In this episode of Fireside Chat, we sit down Warner Thomas, President and CEO, Ochsner Health to talk about communication during COVID-19 and leadership in crisis situations prior to the pandemic.

Please note: The number of COVID-19 cases and the situation referenced in this episode were based on reported data at the time of the interview and are subject to change.

Transcription

Warner Thomas 0:02
You’ve got to adapt. It’s not about reacting. It’s about adapting to whatever the situation is that’s thrown at you and you may have a plan and this afternoon you may have to change it because you get new information and you may have to change it tomorrow because you get new information. And so, your game plans have to adjust and roll based upon what’s happening with your team. And with the environment and the market around you.

Gary Bisbee 0:27
That was Warner Thomas, President, and CEO Ochsner Health, recalling one of the lessons learned from the 2005 Katrina hurricane that the Ochsner team drew on during the COVID-19 crisis. I’m Gary Bisbee, and this is fireside chat. Ochsner Health has grown successfully over the last 10 years, and Warner spoke about potential consolidation opportunities following the crisis, as health systems find themselves in difficult financial positions, or they believe that they need to be part of a larger health system to mitigate risk during the next crisis. Warner discussed the rationale for aligning leadership physicians and employees during a crisis. He also spoke about the importance of communicating regularly with the community, media, physicians, employees and the board of directors to provide up to date news particularly during the COVID crisis when information has been sketchy. I’m delighted to welcome Warner Thomas to the microphone.

Good afternoon Warner, and welcome.

Warner Thomas 1:27
Hey, thanks, Gary. Appreciate the opportunity to chat with you.

Gary Bisbee 1:29
Sure thing we’re pleased to have you at the microphone. We’ve learned that the surge is highly variable by region, what’s the status of the surge in Oschner’s primary service areas Warner?

Warner Thomas 1:41
We’ve definitely seen a continued decline in COVID patients. I would say our peak was very late in March, probably around March 31, or April 1, where we had nearly 850 COVID patients across our entire system. Today that number is down to about 360. And down from last week, it was probably about 480 patients. So we’ve definitely seen a marked decline over the past couple of weeks. And really positive news is that we’re seeing more and more patients discharged successfully to go home. We’ve now discharged nearly 1900 patients who are COVID positive to go home. I think that that’s really heading in the right direction and becoming a much more manageable situation than just a few weeks ago.

Gary Bisbee 2:29
Yeah, that’s excellent. Governor Edwards has a stay at home policy until May 15th. And then potentially businesses opening after that. Does that feel about right from your standpoint?

Warner Thomas 2:41
I mean, that just happened yesterday and that they extended the shelter home through May 15th. New Orleans had already extended to May 15th about a week or so ago and I think it does feel right. Once again, these are moving targets. I think we have to see how things play out over the next couple of weeks. But we have seen continued declines in the number of cases we see certainly, as I said, a marked decrease in the number of patients that are in the inpatient arena. And I think a really a lot of that has to do with the social distancing and the shelter at home and also much better testing capabilities, faster results, which has really helped us to know whether folks are positive or not and if they are to get them quarantined timely and effectively. So, I think there’s a number of things that are heading in the right direction that are kind of helping us head towards getting more reopening after May 15th.

Gary Bisbee 3:35
Let’s come back to the whole COVID situation in a moment but first, you could share with us, Ochsner Health most of us are familiar with Ochsner but give us an up to date view of where Ochsner is today, Warner?

Warner Thomas 3:48
Sure, we really span all of Louisiana cover all the major markets throughout Louisiana, also extending the Mississippi Gulf Coast and have operations there. We really attract patients throughout the entire Gulf south and take care of patients and now attract them nationally as well. We took care of folks from every state in the United States last year and about 70 countries from around the world. So kind of a true destination center. We’re kind of based or grounded at the core with our auction clinic group practice. We have over 1500 physicians in our group. And we have besides our operations in New Orleans, where we have our flagship Ochsner Medical Center campus, we have about 40 owned managed and affiliated hospitals throughout the entire region. So we span a pretty large area we have about another hundred and 30 plus ambulatory care sites around the region as well.

