Podcast: Interview with Dr. Wright Pinson, Vanderbilt University Medical
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Charlene MacDonald: As hospitals and health systems rapidly work to determine the best responses to address the safety of their staff and providers while simultaneously providing a safe environment for patients requiring medical care, the disruption to normal operations was confounded by major staffing and supply shortages, adaptation of current processes and systems, and an evolving landscape of federal, state and local guidelines. At Vanderbilt University Medical Center, Dr. Wright Pinson, Deputy CEO and Chief Health Officer of Vanderbilt University Medical Center, realized early on that VUMC needed to respond to the internal challenges confronting the health system, while also collaborating and coordinating and helping influence the overall planning and response of both the local and state government. I’m Charlene MacDonald, leader of Healthcare and Life Sciences within the strategic communications segment of FTI Consulting. And today I’m speaking with Dr. Pinson about VUMC’s approach and the lessons they learned that health systems can apply to their fight against COVID-19 and preparation for future pandemics.
Good afternoon, Dr. Pinson.
Dr. Wright Pinson: Good afternoon.
Charlene MacDonald: Thank you for being with us today. Those COVID cases surged throughout the U.S. There’s a lot that VUMC has done that I think we can learn from and the health systems around the country can learn from. So I want to talk today a little bit about your experience on some of the challenges and opportunities that, that you faced during this time. So first, what steps has Vanderbilt University Medical Center taken to address COVID-19 in your community and in the region?
Dr. Wright Pinson: So, early on we like everybody else were getting the news reports from overseas and we, we could see that there very well may be a serious problem. And so we pulled together our incident command center like many hospitals and hospital systems and we addressed in a fairly methodic way what we thought our response was going to need to look like.
And, so first of all, we set up a hotline, because we knew there were going to be a lot of people that wanted information. And so that was the very first thing we did. The second thing we did is we, there was no testing at the time. So we had our internal laboratory here sort through the machinery that they had, the platforms and the reagents and figure out how to do COVID testing. And we, we were fairly early on able to do significant numbers of COVID tests which turned out to be crucial for our region.
The third thing we did was note that there were going to have to be locations where people can come be evaluated and get that testing accomplished. And we concluded that we did not want people visiting our main campus. We certainly did not want them coming to the emergency room because I felt like we needed to keep our hospital resources available for patients who needed hospitalization and we did not want large numbers of patients clogging this up. So we used all of our walk-in clinics that are geographically scattered all around the metropolitan area as the location where we wanted that to occur.
The next piece was how were we going to manage the patients while they were waiting for their COVID results or if they had received results and they were having mild symptoms that were not, not going to indicate hospitalization was in order, so the next thing we did is setup a phone bank and a tele-health visit bank so that we could communicate with large numbers of patients who were waiting for the results or were mildly symptomatic, not indicating hospitalization. And that was about thirty different individuals for twelve hours a day.
Then we began to think about how we were going to manage the hospitalized patients. And we sorted through all of the units that we had and figured out which ones had enough size in the rooms, were, were modern enough and also were isolated enough from our other core operations. And so we picked certain units that we were going to focus our COVID services in.
The next thing we talked about is how we were going to staff that because it was clear that we could potentially receive an extraordinarily large number of patients. That, that did not happen that we ever felt like we were getting close to overwhelmed, but we planned for that and so we sorted through how we would create 350 additional beds in our facilities and how we would staff 350 additional beds. That staffing was a, was a big issue because you know there were a lot of places that were laying people off and we knew that we didn’t have a lot of extra staff. And we knew that there was some potential that a proportion of our staff, we weren’t sure how big that proportion would be, but we prepared ourselves for maybe as much as 30% of our clinical staff needing to be laid off or have to stay quarantined at home.
