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Transcript: The Lessons Hospitals Are Learning from the COVID-19 Pandemic

[Danyelle] Hello everybody. Welcome to "Comets Discuss," part of the UT Dallas CometCast network, where we give you mini episodes on big, trending topics. For this series, we're talking about COVID-19. With nearly every aspect of life now affected by this global pandemic, we're interviewing UT Dallas experts, while practicing social distancing, to provide you various perspectives during this evolving situation.I'm Danyelle. Today we're talking about healthcare management with Dr. Britt Berrett. Britt is the director of the BS healthcare management program in the Naveen Jindal School of Management. He is also a clinical professor of organizations, strategy and international management. Prior to joining UTD, Britt served as president of Texas Health Presbyterian Hospital Dallas and executive vice president of Texas Health Resources. With almost thirty years of executive healthcare experience, Britt has navigated some of the most complicated organizational and environmental challenges in healthcare.

Welcome to the show, Britt. Thanks for taking time away from your online courses to join us.

[Britt] I'm delighted to be here. Thank you for the invitation.

[Danyelle] First off, could you give us a quick overview of what healthcare management is?

[Britt] Well, healthcare management is the business of healthcare. You know, healthcare is a $3 trillion industry, it's 20% of the gross domestic product, there are a lot of moving parts and to that end, you see individuals that are drawn to maybe the clinical -- they want to be a doctor or a nurse or a respiratory therapist. Others like the policy side. How is the sausage made in Washington, DC, or Austin, Texas? Our focus has been on the business side. And that's the area probably where we have the greatest challenges. How do you orchestrate all these resources? How do you finance them? How do you integrate technology? How do you look at the laws and the accreditations? All these dynamics make it a part of the healthcare management degree.

[Danyelle] And how does healthcare management relate specifically to a crisis like COVID?

[Britt] Great question. We are charting new territory. In an industry that has been curious and exploratory -- we've been trying to find the solution to clinical questions -- a dilemma that is created is, what about the unknown and how do you orchestrate resources when you really don't know where they're to go and when they're to go. We're at a point now when we're looking for the apex. At what do specific geographies reach saturation with the virus and then you see a decline. Well, epidemiologists are modeling that but how about getting the supplies to the patients, to the providers, in a timely basis. How about ventilators and protective equipment? How to you orchestrate that? How do you finance it? So these are the business questions that healthcare management leaders are looking to solve and we've got to do it in such a way that is dynamic and it's like solving a riddle, a puzzle within a puzzle. So healthcare management gives tools that come from the business world that can be applied in the clinical space.

[Danyelle] That was a great answer. Are you able to incorporate any of the things that are happening on the healthcare management side of the COVID-19 crisis?

[Britt] Oh, absolutely! Last night-- I teach a hospital operations class and every week we got to a different hospital in the Dallas-Fort Worth area and we tour. Now, I've been a hospital president and in executive leadership in a hospital for over 25 years. Most recently I was the executive vice president for Texas Health Resources and I was the CEO of Presbyterian Hospital of Dallas, a 900-bed tertiary facility. So as we tour these facilities I can give the real inside scoop, you know, the inside game. Last night on our Zoom call, a lot of questions about how do you know the volume? How do you know when you're at saturation? What do you do to stage and prepare for a tsunami of patients that have complex healthcare issues? We've been integrating that and the students just shared some brilliant thoughts and I think it elevates their understanding of the complexity of the industry. So yes, absolutely integrating this into our coursework.

[Danyelle] Well that's one silver lining from this whole crisis. With your background as a hospital administrator and someone who studies and teaches the subject, why is COVID-19 such a disaster from a healthcare management standpoint?

[Britt] Well, I, you know, I wouldn't call it a disaster. I absolutely would not call it a disaster. Its one of the most complex challenges our generation has had to deal with. My generation looked at 9/11 and that really set us on fire. Y2K, when we turned over the new year we were all fearful that the electrical grid would fall. COVID is a dynamic dilemma that we're able to orchestrate all these moving parts. You probably recall that in 2014 we had one of the most, the scariest healthcare crisis, that was the arrival of an Ebola patient.