Gary Bisbee 4:45
A major health system you’ve done a terrific job Warner, ins growing Ochsner Health through your time there. Congratulations. Why don’t we go back to the Coronavirus situation? Communicating with your communities and your caregivers are obviously all-important. How have you thought about communicating with your communities? What sources have you used?

Warner Thomas 5:08
We really have been very focused on communicating and upping our communications when this all started several weeks ago. And this is certainly a lesson we learned from Katrina as well. When you’re going through this type of situation, you have to significantly ramp up communications. We went into twice a day calls with our leadership team throughout our entire system. We started twice a week calls with our board members to keep our board up to date. We also, given the magnitude of this in our communities, we started a weekly call with all of our partner hospital boards. We started a weekly call with business leaders around the region, and also a weekly call with media. And I think this really helped to create a lot of transparency and a lot of insight as to what was happening because one of the challenges of COVID, there was so many questions. People didn’t understand what was happening. They’d hear things in the news and they weren’t sure what was happening in their community. So ramping up that communication internally and externally, I think really has created a lot of goodwill and a lot of trust. The other thing we did internally is we went into weekly management. So our entire management team, WebEx’s and we started a number of employee forums and physician forums once a week. So it seems like a lot and it is, but the fact the matter is, if you don’t create alignment with your leadership, your physicians, and your employees, it really is a real problem. And so we’ve had a great alignment, people really appreciate our transparency. And because of that, I think we’ve had a great response and a great outcome as we’ve come through this crisis.

Gary Bisbee 6:51
What’s the morale been among the physicians particularly back when you had 900 COVID patients in your facilities?

Warner Thomas 6:58
Morale has been positive. I think they viewed our response as being very effective. When we were ramping up…when we started this, we had about 275 ICU beds, and we had to ramp up another 120 ICU beds literally in two weeks. So moving patients around moving staff around redeploying people, we got it done. And we never were in a situation where we ran out of beds or ran out events or ran out of PPE or anything like that. But that enhanced communication, and the ability to move quickly and to get our teams to move quickly, was, I think a key to our success. And because of that, I think we’ve come through it with physicians feeling pretty good about where we are, employees feeling good about where we are and the same with our management.

Gary Bisbee 7:43
You mentioned testing earlier, and that’s been spotty throughout the country. For those of you that have been at the epicenter of the surge, that seems to have been a bigger problem. How was it in your service areas?

Warner Thomas 7:54
I would say it was a huge issue early on when we first started this, all the tests had to run through the state public health department. Turnaround times and results took many days. And the criteria to test were very, very limited as far as the number of tests we could do. Once we brought testing in house, which we did probably about two weeks after this whole process started and we worked with Abbott Labs to bring the PCR testing in house. I think that really opened up a lot of opportunities to take better and quicker care of patients, quicker care of our staff, and really has been frankly a godsend to us. Since then we’ve added the ID now testing kits and we’re testing every patient that gets admitted to our facilities or comes in for procedures or is immunocompromised like our cancer patients. And just last week, we had an antibody testing so we now antibody tested about 9500 of our employees and not that that’s the be-all and end all test from I know some people say the immunity test. Which we all know it’s not. But it does give some level of comfort or caution to folks that get the results. If you’re positive, you know, you’ve built some antibody resistance. If you’re not, you need to continue to be very vigilant as you’re protecting yourself. So I think it’s created some level of comfort and I think our employees appreciate it. We’ve made their investment in them to get that testing for all of our employees. And we’re about a third of the way through that process, and we’ll get that done over the next week.

Gary Bisbee 9:28
Excellent. Good timing on that. What about the supply chain for PPE? You mentioned you never actually ran out of PPE, but I’m sure that the supply chain was a challenge.

Warner Thomas 9:39
Yes, I mean, the supply chain was a huge challenge and whether it was working with Vivian to identify sources or working with Owens minor, I would say that Owens did an amazing job working with us to identify opportunities to get PPE. We also like many organizations or Innovation Group and our Supply Chain group got involved locally with some companies who helped us to make face shields. We 3d printed the first one and then got it manufactured locally. We work with a local clothier, who helped us make surgical masks and surgical gowns. So these are things that, once again, you can’t train for these things. These are things that folks, they either have this type of innovation and this type of leadership or not. And I’m proud of our team of how they’ve handled that. And because of that work and that creativity, we never ran short. I mean, we did have to do some conservation, when we were at the height of this situation, but I would say compared to what I hear it a lot of other organizations, I think our team and our organization did well.

