EM Docs is a facebook group founded by K Kay Moody MD and comprises more than 22,000 Emergency Physicians.
It came to the attention of some in the press a few months back when information was solicited from EM Docs by certain members of the Covid-19 Task Force. A move, by the way, which some felt was brilliant since these are the people on the front lines. In the early days of the pandemic, it was perhaps one of the most valuable sources of information for the Emergency Physician community, often days ahead of the CDC, when it came to the exchange of clinical data about an illness whose management seemed to morph hour by hour.
Unfortunately, it also brought out in the open exceedingly subpar responses on the part of some hospital administrators. Administrators who sadly focused more of their attention on what was being posted about them or their institution on social media—specifically in regard to preparedness and the lack of personal protective equipment PPEs or how they might be perceived by their bosses or boards—than addressing the most important bullets of the pandemic. Those being: How do we keep our patients and staff safe? How do we maximize our resources? and, most importantly, How do we maintain morale in this time of crisis?
So we asked EM Docs: Who did a great job? Who went above and beyond, responded with poise, compassion, and leadership that was nothing short of transformational and heroic? Most importantly . . . Who listened to you, who acted as your champion, and who should be applauded? Who should other administrators emulate?
This is a salute to the five administrators that got it right as decided by the physicians working in the trenches.
Number 1: Steve D. Edwards, CoxHealth: Springfield, Missouri
First off, if you personally give 100,000 dollars of your own money to help set up a fund in your health care system to support your staff who might fall ill from Covid-19, you immediately get some consideration of making the Top Five.
Rapidly building an open ward, fifty-bed ICU and securing a $700,000 donation from the CEO of Prime Trucking to completely cover the cost of this new construction also deserves some mention. It is the kind of out-of-the-box, creative initiative with community partners that sets Mr. Edwards apart from the rest.
Bringing the Governor to your health care system so they may appreciate the scope of this problem also helps.
“These are complex and difficult times, and in the wake of Covid-19, hospitals across the nation are struggling financially. Most have been forced to make extremely difficult decisions, including layoffs, furloughing employees, and cuts in retirement plans. At this point in time, CoxHealth has chosen a different path. We are worried about the thousands of patients who have deferred care, and we want to make sure we have the resources—especially staff—to take care of them.” —Steve D. Edwards
But clearly, that is just the beginning when we include Steve D. Edwards in the Top Five administrators.
“The Covid-19 pandemic has brought to light strengths and weaknesses of every hospital in the country. Lack of ability to procure adequate PPE for clinicians, lack of testing capability, and the number of unknowns related to dealing with a novel pathogen have made this an unprecedented time for healthcare around the globe. Mr. Edwards, however, has done an exemplary job of leading our hospital system and inspiring great confidence amongst both staff and community members. He, as well as other members of the leadership team, have been remarkably transparent in relaying the rapidly evolving thought processes and concerns which have contributed to their decision-making. . . .
There was no delay in hospital administration’s response to the pandemic, and Mr. Edwards was able to spearhead an effort that resulted in a 51-bed ward-style ICU for Covid patients being constructed in only two weeks. Preparedness has been the number one goal, and this is just one impressive example. He has been a vocal advocate for the community and hospital; he has not hesitated to publicly call out government and other officials when their positions have been ill-advised, regardless of the political fallout that is sadly likely. While other facilities have been cutting staff and expenditures, the administration led by him has prioritized keeping personnel through the economic downturn recognizing that we must retain employees so they can provide care after the disaster is over. . . .
