A former combat pilot and emergency room physician, Dr. Stephen Markovich knows a thing or two about performing under pressure. And those traits have certainly been tested as the president and CEO of Columbus-based OhioHealth has guided the 12-hospital system through the COVID-19 pandemic. He established an incident command center that meets daily and said he’s given his leadership team the autonomy they need to create a plan that’s flexible and adaptable. Markovich spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.
MH: You are a month-and-a-half away from your one-year anniversary of taking over at OhioHealth. Obviously this is not how you expected your first year to go. How has the pandemic tested your resolve as a leader and how has it affected your leadership skills?
Markovich: A year ago, I probably would have been in (the) incident command (center), potentially even running the incident command process. And I knew when this thing kicked off, I was going to need to elevate this. I’m in a different role now, a different job. And so this was a chance to mentor and develop some of my more junior folks; give some folks a chance to shine and spread their wings. That was probably the biggest thing … my natural tendency was to want to go deep, and when you’re in the CEO chair you can’t do that. You’ve got to have other folks doing the legwork.
MH: Talk about the incident command center. Was it in place even before the pandemic started?
Markovich: We have an incident command process that we would use for any emergency, mass casualty fire, major power outage or disruption. But this was on a different level. We saw it coming, we stood it up fairly early. We were probably three weeks ahead of a lot of other organizations that I talked to. I set out about eight clear goals for everyone.
First and foremost, focus on the mission. We’ve got to take care of our patients. We’ve got to take care of our people because without taking care of the people, we can’t accomplish the mission of great patient care. And when I say take care of our people, I mean, physically, psychologically, economically. We needed to be thinking about it from all those different parameters. We had heard already from the East Coast and other major metro areas that (personal protective equipment) was going to be a challenge.
We knew that how we relate to government officials and the bureaucracy of public health was going to be important. How would we communicate with our patients? We knew that they were going to be afraid, they weren’t going to know what was going on, they weren’t going to understand this infectious disease process. And then in the big picture, we knew over time, we’re going to need to repatriate all these folks that were having their procedures delayed. And while all that was going on, you had to calmly put it in the back of your head, what if the really, really big disaster happens?
It forced a new level of collaboration. The four major health systems in central Ohio got together, and we said, “Listen, if we’re going to have to do a big major, almost a combat casualty collection point, let’s do it together, let’s not do it alone.” And so we went to the county commissioners and the (Ohio Emergency Management Agency), and started on the idea of how do we take the convention center and turn it into a thousand-bed hospital. And while we’re doing all that, you’ve got to have your finance team saying, “OK, what different scenarios can play out here? What options are available? What levers can we pull? What government and federal opportunities are available to help us out?”
All those things were happening at the same time.
MH: Your incident command center is meeting daily. Who’s involved? How do you set priorities?
Markovich: We made the decision fairly quickly that my senior team—the core senior vice presidents and above—were going to try to fly above the fray as much as we could and let the folks who were the content experts and closest to it step up. And we really looked at it from three perspectives. At the early point, there was the traditional hospital operations—PPE, meal service, security, supplies. You had clinical operations. What are the policies and procedures we’re going to put in place to keep people safe? How are we going to distribute ventilators? What are we going to do to communicate? And then you had HR … like many other systems, we saw big falloffs in ER visits. Elective surgeries went away, joint-venture surgeries went away. So as the volumes are falling off, you’ve got 30,000 or 35,000 members of your workforce that you’re trying to manage. How do you redeploy them?
It was a challenge, but we had a great team that stepped up. At that vice president level, those eight or nine functional areas that ultimately were the key leaders—whether it was communications, facilities, HR, operations, physician leadership—came together and they would meet basically 24 hours a day. And then at least once or twice a day, the senior team would (connect virtually). Our job was to break barriers, to unleash them and get those silos out of the way. You have to basically say, “Listen, we’re going to let go of a little bit of control here to keep the process moving, because time is your enemy.”
MH: You say break down those silos, but yet you’ve got a centralized command center. How do you balance operating things from a system level, but let your individual facilities operate as they need to based on their caseload?
Markovich: You’ve got an incident command at every campus. You’ve got an incident command at the headquarters, let’s call it. And then you’ve got the senior leader team above that. The senior leader team creates the vision—here’s the expectation, here’s what we’re trying to do. Cascade that down … their job is resource allocation, establish bumpers, establish guidelines and rules, and then let those campuses do their thing within those parameters and report back when they hit obstacles, report back when they hit barriers. Whether it’s PPE or they learn something that happens at that campus—they can bring that up to the centralized incident command center and then we distribute it.
I’ll give you a great example. We learned quickly that nurses were going into rooms to adjust IV poles. They might have to change an IV out or adjust it. They were having to put PPE on and off and enter the room just to adjust the pole. And one of our hospital leaders said, “Why don’t we just get longer tubing, keep the IV out in the hallway so that people don’t have to actually go into the patient room?” As soon as we had that, let’s lateralize that as quickly as we can, so that everybody’s doing it. And all of a sudden you’re conserving one of your most vital resources, which was the protective equipment.
MH: If we start to look at another surge, maybe in the late summer, early fall, are there some key things that didn’t go the way you thought they should?
Markovich: A couple of great big lessons we learned early and I sort of expected with our culture is that there is a value in being in a big system. What we would call the power of systemness; the ability to leverage those lessons learned from across the campuses. The other thing that is hard—it doesn’t come naturally for a lot of people—is you really do have to trust your people and recognize that you’re operating in an imperfect world. You’re operating in a world where your knowledge isn’t perfect. You may have 80% of what you need. Normally you’d have a team that puts together reams of data and PowerPoints, and you think through every decision and all of a sudden, what in the past might have been 15 people around the table becomes two people standing up in five minutes saying, “OK, based on what we know, here’s where we’re going to go.”
You’ve got to support people who are in that kind of situation and recognize that the environment is fluid, and you’re going to have to adapt. You may have to change what you did yesterday (because it) may not work today. It’s constant disruption.
MH: You’re a former combat pilot and ER doctor. How did those experiences help you in this crisis?
Markovich: I’ve always thought there’s a clear alignment between what I did in my previous career and then in healthcare. It’s very mission-focused, very focused on people. When you take a single jet and get it into combat, it took thousands of people to make that one thing happen. Healthcare is very much the same. Very much a safety-driven culture. You get into elements of leadership, dealing with critical resources, time management. All those things correlate very highly with what I used to do and what we all have to do now.