Gary Bisbee 10:42
Yeah, I’d agree with that. From what I’m hearing, some are saying that there’ll be a “re-surge”, if you will, in the fall, are you feeling pretty good about testing, PPE, and so on if this does come back to some degree in the fall?

Warner Thomas 10:56
I think we’re much better prepared today than we were seven or eight weeks ago with testing, knowledge, and how we would approach this. So, I think we’re in a better situation. I mean, certainly, I think we all worry about a resurgence. And that’s why data understanding where we’re seeing an escalation of cases, speed of deploying testing teams, working hand in hand with our government officials, our business community to make sure we’re taking the proper approach and how we handle this going forward is going to be critical. The health systems play a huge role in being stewards and advisors of this process and helping our government officials and others think through how to approach this. We look forward to that opportunity. I think we will be a big resource to people. But yeah, I certainly do worry about it. I think we’re in a better place today. But we’ve all got to be vigilant and make sure we stay prepared. Should this escalate again.

Gary Bisbee 11:56
Right. You mentioned physicians earlier. How many physicians did you need to redeploy?

Warner Thomas 12:01
I don’t know the exact number off the top of my head. But I would say we had a couple of hundred that were certainly redeployed in a number of different ways into other areas. And whether it was anesthesiologist that helped cover a critical care unit or some of our surgical specialists who had that appropriate ICU and ventilator knowledge to be able to redeploy and help in those areas. There’s a number of different folks that moved around to help us address this peak, which was very challenging. I mean, you may or may not be aware, but New Orleans was the second-highest per capita number of cases in the country, second only to New York. So it really hit this region hard, and certainly was a big challenge for us. But I think we, we responded appropriately. I think the other thing was critical. As we went through this, our health research folks, were very, very critical to take the information that was available publicly. And we got together with the other hospitals in New Orleans and shared all of our ICU all of our ventilator patient data, all of our med surge data. And we were able to predict with pretty good specificity if there was an r naught a three or have to or have 1.5 or 1.1, as the r naught kept dropping after we did the shelter in place. We did a really good job of predicting over two weeks in five weeks what we thought the census would, would be, and that was critical to our planning and I think we really did a good job for their health research folks and did a good job pulling the other hospitals together in New Orleans to take this planning on directly and it really made a big difference as to how the city responded to this situation.

Gary Bisbee 13:49
Well, kudos to them. It sounds like they were right on top of it. Talking to your peers or CEOs…the stress on physicians, nurses, caregivers, they are concerned about it from the standpoint they think this is something you really need to pay attention to not only just now but in the future, how are you thinking about that caregiver stress Warner?

Warner Thomas 14:12
There’s a lot of stress in caring for the COVID patients, it was a lot of fear. But what I saw is not people running away from it. I saw people running to it. They wanted to make sure they had the right protection and the right PPE and the right support behind them, which who could blame them for that? But I saw our people lean in- not run away from it and that was really just rewarding to see and to watch. And then the fact that our corporate teams and supply chain and as we had to convert and open another 120 ICU beds, our biomedical folks, our people in our construction areas. IT, just all stepping up literally working 24/7 to get beds converted, to get equipment in place to be there to support the frontline teams. We redeployed a bunch of our clinic staff; medical assistants who essentially became certified nurse assistants working with our nurses on the COVID units to help give them the support they needed or help be runners for supply chain or PPE needs. So it was an amazing team effort. And I think there was a lot of stress as we went through it. But there was a lot of really positive feelings and a lot of rewarding activities and rewarding behaviors that I think people will look back on this and saying, that was a pandemic. That was a crisis, but it was also our day to shine and a lot of people and a lot of organizations really did shine through this process.

Gary Bisbee 15:48
God bless them from my standpoint, they deserve gratitude on all our parts. Let’s think about telemedicine for a moment, which others have reported huge increase usage in telemedicine. How did that fit into Ochsner’s plans?

