Episode 40:
We Exist for the Public Benefit
Dr. Steve Corwin, President and CEO, NewYork-Presbyterian
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In this episode of Fireside Chat, we sit down with Dr. Steve Corwin, President and CEO, NewYork-Presbyterian to talk about being in the epicenter of the COVID-19 crisis, the heroism of the healthcare workers battling the pandemic and the resolve of people bonding together in a difficult time.

Steven J. Corwin, M.D., is President and Chief Executive Officer of NewYork-Presbyterian, one of the nation’s most comprehensive healthcare systems. Under his leadership, NewYork-Presbyterian has nearly doubled in size, with more than 47,000 employees and affiliated physicians, providing world-class care at 10 hospitals and 200 primary and specialty care clinics and practices. Read more

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Steve Corwin 0:03
But typically health care workers will say I can tough it out. I don’t need help. I’ve been trained to do this. But my response to them has been nobody’s been trained to do this. Because in 40 years of medicine, I’ve not seen this. And I’ve seen a lot.

Gary Bisbee 0:18
That was Dr. Steve Corwin, President and CEO, NewYork Presbyterian, sharing his experience and where the COVID crisis ranked among significant past crises. I’m Gary Bisbee, and this is Fireside Chat. In New York was the epicenter of the COVID crisis and the NewYork Presbyterian caregivers and all employees stood strong. Caregivers saw the unimaginable in numbers of deaths, patients with severe COVID complications, and families who watched your loved ones die on FaceTime because they could not be in the same room. Let’s listen to Dr. Corwin heartfelt comments.

Steve Corwin 0:52
it really stepped up to the plate and we asked them to do the impossible and they did the impossible and that goes for food. Service workers, environmental service workers, up to chairs of departments and senior surgeons, and senior clinicians. It really was remarkable.

Gary Bisbee 1:09
Dr. Corwin had the insider’s view of the COVID crisis and he did not pull punches about the effect on NYP economically, how ICU beds went from 400 to 900 almost overnight, the innovations that were developed in real-time, and the fact that the COVID crisis identified the dramatic necessity of addressing health disparities, social determinants of health and systemic racism. Dr. Corwin detailed the unprecedented sharing of people and intellectual property by other health systems that characterize the strength of this country.

Steve Corwin 1:42
People raised their hands and they were willing to help and provide us resources about people and also intellectual capital. So in any way that we can be helpful to others. Of course, that’s what we want to do. But I think we’re a very good country in terms of people around the country. Recognizing that cooperating with each other is part of the public good that we represent.

Gary Bisbee 2:05
I’m delighted to welcome Dr. Steve Corwin to the microphone. Well, good morning, Steve. And welcome.

Steve Corwin 2:14
Gary, good morning. Thanks so much for having me.

Gary Bisbee 2:17
Pleased to have you have this microphone. As we said, we actually did an interview before COVID and decided not to run it since you hadn’t had a chance to talk about COVID at the time. We’re delighted to have you back. New York City was the US epicenter of the COVID surge within New York. I think New York was the epicenter of it. When was the peak and where are we today in mid-June, Steve?

Steve Corwin 2:42
Well, the peak for us was April 11. And at that point in time, we had a little over 2500 patients in the hospital. Typically our medical-surgical capacity is 3500 med surge beds, and that includes ob so we have About 80% of our hospital. Plus, with COVID patients, we had about 870 ICU patients at the peak. Our typical ICU bed complement is around 450. And we had to expand our ICU capacity to 900. So that was our peak. And it was an incredibly difficult period of time. As you might imagine, we’re now down to about between 10 and 15% of the peak, we continue to slowly come down, and our ICU count is under 100. So starting in the middle of April, we plateaued and then came down. So it feels a lot easier now, obviously, and we’re slowly recovering cases that we had deferred because of the severity of the crisis.

Gary Bisbee 3:49
What are you finding in terms of the patient’s willingness to come into the hospital or surgery care centers?