[Danyelle] Mmm-hmm.

[Britt] That had a death rate, mortality rate double-digit. I mean, not only was it contagious but it was lethal. COVID is different. And with it is teaching us is a lot about studying saturation rates, apex numbers. We're able to look it. The mortality and death rate is, at this point, over-estimated. So while we, we recognize that the losses have been tragic, every year we have pneumonia tragedies as well so we have a lot to be learned here but honestly sitting on the sideline watching this effort, I think actually it's been exceptionally orchestrated. I really do. I don't think there's any disaster other than it's a tremendous inconvenience and complex issue for the entire population. It's a pandemic, worldwide.

[Danyelle] Do you think that there's anything that we missed?

[Britt] How could we have? I mean, we have cold and flu season every single year. And every single year we have schools that close. And we have, I guess, a short memory. This one hit us really fast. And because what happened in China in a different kind of public system -- you know, they have an authoritarian government structure -- where they can close down entities and organizations and industry. We don't. All of ours is on goodwill. All of ours is a request, a plea. So I think we'll learn a lot of lessons when we finally come out of this disaster. We're learning a lot right now about staging resources, protective equipment. I remember when the Ebola patient hit in 2014, we had no idea how to implement universal infectious control processes in something that was so complicated. We thought we knew, but we certainly learned a lot more. We didn't have enough equipment, protective equipment. Well, we're learning that we need to do the same here. Ventilators, the access to ventilators -- we're talking about that in great detail. Now we're going to learn how to deploy those more effectively. And the last part of that is, we're learning about the importance of personnel. When you have a disaster like a tornado or a hurricane or an airplane crash, the first responders are on the scene, they deal with the issue, but then they're down. And they get a break and they get time to take a breath. They're not getting that now. And so we're learning how to retain our resiliency among the healthcare providers. So those are all important lessons to be learned and I think it's of great value for the future.

[Danyelle] Do you think that going forward there will be major changes that have to be made because of this?

[Britt] Oh, there's no question about it. But you know what, we have the resources. I was listening to the mayor of New York City and he was talking about the deployment of ventilators. So they have a number of ventilators, they're not sure which hospitals will need vents for patients. They have a limited number. And so they're trying to figure out and I'm thinking to myself, this is a business problem. That's not a clinical question. The clinicians will tell you what they need when they need. How do you deploy that efficiently and use predictive analytics on when those pieces of equipment are needed. So I think we're going to learn a lot from this pandemic and it will be all additive. I think you will see a much stronger relationship with public health professionals. Public health has really taken a back seat. I mean, let's be honest, we can't get the population to agree on vaccinations. We have measles outbreaks for goodness sakes. So I think into the future we're going to see public health merge with the healthcare providers in a much more collaborative fashion. And the community is going to realize-- With the flu season you could sit back and say, oh, that's the flu, that's not me. COVID's really taught us an important lesson. It can have a huge impact on everyone. So I think not only will public health providers collaborate, but I think our population, our communities will, society will gather together, will help one another.

[Danyelle] And what do you think healthcare management's role is going to be in that future?

[Britt] We're going to look at processes and systems. I was on the phone with Dr. Dover. Howard Dover is in the sales department in the Jindal School of Management marketing program. He's been talking about sales. And so I called him and I said, "Hey Dr. Dover, how do you predict something that's seemingly unpredictable?" He goes, "Well, when you introduce a new product into a new community, a new market, we model what we anticipate the volume to be." I said, "Could you overlay that with some of the epidemiological studies on the increase in COVID?" And he said, "Well that's, that's kind of a cool question." So we're collaborating to look at can we re-model-- he uses, references as the Bass model -- can we use tools in different disciplines and apply them in the clinical side. A second perfect example is just-in-time inventory. We have a phenomenal program on supply chain. Ventilators? Personal protective equipment? That kind of discipline and understanding of modeling would be of tremendous value for healthcare providers. And the third is, how do we use technology -- banks of information -- that we could crunch those numbers and get information out faster and more efficiently and more effectively. It would be of tremendous value with Dallas, could see real-time information of what's going on in the hospitals in New York and adjust their preparation. We don't have that, but I can assure you, into the future we will.