Warner Thomas 16:03
Same with us. I mean, we last year, in the second half of the year, we did about 3600 telemedicine visits. Today we’re doing 4000 a day. So I mean, it’s been a huge uptake. And it’s been, I think, a real positive thing for our patients who are being cared for in a new way and like it. And adoption from some of our physicians was a little more challenging, but now that they see how this works, they absolutely are adopting and we’ve seen great feedback from our physicians as well. So it has been a huge ramp up, no doubt about it. But I would say it’s been a very positive situation both for our caregivers and for our patients. I think that’s a trend that is not turning back. Frankly, I think you’re going to continue to see that type of technology used and used in a bigger way. And I think that’s a positive. I think it’s a positive for the industry, I think that’s a positive for patients specifically and we are absolutely continuing to focus on how we ramp up telemedicine with new approaches and new ways that we can provide care to our patients and new specialties that we can provide to our patients via telemedicine.

Gary Bisbee 17:19
It seemed like CMS in the states relaxed regulations. How helpful was that in this increased usage?

Warner Thomas 17:26
It was really helpful and relaxing the regulations and paying the same fee? Right. So whether you’re seen in a telemedicine visit or seen in person, certainly if it’s something you can do via telemedicine, I think to have the same fee be reimbursed. I think that’s a big step in the right direction if we really want to accelerate telemedicine. So, I think those changes that were put in place were absolutely a key to success in the changes.

Gary Bisbee 17:57
Turning to the Ochsner o bar which we need to have You describe for us, but I was wondering if that played during the surge to

Warner Thomas 18:04
The O bar specifically probably was not a big factor during the surge itself. But I would say the fact that we had digital services put in place with patients prior to this situation, and the fact that we essentially have built digital medicine capabilities for hypertension and diabetes that have been in place for well over 10,000 patients, these are folks that their chronic disease care, never missed beat folks that are on digital medicine that allow us to care for them from home, continue to get the same level of care if you were not on a digital medicine solution for chronic disease, then yeah, I think you took a step back as you went through this process because you couldn’t come in and be seen. So I think this is where it’s so important that we continue to educate people and ramp up technology. Like digital medicine, like telemedicine because frankly, that’s how we need to be taking care of patients going forward and make it easier for them and take care of them where they want to be.

Gary Bisbee 19:12
Yeah, I agree with that. Well, that’s a nice segue into elective and urgent surgeries. When did Ochsner discontinue elective surgeries?

Warner Thomas 19:21
I don’t know the exact date it was sometime probably in early March that we discontinued electives. And we just started back on April 27 with doing surgeries that essentially had been delayed or pushed off that were not emergency surgeries and that we felt we could push off for a period of time. But now those surgeries have been delayed 30 to 45 days and they need to be taken care of. So we rebooked and started those surgeries on the 27th and we’ll continue to expand and grow those surgeries are doing over the next couple of weeks. But once again, I think it’s okay to delay care for a certain period of time. But long term delayed care is not a good thing. And so I’m glad to see that we’re able to get back and take care of patients that need that care.

Gary Bisbee 20:08
Warner, you’re in the unique position of having lived through the whole Katrina crisis in 2005. And now here we are, again, with this crisis. Any lessons from Katrina that you can apply to the current crisis?

Warner Thomas 20:23
I think so. I guess number one, and I got asked about this during Katrina. And I would just say that, first of all, how you respond to a crisis is all going to be about do you have good people? And do you have a good team? And if you do, things go really well. And if you don’t, things become really challenging. And I would just say our team has shined through this whole process. Our team shined through Katrina and our team shined at both of these events because they were talented. They’re good leaders. They communicate well, they know how to take action and work independently. And they don’t just have to sit back and wait for direction. And that’s the challenge. When you get into a crisis, you need people to be independent thinkers and to move quickly. And if you don’t have leaders that can react that way, it becomes very, very challenging. So I think the leadership team is number one, that that was critical. And Katrina was critical in COVID-19. As I mentioned earlier, we talked a lot about communication. You’ve got to over-communicate when you’re going through these situations. And I think we did a good job in Katrina and have done the same in the COVID-19 crisis. And I think the third thing and this really comes back to leadership as well, you’ve got to adapt. It’s not about reacting. It’s about adapting to whatever the situation is that’s thrown at you and you may have a plan and this afternoon, you may have to change it because you get new information. And you may have to change tomorrow because you get new information. And so your game plans have to adjust and roll based upon on what’s happening with your team, and with the environment and the market around you. So I just think that those are critical lessons that frankly play out in any disaster – play out in any sort of urgent situation. And it really comes back to your people and how they lead.