Steve Corwin 3:56
Well, this is quite traumatic, and I think that as you might imagine there was general trepidation, most particularly coming into the emergency department. So we’re still at about 50% of our normal emergency room volume. Our ambulatory volumes have been coming back. And we’ve stressed the fact that we know how to take care of and protect patients from COVID. I think that clearly is a lesson learned. So the whole idea of protective equipment, infection control, being able to protect patients, being able to make sure that they’re social distancing, being able to transform the waiting rooms to do all the registration electronically beforehand, do all the testing in one shot, things that we all talk about all the time, but we had to do in order to gain the confidence of patients to return and I think we’re slowly getting there. It still will take a while and our physical visit volume is not going to be the same as it was pre-COVID. We’ve crossed the river in terms of telematics. At one point, at the peak of the crisis, 85% of our ambulatory visits were telemedicine. Now we’re at about 85% of our normal ambulatory volume 50 to 60% or physical visits, and then the additional numbers getting us up to the 80 to 85% mark. Our telemedicine so that horse has left the barn. Telemedicine is here to stay as far as my system is concerned, no question about that.

Gary Bisbee 5:26
Just moving forward, how are you thinking about another surge? Possibly this year or next year?

Steve Corwin 5:33
We’d like to see the numbers get down to between the 5% and 10% level, we are preparing for an additional search. So how do you do that? Well, the first is, clearly you need higher stockpiles of protective equipment. So we’ve changed our warehousing we bought a new warehouse so that we could accommodate much more in the way of equipment much more in the way of stockpiles. And it’s not just the personal protective equipment things like dialysis solutions. What your pharmaceutical supplies of sedatives and paralytics are. So that whole range of supply chain has to change. We’ve made decisions to contract so that we fast-forwarded our contracts to that we’ve prepaid over a four to five year period to make sure that we have PP that comes from the United States and Mexico as well as from China. So we’ve diversified our supply chain. So you have to think about that. At the peak of the crisis. We were using 100,000 masks a day. And that was with conservation policies around N-95 portion of the masks are surgical mask and a portion N-95, pre-COVID. We were at 4,000 masks today, and 95,000 surgical masks. So we were using 25 times the level at the peak of the crisis that we were doing pre-COVID when we had done are scenario planning for this type of thing. We were looking at using pp. Two to three times what we would use. So that obviously was an incorrect assumption, we were assuming that the Federal stockpile would step in. And we certainly did not assume the major disruption in the supply chain from Italy, which is a secondary source or from China, which was the first source, given what happened in both of those countries. So we had to really rethink the supply chain, rethink the number of ventilators we have in reserve, and we will have a standard number of ICU beds beyond the 450. So we will probably be in the 600 to 650 range, as a matter of course, and then the ability to move beyond that. The epidemiologist think that the next epicenter will not be in New York, given the zero prevalence in New York, and I’m hoping that that’s the case. And I’m certainly hoping that no other city or town goes through what we had to go through.

Gary Bisbee 7:53
On the supply chain issue, how do we build a more reliable and resilient supply chain for the country, not just that In your particular health system?

Steve Corwin 8:01
I think that despite the fact that we need a globalized world for a whole host of reasons, in my opinion, we’re going to have to have a much more resilient supply chain and diverse supply chain. So you have to ensure some manufacturing to me. That’s inescapable. And that isn’t the nationalist route of saying that everything’s got to be made in the US of A but you realize with this, that clearly, there has to be some onshore manufacturing or diversity of supply chain, not dependent upon one country. So there’s no question about that, as well. I think we have to look at what the federal stockpile is. I think that was clearly inadequate. So that needs to be reevaluated. The presumption there was you would use the federal stockpile to be a stop-gap while there was a minimal disruption in the supply chain. Well, this was a couple of months’ worth of disruption is in the supply chain that’s still ongoing. So you can’t assume that the Federal stockpile was adequate.

Gary Bisbee 9:00
What about the states? Should the states have stockpiles?

