Gabriel Perna | March 23, 2020
The Hospital for Special Surgery, a musculoskeletal health system based in New York City, went from full capacity to 15-20 percent capacity in one week.
It was a deliberate decision as COVID-19 runs rampant throughout the city, New York State and across America. Normally the specialty health care provider would be full of patients who have orthopedic and rheumatologic conditions. But for HSS’ CEO Lou Shapiro, the decision to cease all non-essential care and free up hospital beds was a no brainer.
“The balance of our resources, supplies, human resources and fiscal capacity are being repurposed to enable us to provide essential care more broadly and differently. And importantly, for us to allocate all excess resources to join forces with NewYork-Presbyterian and Weill Cornell Medical Center to win this battle we’re in,” says Shapiro.
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New York State has 5 percent of all coronavirus cases worldwide and nearly two-thirds of those are in New York City. Capacity needs to be expanded anywhere and everywhere, whether that’s the Javits Convention Center in Midtown Manhattan, a Navy hospital ship docked in New York Harbor or by HSS suspending non-essential care to take on non-COVID-19 patients in need of essential care from nearby health systems.
Health Evolution spoke with Shapiro about the decision to suspend non-essential care, how the system is working with other health care providers in NYC, and what he hopes the long-term impact of this crisis will be.
Health Evolution: Talk me through the decision to suspend non-essential care.
Shapiro: We have four principles to guide us through this crisis. Protect our staff. Protect our patients. Protect the organization. Contribute to solving this problem. Every organization across the country should be eliminating non-essential activity—in any industry, including health care. Based on our principles, it was an easy decision to make. We don’t have people coming in that could infect staff. We don’t have people coming in who will take staff away from other important work. It contributes to social distancing. The best place to be is at home. It was a decision at an extraordinary level to take HSS from operating at full capacity one week ago to essentially 15-20 percent.
Health Evolution: What does that mean for a specialty hospital like yours, full capacity to 15-20 percent capacity, how will the hospital operate in the coming weeks and months?
Shapiro: It’s totally irrelevant to us being a specialty hospital. How does hospital X operate in the coming weeks and months when they are overwhelmed by COVID-19 patients, in an environment where capacity, resources and human resources are constrained? The way we deal with it is we are uniquely positioned to make a very important socially responsible decision to postpone all non-essential musculoskeletal care. At the same time, we’ve massively scaled up telehealth and repurposed our locations throughout the Tri-State area to provide urgent care, so patients don’t go to local emergency departments. We are joined at the hip with NewYork-Presbyterian and Weill Cornell to maximize use of resources. If there are patients there that don’t need to be there, they can come here. It’s happening today. We’re taking one unit and converting it to another unit so we can bring patients in from [those hospitals]. By curtailing non-essential services, we can reallocate our supply chain, which is robust and can help them do what they do there. As other hospitals have resource constraints that are important, we’re available to do whatever we can do to help them.
Lou Shapiro, Hospital for Special Surgery
First thing is, “What are your values and principles?” Second thing is, “What decisions do you make against them.” It has nothing to do with money. It has to do with winning this war. This war is against COVID-19. Period. End of discussion. All hands-on deck. No one is excused from participating to fight this battle.
Health Evolution: Are you taking in COVID-19 patients yet or is that a plan?
Shapiro: We are not planning on COVID patients, we are planning on maximally using our combined resources to take on [other essential care patients] that are not consistent with core competencies. If we take them that frees up space in those other hospitals.
Health Evolution: Lack of personal protective equipment and ventilators is a major issue right now—what initiatives are you doing in terms of getting those to other hospitals and providers on the frontlines?
Shapiro: We’re working the supply chain through our organized channels at a national level as well as using local channels where there is an opportunity to find resources that someone else may not else find. There is no one who is not gravely concerned and feverishly working on the supply chain matters right now.
Health Evolution: What do you hope the long-term impact of this pandemic is in terms of how it may change the health care industry for good?
Shapiro: There’s a micro and macro view. What we’re seeing is organization over individual, society over organization. That’s promoting a level of teamwork that is unlike everything I’ve seen within the organization, across organizations and across populations. That’s a change we need to make in the long term.
The second thing is preparedness. There’s no good reason we weren’t better prepared. Any reason that anyone wants to give should change the word reason to excuse. Organizations and companies have business continuity and enterprise risk management programs. What could go wrong that we need to plan for? We let the ball drop on this. I’m not talking about HSS, I’m talking about broader societally. Let’s not forget that when this is over.
Unfortunately, I’m not optimistic about that. What happens when there is an active shooter/mass casualty situation? People talk and talk about it and then nothing happens. So hopefully one of the things that will happen as a result of this, in addition to planning for the unexpected thing, is hopefully it will create a level of accountability for people serving the public’s greater good. Enough bickering. Enough fighting. We waste so much time doing that.
The problems I had two weeks ago seemed extraordinary, it is barely a pebble in the shoe in comparison to right now. Let’s focus on what we need to do. Organization over individual, society over organization.