This sort of leadership is incredibly rare and should be recognized; it makes me immensely proud to be a member of the medical staff of this hospital.” —Kari Cooper, MD, FACEP
“He recognized early the potential to be overwhelmed, the risk to healthcare workers and our community at large. This is demonstrated by his recognition for the increased amount of PPE, which he has worked diligently to obtain. He was quick to authorize non-standard measures and enlisted community support to sew masks from material the hospital had stockpiled and the creation of 3-D printed face shields. Additionally he expanded use of technology for virtual visits and the ability to remotely interview patients within the ED. He supported establishing a tent triage station and use of community paramedics to provide targeted mobile testing preventing unnecessary ED visits. Additionally, he recognized that boarding in the ED is a potential risk to patients and rapidly expanded hospital capacity. He protected Emergency Department staffing, ensuring that we remained prepared to handle any additional influx that might occur. . . . I clearly recall him walking through the ED speaking with each of us to obtain firsthand insight of what our needs were and how we were dealing with the potential threat. I have been grateful for his support not just for the hospital and our community, but specifically as an emergency physician.” —Jon Vashaw MD
“I have been with this physician group for twenty-eight years and believe this has been the best administration I have encountered during time in Springfield and better than my two prior jobs. During this pandemic they have been supportive of staff and patients going as far as to finish off a previously unfinished floor to accommodate Covid-19 patients.” —Joe Craigmyle MD
“As I talk to my peers, I feel very lucky to work for the hospital that I do and truly believe it’s due to the administrators valuing and actually listening to the physicians.” —Steven Propst MD
“Mr. Edwards has a long track record of outstanding leadership for the hospital and the community. While crises can bring out both the best and the worst in human behavior, his history and credibility put him in a unique position to lead our system and influence community decision-making. There will be time for further difficult decisions ahead, and I do not envy the challenges he will face. I am confident those decisions will not be arbitrary and will be made with the input of experts and the best available information. I realize there are numerous administrators who are doing exceptional things to promote health and protect both patients and staff. I am confident that Mr. Edwards is near the top of that list.” —Howard Jarvis III MD, FAAEM
With this kind of response, It’s no wonder we choose Mr. Steve D. Edwards for the top spot. It is our hope that this type of leadership is emulated by your peers in the industry.
Number 2: Lori Weston, Park City Hospital, Intermountain HealthCare: Park City, Utah
The number two spot on the list was easy . . . so much so that we’ll just use the words of the doctors in her ER for this one.
“When Covid-19 started, there was fear of the unknown. I knew, however, that we were in the best situation we could possibly be in with Lori as our administrator. Our county (with the main industry being tourism) was hit hard and fast. Alongside our medical administration, she facilitated rapid early testing, strict visitor restrictions inside the hospital, and actually increased our staffing while most ERs were decreasing staffing. Many of the policies she put in place were adopted by our entire 15-hospital system.
While her administrative and interpersonal skills are noteworthy, her compassion may be her greatest strength (although this plays into her other strengths). One of her greatest concerns early on during the pandemic was the low SES community due to their high-density living. She worked to secure other housing options for those with Covid-19 to slow the spread and protect their families.
While cases were ramping up, most people steered clear of the ER. Lori would stop by daily to check in and make sure we had plenty of PPE and wanted to know if she could help us in any way. I even had to send her an email telling her not to come to the ER fearing she could get sick!” —Austin Smith MD FAAEM
“She walks through the department frequently but unobtrusively and shows genuine care for what’s going on. During Easter, she came in on Sunday while I was working and, while there, she handed me an arrangement of flowers to bring home to my wife for when I finished work. And impressively, during these challenging Covid-19 times, she’s working around the clock to contribute to making the best of care, hospital strategies keeping everyone as protected as possible, and actually increased our hours of coverage in the possible anticipation of surges even while at the same time volumes were down.” —Douglas Vogel MD
“By far the most supportive admin in the world. Her leadership is nothing short of amazing.” —M. Mike Dbeisi MD, FACEP
“When we were hit with the coronavirus as a high-risk hot-spot due to our resort status, Lori was able to see the big picture of the impact to our local community. Her leadership was proactive in controlling the curve and preventing our health care system from being overwhelmed. Every action she put in place not only protected our community and surrounding counties but protected the hospital staff. No one was left behind, from our cafeteria workers, housekeeping, to the front-line registration and ER staff. . . . In my thirty-four years of practicing Emergency Medicine, working in many other states and hospitals, I have never seen a hospital administrator who has been able to rise to the occasion as Lori Weston has during the pandemic crisis. She put the hospital staff at ease and empowered them to follow her in a time of crises.” —Debra Martin MD FACEP
Ms. Lori Weston, your commitment to compassionate and strong leadership and your willingness to engage with your physicians on a personal level is why we are glad to include you in the Top Five.
Number 3: Steve Long, Hancock Regional Hospital and Hancock Health: Greenfield, Indiana
Smaller community hospitals often face incredible challenges when it comes to addressing community health emergencies. They simply do not have the resources that major medical centers have, but it certainly did not constrain Steve Long of Hancock Regional Health.
“Just do it, we’ll worry about how much it costs later.” —William Freudenthal MD
That was the first thing Dr. Freudenthal said when asked to weigh in on the job performance of Steve Long during the Covid pandemic. When other ER physicians chimed in, the same themes come up over and over. Dr. Taryn Papandria summed it up the best:
“No staff were furloughed. All staff who could work from home were told to do so well before the shut down. A staff pool was developed of those staff from departments that were closed down and those staff were reassigned to other departments when needed. Anyone who could not be reassigned or was unable to work in the hospital due to medical conditions received essentially 60% of their pay and were not ‘laid off.’
