When Dr. J. Stephen Jones took over as CEO of Inova Health System two years ago, he didn’t imagine that his plan to reshape the organization would be disrupted by a global pandemic. But Jones, who came to the Virginia-based health system via the Cleveland Clinic, says that creating a more integrated system has positioned Inova and its five hospitals well to confront the expected surge in COVID-19 cases in Northern Virginia. Jones spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.
MH: You launched a coronavirus task force and command center in January. What led you to take action so early?
Jones: I think it’s in our DNA to have an abundance of caution. Dr. Stephen Motew, our chief physician executive, at some point in January said, “We’ve talked about this a couple of times. I’m watching it and I think at minimum we ought to get a group together and start scenario planning just in case.”
At the time, it felt like we were overreacting but certainly now, thank goodness that we did what we did because we are in about as good a shape as anyone. Frankly, I think we’re in better shape than anyone that I’ve spoken to in the country as far as our level of preparedness.
I remember teasing, “I hope at some point I have to explain to the board what a dumb decision this was for us to make.”
MH: How is the command center structured? How has its work evolved?
Jones: We were on a journey (before this) and had made significant headway to becoming a fully integrated, unified health system from a former model of mostly being a holding company. I made clear from before I was named CEO that was the direction that we would go. That allowed us to come together as a system in a way that if we weren’t truly integrated we couldn’t have.
The other piece of that is we embraced the concept, which is to me self-evident, but certainly a tenet of the Institute for Healthcare Improvement and others, which is deferral to expertise. I’m a big believer that all of us are wiser than any of us. We brought people together and we’ve made and created an environment that allows people to lead and to speak up without fear. Seeing that team come together across the organization has been probably the most gratifying thing in my entire career.
Every day, someone who’s not the CEO comes forward with an idea that moves us forward. A great example: We’re starting to use iPads in the ICU so that we can communicate with patients without going in and out and that their families can communicate with them, especially considering how much we’ve had to limit visitation. Some of the speakers on the iPads aren’t adequate, especially for some of our elderly patients who are hard of hearing. And there’s a lot of noise in an ICU.
When we looked into our supply chain activities—buying speakers for iPads is not very high on the list compared to buying personal protective equipment and ventilators—someone spoke up and said, “HR has a bunch of speakers that we gave away a couple of years ago for employee appreciation day. There’s still a bunch up in the closet. Why don’t we go get those?”
Our head of informatics noted that pre-COVID it might have taken us six months to go through a process to decide whether to do this. We did it in about six minutes.
MH: Are there other examples that stand out?
Jones: It’s been incredible how every person becomes a member of the care team in some way. Our respiratory therapists, who are often unsung heroes, are teaching others how to assist in the management of ventilator patients. Physical therapists learning from respiratory therapist how to take care of ventilator patients. No one would have thought of that.
Our facilities team, which is not exactly the front line of clinical care, realized that if one of them became ill they would have to cover each other. A month ago, they come forward and said, “We’ve just cross-trained everybody. We made sure that everybody knows, whether you’re at Mount Vernon or at Fair Oaks, where the shutoff valves are and where the electric boxes are and all the critical things.”
Because we were prepared early on, it allowed us to stop and deal with other things … we weren’t still trying to figure out where our masks were.
MH: There are probably a lot of ideas like that coming up. How do you manage that aspect of this crisis?
Jones: The groundwork that we had done to become a fully integrated system and change our operating model … means that we have people truly connected. They know who across the system has the right expertise, as opposed to any of the executives saying they always have the answer.
I’ve been very candid with our team. I film a video at least once a week to communicate with the entire organization that there’ll be times when we aren’t going to agree on an answer, but (we’ll be) getting all the voices in there quickly and respecting the fact that it’s safe to have an idea.
MH: Estimates suggest that Northern Virginia will see a spike sometime around the week of April 20. Have you done an analysis of what that looks like for Inova?
Jones: Our teams started working on those (models) probably in late February. What I’ll say about the models is they’re all based on historical data. There’s no more than about 3½ months of data. There are variables that we don’t know about, including social distancing. My personal belief is the models are helpful and they give us ideas, but … our assumption is that they’re probably not going to be anywhere near as accurate as people hope they’ll be, and that regardless of what happens, we have a responsibility to ensure that we can provide care whether we never get that big surge or the surge is bigger or quicker.
MH: Have you been able to think about what a return to normal, or semi-normal operations will look like?
Jones: I’ve tried to make sure that my focus continues to be balancing the present and the future. The only reason I can do that is because of what I’ve described as an extraordinary group of people who have come together as a team that I trust more than I would have ever imagined any CEO could trust any team.
Every six weeks, we brought a group together and they were a guiding coalition (on our transformation). We were due to have our next check-in (recently) and it became clear that we weren’t going to have four hours to go over to one of our campuses and be in person with each other. I made a decision based on a lot of people giving me great advice that … we were going to take 45 minutes with that group. I was upfront with them: “A lot of you are probably thinking that you have a whole lot of other things you need to be dealing with right now and the last thing you want is to have me take 45 minutes of your time, but that tells you how important I think your leadership is, and so I’m going to ask you to give me 45 minutes … I need you to be your best as you lead this organization forward.”
The reason I bring that up is I told that group, “We will not go back to what the world was just four weeks ago. We will not return to a post-COVID world.”
We need to understand that—even (with something like) telehealth where we went from seeing 100 patients a day to now several thousand a day in a matter of weeks. Someone used the phrase that we’re not going to put that toothpaste back in the tube. How we make decisions now will set us up for what Inova will be well into the future. We’re trying to make sure that everything we do right now is not to get us through the day, but to have us be the organization to thrive when we move into whatever that very different post-COVID world will be.
MH: What kind of financial analysis have you done on the impact of COVID-19 on operations?
Jones: Our primary focus has clearly been on patient care and ensuring that we protect our team members.
There’s no doubt though that this is a significant financial challenge. You’ve heard … people describe this as a war. But unlike most situations where if you have a war, you arm the people who are rushing into battle, here it’s exactly the opposite. The warriors rushing to the front lines, putting their own health at risk, are frankly being told you’re responsible for protecting yourselves, for having your equipment. Of course we take care of that for them. At the same time, as opposed to having more funding to fight that war, you actually have probably a 40% to 50% drop in your finances to have that war.
MH: Do you foresee any furloughs coming up for Inova?
Jones: We have fortunately not had to do that. We’re currently looking at how we ensure that the organization is healthy and able to take care of our patients for the long term.
Although we certainly appreciate the fact that the CARES Act has $100 billion dedicated to healthcare, I think we should be honest with ourselves, that is nowhere near the financial impact on the industry.
Fortunately, we’re a very strong system. There are plenty of our colleagues around the country who live on such thin margins that realistically, they’re going to be in serious danger. So the quicker that our elected leaders and others come together to ensure the health of the entire healthcare system, the more likely that all of us are going to continue to provide the care that people need.
You’re seeing systems saying they’re taking $2 billion hits. It doesn’t take a mathematician to see that if they have a $2 billion hit, it won’t take very long in a country as large as ours to get to $100 billion.