Gary Bisbee 22:20
Well, let’s move from the good news of leadership to economics, which is not a pretty picture for any of our health systems. How are you thinking about economics, your financials this year in 2020 Warner?

Warner Thomas 22:34
Certainly, it is gonna be very challenged. We had a major hit in March and we’ll get in April. We’ve received some of the cares funds through the first two payments, which will mitigate that to some extent, but it’s not going to fully mitigate the situation. That’s why I think ramping our services back making sure patients know that we’re taking extra precautions to keep them safe, making sure our clinics we’re doing the right precautions to make people safe is going to be critical to come back and to have people feel comfortable coming back into the organization. That’s going to be a process. We’re going to continue to work through all of the opportunities for state and federal funding, whether it’s through FEMA, whether it’s through the Cares Act, or through resources provided through our state government, we’re going to need that help in order to come through this with not too much damage. But that is one of the big concerns I have is what ongoing damage from a resource perspective will this leave on the health systems and that’s to be seen? And we’ll have to watch carefully how the federal funding is distributed into the delivery system.

Gary Bisbee 23:40
Well implied in what you’re saying is that 2021 might be a rough year too, how are you thinking about that?

Warner Thomas 23:47
It could be I think a lot of it really depends upon how the overall economy comes back. If we see ongoing high unemployment, which we probably will that’s obviously going to challenge health systems as more and more folks are not in commercial insurance and they’re in Medicaid or being uninsured. So I think it is going to be an ongoing challenge for all of us to keep thinking about how we address that and come through this in an OK fashion. But it’s definitely going to be a challenge. I think every system is going to have to address it a little differently. But we certainly are spending a lot of time thinking about that preparing, adjusting capital plans, adjusting spending, adjusting investments that we’re making, and making sure that we do that to be fiscally responsible, but at the same time, keep looking for opportunities because frankly, in a down market, that’s when there are opportunities that you can capitalize on. And so we’re really trying to look at both of those very carefully.

Gary Bisbee 24:45
Seems like expansion growth is likely to continue maybe even accelerate as certain systems are not as well-positioned economically as others. What do you think about that?

Warner Thomas 24:56
I think we’re going to see probably more consolidation because of this. Because I think you’re going to have systems that were a challenge that is going to be even more challenging now. So I think that’s absolutely going to be part of what we’re going to see is, is more consolidation in the industry in general, and especially in the physician area for a lot of physician groups that are independent that going through something like this. They just don’t have the reserves to make it through this type of event.

Gary Bisbee 25:20
Yep, they’re going to be hard hit for sure. Well, let’s turn to governance. You mentioned earlier communicating with your regional boards. What about your corporate board of directors, Warner, how did you communicate with them?

Warner Thomas 25:31
As I said during our communication section, we started twice a week board calls to keep our board up to date. This really helped to educate them one as to what was happening and two just keep them informed so they could have the right comfort level. I would also say a third benefit of this is especially with our community board members..I mean they have their own businesses, they’re community leaders in their own region, and in their own industries, and I think us doing twice a week calls with them educating them as to what we’re seeing and how things were evolving. It also helped them run their businesses and think about how they wanted to respond to things. So I think I’ve had multiple positive impacts, both for us to get their guidance and feedback, but also for themselves to run their own businesses.

Gary Bisbee 26:19
Have you had a virtual board meeting yet?

Warner Thomas 26:22
We did. We had a zoom board meeting about a week and a half ago. And it was different, but it was very effective. And we certainly got through our agenda had good dialogue, and it was effective. We all are getting used to zoom and various different WebEx capabilities. And it’s a new normal, we all adjust to whatever situation we’re in. And I think we’re all adjusting to this new model of video teleconferencing, using whatever vehicle we’re using.

Gary Bisbee 26:52
One question I’m asking everyone has any tips for a smooth virtual board meeting?