Then we worried about personal protective equipment. And as you know, there was a period of time where it was very difficult and I have to give credit where credit is due. Our supply chain team identified sources early on and as they told me that the supply chain for this particular set of products became very different than their usual methodology. But I was not going to be happy if we did not have enough personal protective equipment. You could see what was happening in certain locations where they had gotten to a point where they were short and so you know my, my message to them is, “Don’t worry about the money. You get millions of masks. You find millions of N95 masks. You find gowns and gloves.” And we created a calculator for how fast we would burn through that based on our ordinary core business, but we also laid it out in terms of whether we had a hundred or two hundred or three hundred COVID patients. And our goal was to try to stay three or more months ahead in terms of our supply.
Both the ability to do tests and our supply turned out to be useful because there, there were members of our community other hospitals or long-term care nursing home type facilities who had shortages and we were actually able to help out in that.
Charlene MacDonald: Yeah. Dr. Pinson, thank you for that. And tell me a little bit more about, I know you obviously did a lot of planning and preparation as an institution and looking at your internal operations, but I know VUMC engaged outside of Vanderbilt as well, so can you tell me a little bit more about working with public officials and with others in the community on the response?
Dr. Wright Pinson: Yes, so pretty early on, as I told you, we knew had to have a hotline and we needed to have locations where people could present themselves for evaluation and testing. Well, we talked to the metropolitan health department and we made recommendations that they also develop a hotline because we didn’t think we could handle the entire load for the metropolitan area. And we encouraged them to develop testing stations in areas of the city that we weren’t necessarily covering well. And we also recommended that they get all of the hospital systems together. And that happened very rapidly and it was a great move to try to get representatives of all the hospital systems and the metro department of health together to get on a page about how we thought this should be handled. And we collectively made recommendations. We actually helped write a reopening plan that we all agreed what we thought was rational and reasonable. And we got 100% behind our mayor and the restrictions that he had recommended early on. And we got behind his reopening plan. So one of the strengths that I think we had in our metropolitan area was working very well with the public health department and all of us who were in the delivery, health care delivery business all of us getting together to have one voice and to try to accomplish meeting the needs of this region. We also recognized though that this was a statewide problem.
And so we were working with the state department of health and also with the governor’s office and their unified command, you know, all across the state. So I would say our role in all of this was to help encourage convenient convening of discussions and then actively participating in them.
And I think that was a crucial piece, to have us all working together and get a single message out there. So there was much less confusion about you know whether masking was a good idea or a bad idea and whether distancing was a good idea or a bad idea. I think we had less problem in our metro area than many places because of the good communication.
Charlene MacDonald: That’s an excellent point. And I know that you had that early mask wearing requirement and that’s still an issue across the U.S. Compared to some of your peers or Nashville’s peers across the country, how do you think that the region has been more successful in handling COVID? Obviously, it’s been a challenge for everybody, but what has Nashville done particularly well that other cities and regions could look to, to replicate and to have a stronger response as they face these challenges?
Dr. Wright Pinson: Well, again, I think we had a pretty unified message that we sent out early on. And I think we shut down pretty hard and pretty fast early on. But then as we were asked to begin to open the economy back up, which included opening the hospitals back up for elective care, we had shut down to just urgent and emergent care which turned out to be only 50% of our usual business. But we made plans to ramp back up and we were pretty much back to pre-COVID operational levels within two weeks of reopening. And I think trying to get coordinated in that and the singular message was probably the reason that we did better than others. I think the fact that we wrote down the reopening plan and we all agreed and supported that. That I know there were a lot of other metropolitan areas around the state of Tennessee as well as other parts of the country that asked up for copies of our plan. And so I think that was a piece of work that we did pretty well.
Charlene MacDonald: Great. So I will turn now to health disparities. COVID-19, as you know, has disproportionately impacted people of color in Tennessee and across the country. On April, following the first wave of COVID-19, the metro public health department found that black residents in Davidson County accounted for almost 50% of the county’s COVID-19 deaths, but only 13% of cases. What is VUMC and the local and state government and the national area done to address some of these health disparities for those that are most at risk during this time?