Steve Corwin 9:03
Well, I think that we have a system in this country of public hospitals, voluntary hospitals, private hospitals, I would be reluctant to say that the states should have the stockpile. I think individual systems need to be able to adequately stockpile and adequately scenario plans. I think that we’ve had a failure of imagination on this one. I think perhaps we were led into some complacency on SARS and MERS and to a certain extent Ebola and maybe by H1N1. I think we were lucky as a country that we weren’t hit simultaneously across the entire country. Because if we had been, I think that we would have had a far worse result than these pockets of hotspots appearing. I’m ambivalent about whether the state should be the source of the stockpile. I think individual institutions and systems are a better source of that. We just have to rethink the way that we look at it. Just in time supplies, the size of our warehouses. And quite frankly, let’s not have a failure of imagination as to how bad something can be whether it’s a natural disaster like a hurricane, tornadoes, or manmade disasters like terrorist events, I think that we have to assume that our current emergency preparedness perhaps is not quite as robust as it needs to be if you take an extreme example, and this clearly was an extreme example,

Gary Bisbee 10:29
Right, for sure. And it might cost us more to have the kind of flexibility in the supply chain you’re talking about. But it seems like there needs to be a general commitment that we are willing to pay more if it takes that to have this kind of reliability.

Steve Corwin 10:45
I think we have to have that much more reliability there. I think we also have to think in terms of flexibility, the flexibility of the physical structures within the hospital to accommodate issues like this, but also the flexibility of training you know, we become more and more specialized in medicine for good reasons. But that becomes limiting then if you have a crisis like this we redeployed 2000 physicians to buttress our care the patients as well as the ICU care, and we redeployed about 1000 nurses to do the same. So one could surmise in that circumstance, that what you need is nurses that can flow to an ICU and be able to provide ICU care, surgical or nurses, pacu, nurses, etc, things of that nature, and more flexibility in the physician workforce. Should our hospitalist be also trained in intensive care medicine or have rotations through intensive care medicines so that they can fill the breach in these circumstances? We had to develop a pyramidal type of staffing structure to go from 450 to 900 ICU beds, so we had our most capable intensivists at the top of that pyramid, most capable respiratory failure. therapists, nurses, etc. And then we layered in nursing and physicians below that to be able to take that surge of patients on, I think we were able to do it successfully, we’re able to go to a nursing staffing ratio of between one to three and one to four, under that structure with a nurse had a lot of support in order to be able to take care of the four patients. And we were able to have the intensivists take care of six to eight patients at a time under the same guys. We also use the electronic ICU resources which helped us in our smaller hospitals. So rethinking that whole flexibility around staffing, as well as a physical plan that would be helpful for people to think about in terms of how they design their capital and operating plans as they go forward.

Gary Bisbee 12:46
Just listening to you talk about that. Really, it’s a core competency, and quickly scaling up and scaling down is what it sounds like. And I don’t know exactly how we teach that but it does seem like that needs to come to the floor would you agree?