Warner Thomas 26:57
The only thing that’s really challenging, is obviously, the discussion can be very, very challenging. Especially in a zoom situation, you have to try to facilitate the right time period for questions and make sure there are the right conversation and discussion. That’s a little more clunky when you’re on a video than if you’re all in a boardroom. But it certainly can be done. And I also think that making sure you got the right and up to date, technology is important. And also, I think our person that kind of helps me run the board did a great job of prepping everybody beforehand on technology, so we didn’t have any technology issues going into the board meeting. So I think that was great, but no big takeaways that I can give you on the virtual board meeting. I just think it worked well for us and I think was a great way for people to be connected. I do think video is so much more effective versus a phone call. I just think being able to see the person on the other side, being able to read body language. Being able to make facial contact and connection is so much different than just doing a conference calls. I’ve actually just started doing many more of my meetings that way versus a phone call, because I just think it’s so much more effective.

Gary Bisbee 28:13
Good point for sure. Two or three issues that your peers are talking about. Let me cover them with you. If I could Warner, one of them is the global supply chain. And many of your colleagues are saying that we need a more reliable supply chain, particularly for life threatening supplies. How do you think about it?

Warner Thomas 28:31
I agree. 100%. I think you’re going to see collaboratives come together to build more of our own supply chain capabilities in the US. I dont think theres been anything specifically done on that. Yeah, but it’s coming. You’re going to see systems come together and make this happen because I don’t think anybody wants because where we were a few weeks ago, something like civica a type model that is geared towards PPE or the right supply chain components is going to be part of the future.

Gary Bisbee 29:03
Another issue being discussed is the health infrastructure. And I think the general consensus is now that public health is part of the national security enterprise. How do you think about that? And particularly, what can we do to help solidify that going forward?

Warner Thomas 29:21
I think health systems can play a role in working with the state, and even on a federal level where larger organizations were dispersed and operate well, and I’m not sure that the public health infrastructure operates in the same way. And I think we got a couple of ways to look at it. We can complain about it and not be happy about it. Or we can step in and say, “What can we do to be helpful and how can we be part of that solution?” We definitely are going to be part of that solution going forward and want to step in and work with the state. We’ve got some proposals in front of them right now about how we can help on statewide testing, and things like that, which we don’t have to do. But I think we have the capability and it’s going to be a better thing for the state. So I think we need to step up and do those types of things and play our part in public health as well.

Gary Bisbee 30:13
Warner, this been a terrific interview. Thank you very much for your time. I have one final question. And that is that both Mark McClellan and Governor Bob Kerry, when they were at this microphone, were making the point and you’ve referred to it several times today that there will be a new normal, what components of a new normal come to mind, what is it that you think will change?

Warner Thomas 30:35
That’s a great question, pondering that a little bit. I do think that there’s going to be… it’s interesting, I think, one set, you could say, well, people are going to be a lot more careful. And there’s going to be a real reluctance as far as external connection, that sort of thing. But we’re also human and we forget these things relatively quickly. So I do think the new normal though, is going to be around technology into the home and video visits in the home and how we care for people in their home or in their place of work. And so, I do think this idea of not having to just go to the physician or go to a visit is going to be a lot different in the future. And I think the video connections is going to accelerate in a very, very large way, like it has and some of that will die off a little bit, but I think we’re gonna see a really big growth continue in that area.

Gary Bisbee 31:35
Warner you’ve done a terrific job leading Ochsner, congratulations. We appreciate your time today. Thanks for joining us.

Warner Thomas 31:42
Thanks, Gary. Appreciate the opportunity.

Gary Bisbee 31:44
This episode of fireside chat is produced by Strafire. Please subscribe to fireside chat on Apple podcasts or wherever you’re listening right now. Be sure to rate and review fireside chat so we can continue to explore key issues with innovative and dynamic healthcare leaders. In addition to subscribing and rating, we have found that podcasts are known through word of mouth. We appreciate your spreading the word to friends or those who might be interested. Fireside chat is brought to you from our nation’s capital in Washington DC, where we explore the intersection of healthcare politics, financing, and delivery. For additional perspectives on health policy and leadership. Read my weekly blog Bisby’s brief. For questions and suggestions about fireside chat contact me through our website, fireside chat podcast dot com or Gary at hm Academy dot com. Thanks for listening.

Transcribed by Otter