He held daily briefings with the executive administration and then with all of the department directors and supervisors to discuss the current state of affairs at the hospital and to be sure that all departments had what they needed and had the ability to address any questions or concerns.
Authorized the purchase of PPE from wherever it was available. Also donated much of our donated PPE to many of our local ECF partners to make sure that they were well-equipped.
Used his community connections to get the intubation boxes built and to use 3-D printing for ventilator and bipap pieces and for some PPE.
Went on Facebook Live daily and then weekly to give real-time updates to the community regarding the current state of the Covid pandemic and the hospital’s preparedness.
Sent a daily and then a weekly written briefing to all hospital employees to be sure everyone was being kept up to date on what we were doing at the hospital and what Covid was looking like in Hancock County.
Has worked extensively with the county commissioners and community leaders to be sure that they are following healthy guidelines regarding shutting down and then reopening business, places of worship, and non-essential services. Has also insisted that they allow a clinical representative of Hancock Health to be present at every commission meeting to be sure that their goals are in line with ours.
Most importantly, he has listened to the experts, implemented nearly every suggestion that we have made within reason, actually understands the science and the data, and has put patients and staff over profits at this time.” —Taryn Papandria MD
“Steve Long is great. Also writes the ER physicians a handwritten note on their birthday each year. Now that is no big deal, but it sticks with me.” —Matt Orme MD
Creativity, physician-friendly attitude, and an “all problems have a solution” mentality is why we are proud to include Mr. Steve Long on the list of the Top Five.
Number 4: Dr. Dennis McKenna, Albany Medical Center: Albany, New York
As an Emergency Physician who, “spent five years in service to the United States on active duty as a medical officer, including a deployment as a battalion surgeon for the Marines to Somalia. He joined the Reserves in 1997 and was mobilized to active duty three times after 9/11, including two tours with the Marines to Iraq. He retired as a Navy Captain . . .”
Is it any wonder he rose to the occasion during this crisis?
“I speak for many when I say there is no one else we would have wanted at the helm when Covid and its myriad challenges hit us. His leadership at Incident Command reflected his general approach: hands-on and present but not micromanaging, allowing the experts in each area to apprise. His thinking is strategic, quick, and with an eye on the entire picture . . . and I was not surprised that he was one of the first to volunteer to work in our Covid tent. He is a hands-on leader and he familiarized himself with all aspects of the Covid crisis.
Perhaps what most distinguishes Dr. McKenna’s leadership during the Covid pandemic is his recognition of the critical role communication has played. He has been visible throughout the healthcare system, fielding and answering questions and concerns. . . . He communicated to the entire Capital Region via radio spots and page in the local newspaper. He also jumped out as a leader in coordinating our regional response to Covid.
As AMC is one of the largest employers in our region, it was also Dr. McKenna’s priority to keep people working. While other healthcare systems in our area have furloughed workers, no full-time AMC employees have been furloughed during the crisis due to his efforts.” —Heather Long MD
When the hospital CEO actually works triage during the pandemic, it says volumes about leadership.
“Dennis is a true leader who leads by example. He is always upbeat and positive during his clinical shifts—he has never been afraid to roll his sleeves up and do whatever needs to be done. In his first address to the combined leadership group as the incoming CEO and president, Dr. McKenna announced that he would continue to work in attending in our emergency department, which quite frankly did not come as a surprise to any of us who know him well.” —Joel Bartfield MD
“Under Dr. McKenna’s leadership, the Albany Med system has been working closely with other hospitals in the region to share resources and protocols in developing a regional response to Covid-19. Rivalries between systems have been put aside for the sake of our community’s health. In fact, this regional coordination extended beyond our local community when a number of patients from the New York City area were transferred to Albany Med and other regional hospitals. Although this was certainly a team effort, it came together in no small part due to Dr. McKenna’s leadership and acknowledgment of our responsibility as an academic medical center to use our resources to serve others. . . . We wish you the blessings of working with administrative leadership who are similarly skilled communicators and leaders for their communities.” —Shellie Asher MD
So Dr. McKenna, while it might seem like a cruel joke to have taken over the helm of a major medical center, right at the start of a global pandemic, it’s clear that the leadership you displayed, your willingness to jump right in and even revisit your roots as a clinician, deserves special recognition and praise. Albany Medical Center made the right choice in appointing you at the helm.