Steve Corwin 13:02
I do. I think that we usually think of these things within our current envelope so that a surge would be from 450 ICU beds in our example to 500 ICU beds or 550. ICU beds, not doubling the ICU capacity. So the question then becomes, okay, if the worst is going to happen, if we have this sort of, imagine a worst-case scenario, what would we do? Then you get into the “Okay, we’re going to need more flexibility to be able to do this.” We’re going to have to build this in so we know how to do it now. We developed those protocols as we went along. We certainly did not know how to do it at the start. But it became quite obvious and probably would be representative of any such similar crisis and these things are never exactly the same. That one of the key things you need is to make sure you have enough emergency department resources in place. resource. Everything else is sort of derivative from those two things. And in certain circumstances, of course, operating room resources. So if you look at those types of things, how can I be more flexible? How can I ramp up? I think that it starts to lead to a planning process that’s somewhat more robust than what we’ve typically done. Now, some of our systems may have done this in a more robust fashion than we did. I think we underestimated what a surge could be. And now I think we were chased by this, we were able to do it. But there are mundane things like, what are the airway protocols across the system? What is the ICU staffing model across the system? Who are the best people that we can identify? How do you redeploy? What do you do with outside resources that have to be brought in? What are your pharmacy supplies? What are your PPE supplies? How do you deal with the supply chain under those circumstances? We had to domiciles for 3,000 employees, either people that were coming in to help us from the rest of the country or employees that were afraid to go home and infect their loved ones or infect somebody that in their family that might be immunosuppressed. We had to identify 3,000 dormitory or hotel rooms, we had to develop a bus service between 50 to 70 buses because we didn’t want our employees to take mass transit. So our facilities group had to construct negative pressure ICU out of operating rooms or pack us, we developed a protocol that was first developed in Seattle, where you can actually extend tubing and the ventilator outside of the ICU room so that you could conserve protective equipment because the nurse Ward doctor or therapist wouldn’t have to go into the room as frequently. So there are all sorts of things that you learned during this debt are not necessarily applicable to every crisis, but boy, you can see a lot of crimes. sees where this knowledge comes into play.

Gary Bisbee 16:02
Kudos to you and your New York press folks in that almost every health system I’ve spoken with, called somebody at New York press to gain your input and your counsel and ideas and suggestions and so on. It seemed like you were the center of ideas throughout the country. So again, great work on your part. I wonder how we develop best practices out of what you did so that other health systems can learn from that?

Steve Corwin 16:33
Well, first, we learn from other health systems as well. I think one of the things that’s very comforting, especially in the country at this point with everything that’s going on the polarization of our politics, and all the negative things happening is that we tend to rally around each other. We had volunteers come to us from the University of California, San Francisco from the Cleveland Clinic from the University of Arkansas, from Intermountain health, just to name a few Mayo Clinic helped us with our ICU. The University of Pittsburgh to help us with our ICU. People raise their hands and they were willing to help and provide us resources about people and also intellectual capital. So in any way that we can be helpful to others, of course, that’s what we want to do. But I think we’re a very good country in terms of people around the country, recognizing that cooperating with each other is part of the public good that we represent.

Gary Bisbee 17:29
So what’s the morale among your caregivers like?

Steve Corwin 17:32
I think it’s been terrific. And we couldn’t have done this without our people. There’s just no question around it. We were scraping by the first couple of weeks with PPE, we were able to get enough PPE but it was a day after day concern. They really stepped up to the plate and we asked them to do the impossible and they did the impossible and that goes for food service workers, environmental service workers, up to chairs of departments and senior surgeons and senior clinicians. If it really was remarkable, having said that the psychological toll on many of our caregivers is profound. And your audience probably knows that one of our respected emergency department leaders, Dr. Lorena Breen committed suicide after having gone home to Charlottesville, Virginia, been hospitalized for depression and then came home and committed suicide. All of which is part of the public record. So not violating HIPAA. It’s a tragedy. And she was a better person than a physician and she was a terrific physician, but the pressure feeling that you’re dealing with death every day, 12 hours a day, people coming into the emergency department, intubated, near death. It was cataclysmic. And a number of our clinicians I’m sure will have PTSD and for Dr. Breen, she went to a very deep dark despondent place which is a tragedy and I feel that every day as a leader I was we were putting everybody on the frontlines in harm’s way, in an unprecedented situation, and they responded, but I can’t imagine having to go through this again. And I’m sure some people would not be able to go through this again, the degree of profound sadness and grief associated with this. Imagine being the clinician in the ICU, let alone the family in the ICU where you can have to say goodbye to your loved one over FaceTime. It’s just incredible and it’s indelible. I’m sure we’ve all had family members, parents pass away. My own father, when he died, I was by his bedside. He was in an ICU quite ill on a ventilator. And my ability to touch him gave me tremendous solace and comfort. I can only imagine what I would have felt like if I had to say goodbye to him on FaceTime, with a nurse or doctor or respiratory therapist or chaplain by the bedside, serving as my surrogate And all of those providers at the bedside felt the same thing. So it was a cataclysm,

Gary Bisbee 20:06
It feels like the stress levels are going to have long term consequences in the sense that you’ll be addressing this for some time to come.

