Understanding Resilience In The Epicenter Of The Pandemic

John August is the Director of Healthcare Programs at the Scheinman Institute

If you haven’t read it, the New York Times article from April of this year, attached here, now is a good time to do so. 

‘A Tragedy Is Unfolding’: Inside New York’s Virus Epicenter - The New York Times (nytimes.com).

As the City braces for a new set of challenges and suffering from another wave of the virus setting in now, it is a good time to appreciate and understand how frontline health providers have developed resilience.  Resilience for them is part science, part intuition, part organization.  Resilience in New York City is not unique to New York, of course.  Then again, the staff at Elmhurst Hospital did experience a wave of sickness, care, and death on a scale greater than anywhere else.

Please take two minutes to view the embedded video of staff at Elmhurst Hospital coping with the impact of the then-unprecedented surge in COVID-19 patients from this past Spring:

Mental toll of virus fight lingers for NYC doctors - YouTube

I have the privilege of knowing Dr. Suzanne Bentley who is featured in the video. She is Medical Director of the Simulation Center at Elmhurst, Attending Physician, Emergency Medicine Department, NYC Health + Hospitals/Elmhurst Hospital, Associate Professor, Departments of Emergency Medicine and Medical Education, Icahn School of Medicine at Mount Sinai.   She is also an active Union member and co-chair of the Collaboration Council at Elmhurst Hospital.

The Doctors Council, SEIU and the Health System have established Collaboration Councils at all 21 of the hospitals, outpatient centers, and nursing homes operated by the City Health System.

Some of my work includes sharing technical assistance and consulting with her Union, the Doctors Council and with New York City Health +Hospitals, the nation’s largest public health system.   I asked Dr. Bentley to share  some of  her accumulated knowledge and experience about the toll the pandemic has had on her colleagues, and what they are doing going forward as the next surge of illness hits.

In her own words:

“It has been a tremendously overwhelming time for all of us, across the hospital and the community. The first surge, as I'm sure you are aware, hit Elmhurst like a tidal wave, nearing full surge in just 48 or 72 hours after our first case, despite its slower mounting in the areas and hospitals around it.

Simply said, it was quicker onset, larger magnitude of patients, most of whom were critically ill, and truly unlike anything any of us had ever worked through or been through before. Emotionally, it left so many feeling helpless but that was where a seeming new strength was born at Elmhurst,  and the hospital community truly banded together to become, our now tag line, "Elmhurst Strong."

 The pandemic affected every single staff member, both at work and at home, and was somewhat unifying in its sheer devastating magnitude.  People came together to help however they could and support each other because truly we were in it together. Its effects were far reaching and it was hard to ever feel safe- there was fear for the patients, fear for your own health, fear of spreading COVID to your loved ones at home, fear of enough resources like ventilators, fear of what was to come, and many of those fears continue now as we face the second surge. We lost colleagues and dear friends from Elmhurst, we lost family members and friends out of work, it has been a period of much loss, real and perceived, perhaps even grieving the loss of "life before COVID."

With all of that said, the H+H and Elmhurst leadership specifically took action ahead of the surge and throughout and truly served as a beacon of hope and collaboration. Novel communication systems and outreach were created such as

• Town Halls with leadership to give updates and allow for people to directly ask questions,
• a central email was created from which any staff member could ask a question, request information, or share suggestions of feedback directly to the command center and executives,
• and group specific whatsapp, email and text chains to allow for real time updates, sometimes multiple times a day and serving to "crowd source" real time conditions and keep all aware of what was needed and occurring during a time when conditions and resources fluctuated greatly.

These are just some examples of things of that helped build resiliency- they allowed for bidirectional information sharing, leveling of hierarchies, and gave people back some semblance of feeling control and having somewhere to turn. 

Personally, I was very involved with our Helping Healers Heal (H3) program, both before but more so during the surge and the hospital's commitment to H3 and expanding our resources and capabilities I truly believed help many weather the pandemic a bit better.

H3 opened and staffed a "Wellness Room," a physical space for staff to come to speak with a Peer Support Champion or just share stories with another colleagues, have a cup of coffee and sit down and pause for a moment. We offered debriefings hospital wide to help staff process and feel less alone and we adapted as we became aware of evolving needs, such as offering debriefing virtually to help with social distancing and logistics with scheduling, starting a standing bereavement group, and opened a Memorial Room to help offer staff a place to visit, to mourn, and to remember those lost will never be forgotten. This offered some closure during a time when social distancing precluded funerals, rituals of closure, and gathering physically to provide strength to one another. Clinically, there were many ad hoc responses and actions taken by staff, including amazing improvisations with equipment when needed and staff partnering with leadership and engineering to share ideas on how to do things differently in a quick fashion. 

After the surge, the most impactful response was

• the deep dive taken across the hospital to debrief, analyze, prepare, gather and document innovation and out of the box ideas,
•  and capture all of the opportunities for improvement in order to further prepare us for the future. Additionally,
•  continuing to expand H3 and our mental health resources was key- people often needed reminders that "it's ok to not be ok" and that just because the worst of the surge was over, it did not mean this was behind us.

Many struggled more after the surge and continue to struggle because during the height of the pandemic there was almost no time to really process and absorb the magnitude, it was crisis survival mode, and there has been a lot of suffering in the aftermath, which is not behind us, and now further magnified as we enter the much dreaded second wave.

That said, there is light at the end of the tunnel and now we work actively towards not getting "COVID fatigue" and letting our guard down as we've entered the middle of this marathon. This pandemic has definitely made us "ElmurstStrong" and much more united than ever before and I really credit our leadership, at the departmental levels, the hospital level, and at H+H for sheparding us through this, having true leaders at the helm who encouraged bidirectional collaboration and input from all, and continue to work to move us forward with an understanding of the need to continue to support our staff, now and for a long time to come as we all work to recover from the toll of COVID-19 on healthcare workers.” 

The Helping Healers Heal Program, developed at New York Health + Hospitals is a nationally recognized program, copied and adapted all over the country.

While we must recognize that from nursing homes to large academic medical centers to rural hospitals and community clinics, from urban centers, to remote indigenous reservations, to prisons, and farming communities, frontline doctors and health care workers struggle just as Dr. Bentley has so profoundly described…everywhere.

It is very easy for all of us on the outside of the walls of hospitals, nursing homes, and clinics to on the on the one hand, show appreciation and support for our workforce on the inside.  It is a bit harder, but essential for all of us on the outside to recognize these facilities as workplaces where organization and relationships determine successful outcomes for patients.

At the same time we must understand that both resources and strong institutional support for a workplace environment which includes space for learning and collaboration is as important as anything else.

Too often, the workplace is only seen as a place which produces products and services.

Workplaces are where human beings reside for much of their lives.  To cross the threshold of the workplace should not mean a separation of life outside of work and inside of work.

Dr. Bentley and the millions who serve each day in the healthcare workplace see little difference on either side of that threshold. 

We will all be better off as a society when we live in one where work is supported as our collective foundation for a more humane social experience overall.