By: Ron DiGiaimo, MBA, FACHE, Dr. Louis Potters, MD, FACR, FASTRO, FABS, Ben Adams, Bri Driggers
Operating the 2nd Largest Oncology Department in Metropolitan New York
“In March 2020, we were right there in New York,” Dr. Potters began, “and given our size, I think we as a single healthcare system have cared for more COVID-positive patients than anywhere else in the United States, maybe the world.” Dr. Potters is the Chairperson of the Radiation Medicine Department at Northwell Health, part of the second-largest cancer care department in the New York Metropolitan area, with 22 full-time faculty and 9 different locations across the city. The COVID-19 pandemic hit very fast and hard in New York, with the city reporting over 41,000 total cases at the end of March 2020 and expanding to over 160,000 the following month.
To recall exactly what the United States was facing at the beginning of the pandemic, one must be reminded of how uncontrollable COVID-19 was during the initial lockdown. “When our ICUs filled to capacity, we had to start converting pre- and post-operation areas, auditoriums, and even hospital lobbies into COVID-19 wards,” Dr. Potters described. Northwell Health worked fast to institute safe, improvised patient management practices and interventions and maintain access for patients. Immediate adaptability defined every action taken in early 2020. “There were days where the rules would change almost by the hour in terms of what we were directed to do, but we came through.” Dr. Potters stated, looking back at their efforts, “we were definitely in the heat of battle.”
In spite of it all, Dr. Potters relayed his pride in radiation oncology as a specialty and community. Providing the best possible care while managing issues like limited PPE resources (remember nurses wearing garbage bags due to the lack of medical gowns?) was one of the real and daunting issues provided by the initial pandemic wave, felt more than ever when managing high-risk patients. Chemotherapy, as an example, provided exponential risk with COVID-19, and creating safe processes with patients was always of the highest importance.
With information and practices still being improvised and developed, community resiliency shined. “I’m not sure that any other part of the country has seen the ferocity of the crisis in the same way that New York has.”
Gaining a Greater Understanding of COVID-19 and its Toll on Mental Health
As systemic developments evolved, and our understanding of the disease became clearer, Dr. Potters began seeing encouraging progress. Understanding of the disease increased dramatically over the past two years, with the abilities to care for critically ill patients, tested safety protocols, and of course vaccines paving the way for prepared and stronger care. Unfortunately, as health care systems focused on managing the virus’s spread, elective procedures and clinical trials were affected, which have already shown the beginning of undoubtedly long-term effects in the world of cancer care.
Tiered programs and hierarchy organization for patients based on risk, necessity, and safety of procedures were key to organizing patients during the pandemic. After recovering from what amounted to a nationwide sucker punch in the first few months, Dr. Potters and his team worked to implement such procedures to space out appointments and continue care. Additionally, multiple prescriptive pathways to treatment were inserted, allowing for every unique case to be on the fastest possible track to necessary care. These practices would be the first of many protective barriers against the pandemic that succeeded and helped the United States move towards more efficiently and effectively combatting COVID-19.
However, as cancer care departments and the wider world of health care banded together and worked harder, longer hours, the spotlight turned to inevitable side effects. Higher stress, staff burnout, and fear of contracting the virus were felt by numerous health care professionals, requiring facilities to redouble their staff support efforts while caring for patients. Returning to early pandemic issues, the lack of PPC equipment for medical professionals increased the chances of falling ill or spreading the virus to their families, adding to the stress and mental toll of the time.
The United States stood in solidarity with health care workers, with the nation recognizing and supporting their sacrifices, but within the walls of a cancer center, it became difficult to feel anything but isolation. That is why Dr. Potters and health care leaders around the country are working to provide the necessary resources for front-line nurses, physicians, and all other workers. “One of the lessons for me was the importance of being physically present,” Dr. Potters noted, “spending time with the staff who were in the office really helped us all get through this.” Physical support, combined with efforts to provide meditation rooms, behavioral health programs, and mental health awareness resources are available to this day and will continue to be a focus for organizations.
“Even before the pandemic, we knew that mental health resources needed developing and staff appreciation was imperative.” Staff surveys to determine engagement, cooperation, and personal stress were tested pre-pandemic, and after 4 months in, test results noted higher cooperation rates and overall resiliency.
Additionally, work from home policies contributed greatly to decreasing stress, while still “losing zero in terms of efficiency.” With fluid work schedules, things would get done at all different times of the day to accommodate taking a scheduled afternoon off to continue at home, resulting in the team improving morale and efficiency. While this may appear to cause disorganization with many clinics and teams working at alternative times, Northwell’s No Fly Process, which will be discussed in the following section, has made it all possible and methodical. “Before the pandemic, we may not have had the wherewithal to implement these practices, but now that it is standard policy, we can see the clear positive effects on workflow.”
Adapting Pandemic Practices for 2022 and Beyond
Improvements to preparation, support, and care are the silver linings of the pandemic, with health care being thrust into an unusually flexible state, requiring innovation and improvisation. The headlining changes seeing nationwide adoption are telemedicine and WFH policies, both of which showing value and are currently being pushed to permanence.
Northwell Health has also implemented a treatment error diminishing program called the “No Fly Process.” After many years of development, the No Fly Process was designed to produce unique, interlocking treatment pathways and directives. For a large health system with many different locations across the New York area, this program helps define a Northwell standard of care and informs staff, creating a better sense of anticipation to what is going on within the system.
Production and implementation of the No Fly Process was done almost entirely pre-pandemic, but in 2020, the process played a major role in expediting care and resulted in smoother processes when they needed it the most. It also opened the doors for flexible work times, with a seamless understanding of expectations allowing dosimetry and physics to gain efficiency and work from home. Touching general operations, mental health, and patient management, the No Fly Process was an incredible success for Northwell Health and provided the basis for more system-based approaches to gathering information and improving care.
Telehealth integrations were also made easier by a system-wide process of information and care. Due to a wider understanding of system operations, telehealth is used when needed, like in a follow-up setting. However, with many procedures requiring physical examination, telehealth is being utilized at lower rates in 2022 than in earlier stages of the pandemic. In regard to the future of telemedicine and its utilization, Dr. Potters said that “the process is still evolving, but it’s undoubtedly here to stay.”
Looking back at Northwell’s pandemic response, Dr. Potters believes that “there isn’t much we could have done differently in terms of how our department managed patients.” The difference is now we better understand “how to live and manage crises better, as a natural evolution.”
However, in a broader context, Dr. Potters saw the public reaction and handling of vaccines to be a missed opportunity. “The politicized approach to vaccinations was unfortunate, and the degree to which it happened was a little bit disarming.” Reflecting on how we came together to overcome the pandemic’s initial impact, the unity and ferocity that carried us through may be needed again to end it and move forward.