[Danyelle] Sounds like a really exciting edge to the discipline. Do you think that's an interesting time for student who are just either about to go into the healthcare study or that are getting into the program itself to be a part of these dynamic changes?

[Britt] Oh, they're gonna look back and say "I was there. I was part of it." You know, "I was sheltered in my home, I didn't have toilet paper." We're going to have all these experiences. You know, when I was called a couple of years ago by Dean Pirkul, he called me up and said, "We believe healthcare is a huge industry and it doesn't have the business discipline that's needed." I said, "Dean, I couldn't agree with you more. It is a huge industry and we have not introduced smart business practices in it." He said, "Would you come start a program," and I said "absolutely, I am all in." We've started our program, we have 400 undergraduates, we have over 100 graduate students. We have an executive program for physicians who can get a masters in healthcare leadership and management. So a physician can be given tools so that he or she can manage the clinical side with business practices. So the program is working right now with live ammunition. We're experiencing it in real time. All of our students go through internships in the industry so they're sharing with me story after story of what they're experiencing, whether that's in an optometry clinic, a freestanding ER. We have people working at Blue Cross Blue Shield that are now remotely. Its a working laboratory and it's exciting to be part of it.

[Danyelle] Another small silver lining. You talked about some of the shortages as far as personnel were concerned and how we have to figure out the resilience side of that. Do you want to talk a little bit more about what's being done to address the shortage of nurses and respiratory therapists?

[Britt] Yeah, I have a lot of friends in the industry. I was talking with a CEO that's in the Midwest. I said "How are you doing?" He said, "The schools are closed. A large portion of my workforce are dual income so they have children in daycare and school." I said, "What are you going to do about it?" He said, "I went the state legislature and I said we need a daycare license so we can open our cafeteria, which has been closed down, we can open our cafeteria as a childcare center." I went, "That's genius idea." So what you're seeing is innovative ideas that are being introduced in the delivery of care. And healthcare providers are looking at the personnel and saying, what are you needs? Another one told me they have a relaxation room. I said, "What?!" He goes, "Yeah! We took a patient room , we took a bunch of chairs, you know, those chairs that massage, low lights and aroma therapy." I said, "You're kidding." He said "No, we'd created a group of employees to think of ideas of how we could alleviate some of the stress and this is one of the ideas they came up with." And I said, "Well, how's it going?" He said, "Not only is it going wonderful, they're asking if they can keep that place after the pandemic. So I think we're, we're really responding to that need. Caregivers, the clinical folks, are just absolutely amazing. They inspire me. They're why I got into this profession. I don't have the gift of healing in my hands like they do, but I guess I have the gift of a business mind. So the things that we do behind the scenes can allow them to be effective and allow them to care for those in need. Uh yeah, we're really learning a lot about how you deal with personnel in this pandemic.

[Danyelle] How do we know when this crisis will be over? What will be a sign that it's all said and done?

