected—our frontline team members. Team Resource Tranquility Tents offered on-site emotional support, provided resource information and small respite items. Team Lavender, our internal care for the caregiver program, was and continues to provide timely, emotional support to interdisciplinary teams. An Emotional Resource Call Center was launched through a collaboration between the EAP and behavioral health service line for personalized assistance.

Hospital cafeterias were revamped to serve as markets, allowing staff to purchase food, household items, and ready-to-go meals before leaving work. Chalk drawings of inspirational words, quotes, and images were hand-drawn on employee entry sidewalks and pathways. Members of Fire Department New York (FDNY) and New York Police Department (NYPD) lined outside hospitals and post-acute facilities, applauding health care workers during change of shift (Figure 1). All of New York participated within their local communities, with people cheering and applauding from their apartment balconies, building rooftops, and house front porches. Children wrote letters of thanks and drew pictures of our health care heroes—doctors, nurses, therapists, and workers all proudly wearing capes. The community outpouring has been overwhelming with donations of meals, snacks, fresh fruit and vegetables, iPads and tablets, and monetary contributions.

Figure 1.

Heroes honoring heroes: Fire Department New York/New York Police Department lined employee entrances to thank the frontline health care professionals during change of shift.

Throughout this crisis, OPCE and culture leaders have played an absolute essential role in delicately balancing the needs of patients, families, and our employees. Each day posed different challenges due to new mandates, updated protocols, volume surges, and operational logistics. We leveraged our organization’s core values of teamwork, collaboration, and partnership as well as the culture leader network to successfully and quickly implement many of the large-scale system programming and best practices. However, during this crisis, what stands out most, is the compassion, humanity, camaraderie and outpouring of community love that once again defines the heart of New York. The role of the Patient Experience leader after COVID-19 will continue to evolve as we learn, adapt, question, and innovate. It is during these most challenging times we realize the incredible honor and privilege we have working in health care. At Northwell, we know this storm will pass, the sun will rise again and our New Yorker families will be restored with renewed strength, resolve, and resilience.