Number 5: Laura Grill East Alabama Medical Center: Opelika, Alabama
Multiple members of the administration and Covid-19 task force at East Alabama Medical Center were mentioned, but one in particular—Laura Gill—was singled out for her extraordinary response and commitment to safety of her physicians, staff, and the community at large.
“Our facility began aggressively approaching the threat of Covid-19 in early January. A committee was formed including ED/ICU/ID leadership. A screening process was set early to try to catch patients before entering the facility. A call line started to help keep the worried well out of harm’s way by encouraging those with minimal symptoms to stay home as well to arrange off-site testing. Our first Covid + screen (not test) was on January 27. Soon thereafter we set up an isolated 1/2 of the ED and isolated ICU space.
Administration worked with the supply chain aggressively to insure we had appropriate PPE. As many of our service lines shut down, administrators worked overtime to insure the safety of our staff and community and took a pay cut to attempt to insure there would be no cuts to frontline staff.
When local and state governments were lax with social distancing and stay-at-home guidelines, the hospital put out a PR campaign encouraging social distancing and educating the public on the importance of staying home. Administration has done a great job of keeping medical staff and the community informed on our daily Covid census, amount of ventilators in use and available, amount of PPE supplies, and amount of Covid testing supplies.” —Austin M. Reece MD
“EAMC was locked down with regard to visitors and entrances. Second, once we identified our first local case, we moved the Emergency Department triage and screening to the outside ambulance bay. Simultaneously, we set up tents and established guidelines under the direct supervision of an Emergency Department Nurse Practitioner to divert all appropriate patients to testing located at sites off the main campus. This was all in an effort to limit the spread of Covid and to protect our frontline workers. EAMC established a Covid “SICK” line that fielded over 500 calls a day for several weeks. That decompressed the ED significantly. Those cases that “screened” positive were sent to the EAMC drive-through testing center.
Administration formally met twice a day for over six weeks to keep all plans moving correctly. Ventilators were located from less hard-hit areas. PPE was purchased. Testing capabilities were greatly expanded. All of this was a direct result of individual effort on the part of the Administrative team. It was my observation that this was all just plain old hard work and perseverance toward finding and purchasing what our community needed.
Contact tracing was done on all positive cases identified by EAMC. Telemedicine was initiated for all local EAMC affiliated practices. Secondary ICUs were organized to handle overflow from the Covid ICU as well as multiple areas of the facility that were converted to Covid units. The list goes on and on. This is only a small part of the work that was done to handle this crisis.
It is hard to imagine how they could have done any better.” —Alan Moore MD
Ms. Laura Grill, congratulations on being recognized by your ER physicians as one of the outstanding administrators during a time of significant turmoil in healthcare.
So, while much attention and deserving praise has been given to the doctors, nurses, and other medical professionals in the trenches of this pandemic, it’s sometimes easy to lose sight of the contribution a physician-friendly administration brings to a crisis. In almost every instance where physicians on Facebook’s EM Docs were critical of administration, you can see an underlying theme of “administrators VERSUS physicians.” In all settings that flourished, it was in an environment of “administration AND physicians.” Sadly it seems the pendulum has shifted a bit to “versus,” but it’s our hope it will swing back to “and.”
Countless administrators have earned new respect from their physician partners during this time of great anxiety. We applaud those. Sadly, others have been shown to be incapable, or were plain obstructionists and out of touch in this crisis. We encourage the hospital boards and community leaders to immediately identify them by independently reaching out directly to the ER and ICU physicians at your institutions. These are the physicians that have their finger on the pulse of your hospital and the community at large. These are the ones that showed up and saved your community. If they have concerns, then you better listen. You just need to ask a simple question:
“How’d the administrators do?”
If the answers you receive don’t in some way mirror those quoted in the Top Five . . .
Your hospital may have a problem.
Dr. Louis M. Profeta is an emergency physician practicing in Indianapolis and a member of the Indianapolis Forensic Services Board. He is a national award-winning writer, public speaker and one of LinkedIn's Top Voices and the author of the critically acclaimed book, The Patient in Room Nine Says He's God. Feedback at firstname.lastname@example.org is welcomed. For other publications and for speaking dates, go to louisprofeta.com. For college speaking inquiries, contact email@example.com.
Dr Louis M. Profeta is an emergency physician practicing in Indianapolis. He is one of LinkedIn's Top Voices and the author of the critically acclaimed book, The Patient in Room Nine Says He's God. Dr Louis holds a medical degree from the Indiana University Bloomington.