[Britt] Yeah, that's a good question. I think we need to look for faint signals. Because when this virus hit us we didn't know how to treat it. There was no protocol. It was very, very strong and communicable disease, flu season. So it was much more than typical flu, it was-- At the, initially we thought it was lethal. We thought the death rates were in the double digits. We've since learned that it's been more prevalent and we're learning about that. I think the first couple signals will be when we see less patients on ventilators. When we see less need for patients that are not immunosupressed or with comorbidities, that's a term that we use. So someone who has congestive heart failure or chronic obstructive pulmonary disease, they're prone to get these kind of illnesses. And their mortality rate is pretty high. That's to be expected. How will we know that it's really affecting the mass population? When we see less utilization of ventilators. So I'm watching that very closely. The other is when we start seeing hospitals and their emergency rooms start to slow down. Right now in the Dallas-Fort Worth area hospitals have closed all their outpatient imaging, outpatient therapy, outpatient surgical procedures. They're anticipating the tsunami. And they've been waiting on their hands for two weeks. It just has not hit like perhaps New Orleans or New York or even Miami. When hospitals start reigniting their services, then you know we're moving in the right direction. How long? No one can tell at this point.

[Danyelle] In the meantime, in the midst of this COVID-19 crisis, what do hospitals need from their community or from their local governments?

[Britt] Well, I think what we need from local governments is to be purposeful, intentional and not inflammatory. There's no value in seeking the one-off. A good example is, what is the incident rate of patients that are being determined to have this virus and what's the mortality rate? And what are some commonalities? Sometimes I think we look for the one-off. I heard a reporter aghast at the thought that three children had died from COVID and I agree, how tragic was that. And later in the report they said well, two of them had previous compromising healthcare histories. Meaning they had some type of other disease. COVID contributed but they were immunosuppressed and compromised so they did not have positive outcomes. Another reporter was talking about individuals within a specific age group and talking about the death rate, number of deaths, and he said we saw four deaths last night in our emergency room. Oh, but three of them were DNRs. Well, you and I, the common person wouldn't know what a DNR is -- that's a do not resuscitate. Those are patients that are critically ill that have illness that are in hospice care that if any illness hits them, they're not to be resuscitated. Do you consider that a COVID patient? It's hard for me to see pass that. So I think we need to tone down the inflammatory rhetoric. We need to support our healthcare providers by sheltering at home and being very careful and cautious on interactions so that we minimize the spread so we lower the curve. The third thing I think we can do is celebrate them. Not only the caregivers but everyone that's really stepping up. And share their work. Gosh, I don't know about you, but the supply chain for food has remained strong. Those are truckers. The cleaning of the hospitals, those are housekeepers. The maintenance of flights, well those are flight attendants and pilots. All of these things should be celebrated and reported as opposed to looking for the inflammatory and the one-offs that don't help anyone in this, in this time. That would be my counsel.

[Danyelle] That's great counsel. Ok, well, Britt, is there anything that you want to add to this conversation? Is there anything that you think that our listeners can take away from this?

[Britt] What I'd like to share with the listeners is the importance of leadership during this time. There's a tremendous amount of ambiguity. And individuals start fearing something that really has no merit. And I think UTD grads, Comets, are a great group of men and women and they paid the price to earn a degree and be part of this great institution. They have a better perspective on the bigger picture and so as I've asked my students, rise up. Be leaders. Be a voice of reason. Don't stick with the inflammatory. Gossip is unnecessary, it's counter-productive to look for the negative on this. I would suggest we celebrate the positive and learn what we can do better cause this will happen again.

[Danyelle] Thank you so much for joining us. It's been a pleasure to have you. We're very, we're very that technology allows us to all still be face-to-face and have this chat.

[Britt] It's cool. Very cool. Delighted to be part of this podcast.

[Danyelle] We wanted to plug some of the programming Britt is involved in at the Center for Healthcare Leadership and Management. You can find their podcast at businessofhealthcarepodcast.com and look out for info about upcoming webinars by searching for the Center for Healthcare Leadership and Management at utdallas.edu. We'll provide links to these and more in our show notes.

Thanks for joining us. "Comets Discuss" is brought to you by the UT Dallas Office of Communications. A special thanks to senior lecturer Roxanne Minnish for our music. Be sure to check out our other shows at utdallas.edu/cometcast. For the most up-to-date news at UT Dallas, visit the University's official COVID-19 information webpage at utdallas.edu/coronavirus. Take care and stay healthy. [whispering] Whoosh.