Steve Corwin 20:17
I believe so. And I’m hopeful that a surge will not result in the same level of insult in terms of numbers of patients, etc. I think a lot of people will suffer PTSD after it’s all over meaning Now, some people suffered it during the course of this, some people will probably be immune to and it is going to be a distribution. But I will say that we provided a lot of mental health resources, ongoing support, we’ve been open about it. We wanted to D stigmatize it and we’ve done a lot, but typically healthcare workers will say I can tough it out. I don’t need help. I’ve been trained to do This, but my response to them has been nobody’s been trained to do this because in 40 years of medicine, I’ve not seen this and I’ve seen a lot.

Gary Bisbee 21:08
Moving to telemedicine, telehealth. New York Pres has been a leader, you have the platform already set up. But how did telehealth contribute to NYP in response to the covert crisis?

Steve Corwin 21:20
Well, it was instrumental. So forget about the fact that we were able to see patients who needed to be seen who couldn’t come in or didn’t want to come in via this mechanism and with remote patient monitoring with the oppression of diabetes or heart failure, etc. So that was a godsend in terms of patients who were deferring care because of fear of getting the virus and we needed to see them so that was one aspect. The second aspect was, we were able to monitor COVID patients that we sent home, and COVID patients that we had sent home from the emergency room were not sick enough to be admitted we could send them home with a pulse oximeter With video visits to make sure that they didn’t get worse and if they got worse bring them in. And of course, after discharge, we were seeing COVID patients at home. So in terms of being able to respond to the pandemic itself, it was instrumental in our ability to respond to it.

Gary Bisbee 22:17
So how important was CMS providing waivers in terms of payment, relaxing Physician Licensure requirements?

Steve Corwin 22:24
I think that was very helpful. The governor issued a number of executive orders from the state perspective, which was extremely helpful for us during the crisis in terms of credentialing, etc. We had a credential, a couple of thousand people that were coming in the volunteers that I mentioned from some of the health systems plus people that we had hired as travelers, etc. So easing the credentialing was helpful. I do think that the country as a whole should recognize that with telemedicine, the ability to cross states and the ability to deal with that set of issues was extremely helpful for us. So I think we’ve got to rethink the regulatory framework around this as we develop a national response to a pandemic. And look, the same thing applies to the weakness that we saw in the public health response. We have a patchwork of local, state, and federal responses on the public health side. That’s got to be much tighter. I think we were hampered by the lack of testing capability, the lack of an adequate test, the CDC guidelines about who should be tested. I think we missed the boat on community spread. Certainly in New York, we missed the boat on community spread. And we were testing people who had a travel history and flu-like symptoms from China. We didn’t test people who had traveled to Europe, in the first case that we saw was clearly no travel whatsoever. And we knew we were in trouble because it was community spread. And once you’ve got widespread community infection, then contact tracing is almost moot because you Just there are too many cases you just can’t contact race. And so then you’re dealing with a full-blown out of control pandemic, which hopefully, we will not see in other parts of the country. And I know people are keeping a close eye now on Euston on Phoenix. I know that people are weary of the social distancing the mask, no mask has become politicized, which is absurd. It’s helpful. I know that people would like to get out and about. I know that opening-closing has also been politicized. But the harsh reality is in the absence of effective therapy, or the absence of an effective vaccine. This is the only weapon we have. And 200 people congregating in outside of bars in New York City, or people congregating in a pool and Lake of the Ozarks. That’s not a good look. And once there’s enough community spread, then it becomes out of control. And yeah, if you’re young and healthy, the likelihood is less that you’ll get severely ill but do you really want Want to spread it to everybody else? So I think we’ve got some soul searching to do as a country to make sure that we get through this first wave, let alone a second wave, and that we don’t cause permanent damage to the economy by opening up in an insensitive way, perhaps even negligent way.