Dr. Wright Pinson: Well as we know, health disparities is a topic that is getting increasing attention. Health disparities have existed for a long time. But I think this COVID pandemic brought those disparities into much better relief for people to visualize some of the statistics you just quoted or points that people were beginning to appreciate. So we had convened a racial equity task force early on about, I think it was about the 8th of July. And we brought this racial equity task force a charge and we asked them to figure out how we were going to reduce the barriers in our region.
And it included individuals representing not only our medical staff but students, trainees, and faculty but we also solicited input from all across our geographic region. We began some training of our senior leaders and of our board with the support of racial equity and any racism experts we began examining how our existing policies, our existing practices, how our organizational culture disadvantaged some of our racial and ethnic minorities. And then we reasserted our organization’s commitment to inclusive learning by identifying gaps in our curriculums and opportunities to embed structural racism and racial justice training. And then finally we increased the availability of racial equity resources and that was resources devoted to implicit bias, cultural humility training, racial equity, tools to evaluate these policies and practices in curricula that I mentioned before.
I would tell you that we also created an office within the past couple of years of health equity. And that office has begun to do the community health needs assessments even more focused on the disparities of outcomes for certain communities: our Latinx communities, our Black communities. But frankly it’s a lot of minority communities. There are about 80 different languages that are spoken in the Nashville metropolitan area so, it’s not just one or two, I mean it’s a lot. And one big piece of that was trying to figure out how we create interpreter services so that we can communicate with a lot of these different subcommunities. That office early on in that work that I told you about when we brought our command center together and we had our work streams going, well one of the work streams that they brought in was how to deal with disparities. And so every day when we had our report out from various support lines and our major operational division leaders, we also had a report out on disparities and what we were doing to deal with those issues. So every single time we met we had that discussion. So those are some of the things that we did to try to address that issue.
Charlene MacDonald: That’s great and it’s such an important and challenging issue with a lot of benefits to the community when you address that at the institutional level. When you think about, as we wrap up here, when you think about the advice that you’d give to your peers at other academic health centers, what are the benefits to the institution itself from the collaboration between academic health centers and governments? So you’ve obviously done a lot to inform the government response and to help the community through this, but what does, how does Vanderbilt benefit from that collaboration?
Dr. Wright Pinson: Charlene, I think it’s fair to say that our public health system has not been kept in robust shape to deal with the sort of pandemic that we are facing. And the health systems, the health care delivery systems, and especially academic health centers, have really stepped in to provide a lot of that public health capability.
And I feel like we have the resources, you know we have a department of public health policy, and so I think a lot of academic medical centers have the resources to try to accomplish some things that maybe in the past the public health departments would have accomplished.
One area, for example, is modeling. And we have modeled for our own organization what we thought the rate of change was going to be in terms of infections, in terms of hospitalizations, in terms of people who would need ventilators. But we have also through our health policy department provided modeling for the entire state of Tennessee.
Charlene MacDonald: So if we go back to an earlier point in our discussion where we said we communicated well with our metro department of health and with our state department of health, well part of those communications was continually updating them every week with modeling for what we should be expecting. One of the greatest pieces of work out of that, by the way, just came out this past week that demonstrated that hospitals where a low proportion of patients came from geographic regions where there was less than 25% of people wearing masks or were under mandates to wear masks, the growth in the percentage of hospitalized patients with COVID grew by 300% from July 1st until now. Against another situation which is if more than 75% of the patients came from regions where masking was required, the growth from July until now in terms of hospitalizations was zero. So that kind of information is something that an academic medical center and its groups can produce that actually create the kind of information that helps our public officials make decisions and develop their strategies. And you know they need that kind of information. They need that kind of support.
Absolutely. Well on behalf of FTI and from all of us around the country who are benefitting from the public health work that you are doing, I want to thank you and VUMC for your time this afternoon and to wish you the best of luck. I know the challenges are still ahead, but we really appreciate learning from your experience, so thank you Dr. Pinson.
Dr. Wright Pinson: Well, thank you very much and I just want to make clear that there are literally thousands of people who have been working on all of this that I have happened to talk to you about this afternoon. And I want to be sure to tip my hat to all of those people who made such great contributions here.
Charlene MacDonald: Thank you.