Ed Mintz, M.D., WG’01, attends patients in the Emergency Department at NYU Winthrop Hospital, and since 2002, has held a faculty appointment in the NYU Long Island School of Medicine. In addition to his medical pursuits, Dr. Mintz has worked in finance and private equity in healthcare-related pursuits. Dr. Mintz lives in Nassau County, New York with his wife, daughter and two golden retrievers.
Today’s interview focuses on Dr. Mintz’s experience at NYU Winthrop during the COVID-19 crisis, and on the innovations that the hospital’s leadership and co-workers put in place as they faced an onslaught of new demands.
How does an urban hospital take on the onslaught of a once in a century pandemic?
Hospitals, historically, are large institutions. Like cruise ships, they move slowly. In the COVID-19 crisis, we had only several weeks of lead time before it hit, and the hospital knew it had to make dramatic shifts in how it operates.
The business model of hospitals depends on elective surgeries, and operative procedures such as cardiac catheterization. When the system is overrun with COVID-19 cases, anything that’s not an emergency is put on hold. Bed capacity is down. Rooms need to be reconfigured. Physical and personnel resources need to be redeployed. The usage of ventilators increased from 10 to 120 at one time. The hospital had to flex like an accordion.
Traditionally, emergency physicians are set up for short-term trauma, the result of violence in the streets or a hurricane. This is a longer-term campaign. When I walk around during my entire shift, I have to keep changing gloves, masks and other protective equipment. My hands get abraded from washing so much. We have the stress of knowing that we are taking a huge hit, losing hundreds of millions of dollars, but we know we have to do right by the community and keep patients safe. We survive with gallows humor and camaraderie — like the rest of the country.
How was NYU Winthrop Hospital able to quickly innovate?
First, the hospital was in a state of emergency, so external factors that impede the decision making are put aside, such as regulatory issues. Normally, if one wants to change a form or a process, one must go to a committee. In this situation, there is a partnership, with the hospital as a public health service where the government says (about a particular decision), “Go ahead and do it” — so the hospital can move faster.
Second, internally, your focus is changed to crisis mode. Everything does not have to be perfect to deliver appropriate care. You can get creative. Engineers can become construction workers. For example, you can redeploy a windowless room and create infection control, by creating a negative-pressure environment. The air flow needs to move a certain way that minimizes the number of viral air particles sitting in one place, pulling fresh air in and pushing bad air out. By varying the speeds of an air conditioner while monitoring it, we can repurpose the space. The question always is how we can do something that hasn’t been done before. Our engineers look at the room and ask, “Can we do this? Yeah, I think so. Let’s see if it works.”
Productivity is another challenge. Your normal productivity is x, but now, it is ½x, because you have to be careful to protect staff and patients. It takes twice as long to get an X-ray or a CT scan. At the same time, the volume of patients rose 50%. So, the hospital has to overstaff.
The department leaders (Drs. Rosenthal and Liametz), and the hospital’s senior leadership, set up the system to respond. They faced high uncertainty and financial loss, not knowing which investments they would need to make or hold back on. When does one start committing tens of millions of dollars to something that may not happen? Plus they faced tremendous professional risk. At NYU Winthrop, I saw sparse resources judiciously applied.
They had to anticipate a pandemic. Because of their experience and innovation, they rationed, but never ran out. They reimagined and reengineered rooms, turning a conference room into an intensive care unit. They did not furlough. They took care of people. This is important in the wake of tragedies we saw elsewhere, including the suicide of one ER director in New York. I give credit to our leadership.
In such a crisis, how did NYU Winthrop handle its relationship with the community?
NYU Winthrop leveraged this crisis to build bridges with the community. For the first time, in my many years, people on the street saw us as heroes. People feel more faith in humanity and flexibility toward their hospitals. They know healthcare workers can become patients, too, putting their health at risk. They thank you for being there! Here is an example: I think I haven’t bought dinner for a month now. We have grateful donors who call a local restaurant and say, “Charge me $500, and feed the ER department tonight!” Sometimes, we joke, “Tacos, again? Can’t they send something to drink this time?” But seriously, we are so moved and appreciative of their support! Now, our challenge is to get back to business as usual. As we reopen, it’s critical that people don’t delay care out of fear. I hope that patients won’t put off cancer surgery or defer routine medical care, because we go to great lengths to protect them. We reassure them that they can safely return to the doctor’s office or get that procedure they delayed.
You mentioned that people were repurposed?
At business school, remember how we studied about building teams and managing others? Our hospital staff’s collaboration worked! Each person thinks, “How can I change what I do?” But nothing prevents a surgeon from seeing patients in the ward. An oncologist I know hadn’t worked in an ER in many years but were given a chance to respond creatively. They are quite capable on their own, even better if someone mentors them. We had the chief of plastic surgery in the ICU, doing quite well. For him, it was a change of pace and, in some ways animating.
A fellow employee I met in the ER, normally works in marketing. She asked herself, “What can I do? I want to be valuable.” She distributed equipment and helped with throughput and logistics. The hospital worked to cross-train people, which was financially sound and good for morale.
How about the safety and well-being of the hospital staff?
Emotionally, it is very draining. When I come home from a shift, I see my neighbors. They watch the news. They have a sense that there is a crisis, but it is somewhat abstract. When you are in the middle of the crisis it is not abstract. In normal times, the family is at the bedside, so the patient has someone to talk to. Not now. Someone is talking to the patient through an iPad or by phone. The patient is afraid of dying and thinking, “Who will take care of my kids?” To see that multiple times a day is heartbreaking.
From the viewpoint of our hospital’s leadership, they wonder how to rally the troops. They are aware of the stresses. I’ve been through 9/11, anthrax, SARS-1 and Ebola, which were short- lived. This paradigm is more like a marathon. It’s important not only to take physical precautions at work, but also to take time to emotionally recharge until this, too, passes.
I’m optimistic that, with 100 vaccine candidates in the works, at least one will be successful. We’re fortunate in this country to have the resources and investment capabilities to drive research and innovation.
How did the hospital manage logistics and patient control?
A patient comes in, and you have to make a decision, “Do I need to separate this person from other patients? Does this person have the disease or not?” We had only so much space, so we literally thought outside the box and put a tent in the parking lot! Again, managing that required proactive planning.
What have you taken away from this experience?
As we discussed at Wharton, being able to adapt is key to a business’s survival. You can plan, but when it’s crunch time, you have to be a doer and not hesitate. I also learned that it’s important to maintain the skills we accumulate as we traverse careers. We may need them again.
Beyond the business school questions, in our busy lives, we often take the people around us for granted. This reminds me that you not only have to be good to yourself, but you have to carve out some time to reconnect with friends. You have to keep some focus on what’s truly important.