Gary Bisbee 25:17
Right. Well, it’s other than just listening to you that public health is part of the national security at this point. I don’t think we’ve thought about it. I think we probably thought CDC was all it took. But clearly, we need more than that. Wouldn’t you agree?

Steve Corwin 25:32
Yeah, I would agree with that. And I think that we’ve always held up the CDC is the paradigm of excellence in the world. I think that we need some work to do there. You have to fund these things adequately. I think some of the defunding around the national response to pandemic was hurtful here. I think that the CDC underfunding was probably hurtful here. I do think that you need an organization like that, who despite its flaws, We did have representation on the who pandemics don’t know country barriers, zip codes red or blue, the virus doesn’t distinguish. And so you need worldwide responses and you need worldwide organizations as well as a much more robust public health structure within this country.

Gary Bisbee 26:20
Turn to the economics for a moment, which is not a pretty picture for any health system around the country. I can’t even imagine what it’s like in New York Pres. But what will the effect on NYP finances in 2020 be Steve?

Steve Corwin 26:35
Very substantial. Even with federal aid, we anticipate losing up to a billion dollars billion with a beat. And that’s a combination of things that were deferred volume coming back more slowly the pandemic itself in terms of the care that we had to render in terms of dramatic increases in expenses for staffing for protective equipment, ventilators, and so on. So it’s not pretty I know many places around the country have not seen the devastation of the virus as much as we have, but the lockdown certainly affected elective procedures and surgical procedures, etc. And given the state of how most people will balance themselves, the combination of 40 million people out of work and not necessarily having insurance benefits, the shutdown in terms of surgeries and elective cases, you can easily see that it’s been a problem around the country, as well as for New York. So we’re going to have a whole to dig ourselves out of both as an institution and many institutions around the country. Fortunately, the NewYork Presbyterian balance sheet is such that we can withstand it for a period of time, but I worry about the safety net institutions that can’t and the organizations that do not have the liquidity that we have, because of liquidity problem can become a solvency problem. pretty quickly. So I still think we’ve not gone through that whole cycle yet, Gary.

Gary Bisbee 28:04
Yes, I agree with that. It looks like payer mix is going to have to change, aren’t there going to be more Medicaid patients probably be more bad debt. How are you looking at that?

Steve Corwin 28:16
Yeah, I think you’ll have more Medicaid patients, but I don’t want to sound overly political. But you know, what do you do in a state that didn’t expand Medicaid and so that’s a problem. So people are talking about extending Cobra benefits, but that only goes for a period of time. The second thing is this doesn’t expose the floor. Even if you had expanded Medicaid. It does expose the flaw in block granting This is exactly the situation where a block grant becomes a problem. A severe recession with a lot of unemployment. Now you have the block grant, which is a fixed amount, and now you have x million more people on Medicaid. So I do think we’ve got to rethink Medicaid expansion, I think this is a perfect opportunity to do that. We will have to have a discussion as a country as to how the system finances itself. We finance it with commercial subsidizing Medicare and Medicaid. Do we have to look at that? Again, I think this is a season of politics where you will see a real discussion of what is Medicare for all mean, you have a range of those issues. Now, that will be discussed. Not that they weren’t discussed before. But I think this will exacerbate the discussion. And when you add to that the inequality of the virus in terms of mortality in people of color and lower socioeconomic groups, but particularly people of color that will also influence the discussion. Why was that? Is it social determinants of health? Is it crowded housing? Is it that a lot of people of color are the frontline essential workers that were going to work through this that didn’t have the opportunity to isolate perhaps the way that you are isolated? There are very big questions in If you add to that black lives matter in all the discussions about systemic racism, you can see that the healthcare system will need to address some of those issues, whether it’s health disparities, social justice issues, we exist for the public benefit, and we’re going to have to help in this for the country to heal and for the country to move forward.

