RWJBarnabas Health CEO Reflects on COVID-19 Surge and Prepares for Second Wave

CEO Barry Ostrowsky shares the strategies implemented during the coronavirus outbreak, and how the health system is preparing for a potential second wave.

Since the beginning of the COVID-19 pandemic, New Jersey has had over 155,000 reported coronavirus cases according to the Centers for Disease Control and Prevention. According to a recent New Jersey Hospital Association study, the coronavirus outbreak has caused hospital revenues to decline by $650 million per month, and has left small, local health departments stretched to their limit.

President and CEO of RWJBarnabas Health, Barry Ostrowsky spoke with HealthLeaders about what the COVID-19 pandemic surge looked like in the New Jersey health system's hospitals. Ostrowsky shared the strategies that were implemented to not only make it through the first wave, but to get ready for a potential second wave.

RWJBarnabas Health has 11 hospitals and numerous care facilities located throughout the state. In 2018, RWJBarnabas Health and Rutgers University launched a partnership, making it the state's largest academic health system.

This is part one of a two-part interview series. Part two will focus on RWJBarnabas Health's strategic initiatives for 2020, including their focus on community investment and upcoming plans with Rutgers.

This transcript has been edited for clarity and brevity.

HL: How has the COVID-19 pandemic affected your ongoing relationship with Rutgers University?

Ostrowsky: Before the pandemic we were busily building this partnership in a conventional way. We've been building it, making sure we touch all the sweet spots legally. Now, along comes this pandemic and the relationship becomes more intimate overnight.

The School of Public Health in Rutgers is front and center. It partnered with us to look at how we can ignite a public health program in our most significant urban area in Newark, New Jersey, to ensure that that vulnerable population is now being better evaluated for COVID. The pandemic has made the relationship with Rutgers all that much more meaningful, mutually, and much more effective for the communities we serve.

When we were jointly faced with this challenge, we tended to make decisions more quickly. And if nothing else, I would love to see that continue. Presented with the practicalities of what we've had to face, you do need to make decisions quickly and mobilize the resources you have. That's been a gratifying part of how this partnership has reacted over the last two months.

HL: What strategies do you have in place as we move towards a potential second wave of the pandemic, and as we move into a post-COVID world?

Ostrowsky: We're about to officially reopen elective services come [May 26], and we'll continue to have COVID patients in our institutions. Fewer, thankfully, than we've had in most recent past. We will be doing all the things you have to do in terms of testing, and taking temperatures, and cohorting patients. We hope of course that the footprint and volume in our institutions for non-COVID patients continues to grow.

When this inevitable next wave of [the] COVID surge hits us, we'll know a number of things.

We'll know how to protect [patients] and the clinicians will know how to even better treat those patients, [including] whether ventilator care is as necessary as we may have thought it was initially. We'll know better what, if any, medications work or don't work. We'll have a better idea of how to staff and create the teams that we ultimately created to treat patients.

That creation of teamwork is something that will be everlasting, but was particularly effective in the COVID surge. We already understand how some licensed professionals can provide care that they weren't used to providing, so we will be prepared from a physical, staffing, and clinical delivery perspective to treat the next wave. The concern is if that surge is so dominant, that it requires an ever-increasing footprint within the facility. We'll once again have to curtail, if not eliminate, the elective cases and surgeries. I think we continue to learn what it means to effectively respond to this.

I had asked our people to keep a diary [when this started] in their subject matter as to what they found was happening as we went through it. We're just about to take the data that was compiled in those diaries and look at a comprehensive after-action report that says these are the things we found out, these are the challenges, these are the solutions. I didn't want to just do it retrospectively, I wanted that report to be reflective of immediate, real time reactions to problems. You get a better flavor for what happened if you recorded it the time is happening. I think the strategy and how we'll deal with a second surge is there and I am sure we can execute it.

Naturally, telehealth and digitally based care was crucial to our ability to treat patients during the surge, particularly non-COVID patients. That's up and running and will be expanded and will be of great benefit to us when the second wave hits us.

I think the community at large understands [COVID] better and will accept the notion that there's limited visitation and that it's tough to communicate with a loved one who is in critical care, those kinds of things that were new as the pandemic hit. Unfortunately, people now understand it.

I don't want to have to do it, but if we had to operationalize all the things we learned through this first phase for an upcoming phase, I think we'll do ourselves well.

HL: What did the pandemic surge look like in your New Jersey hospitals?

Ostrowsky: Our facilities in North Jersey and Central Jersey [were in the hot spot]. In the institutions during the brunt of it, [we] used spaces that were never used for patient care, completely renovated in order to accommodate patients.

You'd see teams of professionals that didn't work as a team prior to that, make rounds and provide care collectively. You'd see staff doing this heroic work all the time. And you would in fact feel the emotional commitment that the staff has.

The patients that are admitted were sick in many cases, and sadly, terminally ill with this. That created an incredibly emotional environment that no matter how corrode you are, affects you. We had in our area, not to be too ghoulish or graphic, expired patients, and there was no more room in the morgue. Funeral directors were not picking up patients in the early stages of this, and that actually continued for some time. [We] had to rent more trailers to bring onto our sites, and just the fact that [we] had to do that affects everyone who works in the building.

Years ago, many of us used to say, "Well, the hospital of the future is going to be one big intensive care unit (ICU)." The truth is that this pandemic resulted in a number of institutions being just that: one big ICU. While that is highly active and it looks to non-clinically trained individuals chaotic, but it isn't chaotic, there's an order to it. It was full of energy. It's just sad that the energy, in many cases, wasn't enough to save as many people as we would have liked to.

That was the picture of the hospital; it runs on the adrenaline of a lot of people. The institution itself is activated, every department from environmental, food service, and security is at a fever pitch quite literally. When the surge passes, recovering from that and getting ready to do a more normalized menu of service is probably more difficult than it is to jump to that level of acute activity.

Taking it up to that is something that healthcare professionals are trained to do. I don't think anyone expected to have to continue to provide care at that level for as long as they did, with as many patients as presented. Getting up to that level of response was almost a reflexive, natural action. Now, stepping back from that and returning to what we hope is a more normalized level, people are talking about post traumatic stress [disorder] type of things. You have to come down emotionally, you have to take a deep breath, and go back to care that isn't generated by this challenge. You keep in the back of your mind that at some point, whether it's next week, next month, or six months from now, [we] may have to go back to address the second wave. And that, of course is going to weigh on people's minds.