Gary Bisbee 30:22
That leads us into leadership, particularly leadership in a crisis. I mean, you’ve mentioned this before, but just to make the point you’ve lived through September 11. the AIDS epidemic, H1N1, the Great Recession, how does this crisis compare Steve?

Steve Corwin 30:36
This was the worst in my lifetime. I think that September 11, was devastating. From the hospital standpoint, of course, we never saw patients because unfortunately, as the towers collapse, those poor souls died. H1N1 was not particularly severe. The AIDS epidemic unfolded over years This was increasing intensity, incredibly devastating, over a relatively short period of time. And I’ve never seen anything quite like it. Every catastrophe, of course, is its own set of sorrows and calamities associated with it. But I’ve not seen anything like this, to be honest with you.

Gary Bisbee 31:18
So what are the most important characteristics of a leader during a crisis of great magnitude like this?

Steve Corwin 31:23
I don’t want to flatter myself in this in any way, shape, or form. Our people pulled us through this. So I think that the reality is that the culture of the institution really is what shows so I think that building the culture of the institution, building the values of the institution, makes the institution resilient, as resilient as one can be in the face of this crisis. I think in the absence of having that core set of values and culture and culture of respect and teamwork and diversity. I think it couldn’t have happened. So I think the groundwork around culture, which relates to these issues around, we have to have real conversations around racism, anti-racism, and we have to address unconscious bias. 50% of my employees are of color. So we have to have those discussions in order to have a culture that’s resilient and respectful. So I think that the antecedent to this is incredibly important to be able to face the crisis. Then I think, you know, my personal belief on this is you’ve got to tell people the truth, you can’t sugarcoat it. You’ve got to tell them what the problems are. I think people see it anyway. And I think people will see through false statements or misleading statements or overly optimistic statements. And you’ve got to communicate, communicate, communicate, communicate. Laura Furies, our chief operating officer had a daily briefing that went out to not only our trustees and senior management went out to the entire institution, and I can’t tell you the number of comments I got from everybody about how helpful that was. How helpful it was for her to explain with our infection control people, the PCP practices. How helpful it was for her to go over the numbers, how helpful it was for her to tell people where we were going, what the city was seeing what the state was seeing. So communication was key. And I also think the way that we structure our command structure, however, you want to call it, the virtual command center. We were meeting twice a day, Laura would run the ATM meeting and a 4pm meeting with all the senior staff and some of the key members of the Board of Trustees. We would go through every specific issue on a daily basis seven days a week while this was happening so that everybody on the management team understood what everybody else was doing. And everybody had specific assignments and everybody was reporting out on a twice a day basis. So that helped an awful lot to congeal the senior management across 10 institutions And close to 3500 beds, 4000 beds. So we really needed to function like a system. And we did. So I think that was important as well,

Gary Bisbee 34:09
We appreciate your time. Let me ask one final question, Steve, if I could. So how does COVID crisis change you as a leader and a family member?

Steve Corwin 34:19
Well, I’ll tell you one thing. It makes you appreciate God’s green earth, and it makes you appreciate the small things in life and makes you appreciate going outside and breathing fresh air and makes you appreciate your family a little bit more, and makes you appreciate life. Because you see so many people die. And maybe, if I’m lucky, it’ll make me a better leader because of the appreciation of those things. I think that we all are grains of sand in the course of time. This clearly punctuates that and I think we recognizing that as a human being, sometimes we especially in leading big organizations are having important jobs or doing any job really tend to become wrapped up in that and missed some of the important things in life. And I can tell you that it’s given me a renewed appreciation for some small things.

Gary Bisbee 35:12
Steve, I think it’s fair to say all of us in healthcare are proud of the work you and NewYork Pres. has done through this crisis. We appreciate your time today. Many thanks.

Steve Corwin 35:21
Thank you, Gary.

Gary Bisbee 35:23
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