by Elizabeth Hofheinz, M.P.H., M.Ed., March 23, 2020
President and CEO, Hospital for Special Surgery (HSS)
For 10 consecutive years, Hospital for Special Surgery (HSS) in New York City has been ranked #1 in the country for Orthopedics by U.S. News and World Report. Much of that is due to the steady leadership of Louis A. Shapiro, the institution’s longtime president and CEO. Ortho Spine News (OSN) wanted to learn what this leader among leaders is doing during these unprecedented times.
OSN: What are you seeing ‘on the ground?’ 
LS: The impact of COVID19 knows no boundaries and changes daily. Each day brings new challenges and more anxiety…but it also is bringing out the best in people.
It is becoming clear that the government and related bureaucracy have a hard time caring for people. It is difficult for them to make and implement decisions effectively. Every organization has a bureaucracy, but in the private sector we are now seeing those bureaucracies being dismantled. Silos are being eliminated and people are rising to the occasion and displaying extraordinary commitment to beating this scourge.
Our overarching goal at HSS is to ensure that people are safe and feel safe. The enemy has different ammunition than we have. Leaders need to create an environment where people have all available resources to fight this fight and get everyone through this.
The opportunity exists for society and organizations to be better after this crisis passes. Winston Churchill famously said, ‘Never let a good crisis go to waste.’ It is time that we capture the best in ourselves and others and translate that into meaningful action that leaves us better than before.
OSN: What type of leadership is needed at this time?
LS: HSS is a leader and we must act like a leader. This means doing the right thing to protect staff, patients, and our organization. It is important to have established values and principles and then live them. We established our principles early during this crisis and have been communicating them nonstop and in a transparent manner. Two weeks ago, prior to the time when we were considering canceling elective cases, we discussed how we could mitigate exposure risk by ramping down. Our physician leaders got together and defined what is essential is for musculoskeletal health (see hss.edu). On March 13 we were at 100% of staff and then one week later we were down to only 12%. We did this to protect our staff and our patients.
In terms of serving society we have ramped down to essential musculoskeletal care and ramped up televisits. By March 27 we will have 200 doctors providing televisits. We are repurposing all satellite locations to provide urgent care for musculoskeletal problems. In addition, we are creating an ‘orthopedic triage center’ with our staff based at NY Presbyterian emergency department. At our main campus we have converted an OR suite to a triage treatment center that is staffed by surgeons, physician assistants, and nurses who are seeing non-COVID19 patients from NY Presbyterian. At the present time, HSS and NYP/Cornell are acting as one. To that end, we have pivoted our supply chain to support them. We have 900 staff volunteers available to help NYP/Cornell as needed.
OSN: What are your most significant challenges at the moment?
LS: Keeping people safe. At present we have approximately 90 staff under quarantine, with five employees who have tested positive. Second, we have to help New York Presbyterian do what they need to do. There are significant supply chain efforts underway…we are beginning to put together joint organizing units so that we eliminate anything that naturally exists between organizations that could slow things down.
When this started, we had to create a new company. Its leadership structure is: 10 cross-sectional teams with 8 subteams that support them. Each team addresses different issues. For example, one team is the ‘return to normal’ group. Today [March 23] we are standing up a team to think about the future. This team will not distract the organization from what we are doing to combat this crisis. But these individuals will begin the process of considering how to eventually get back to normal operations.
The financial health of the organization is strong, and we are leveraging all that we have learned. Going forward we will be making decisions differently, we will be organized differently, and we will spend less time on things of little consequence. If we all conduct ourselves appropriately—instead of trying to outdo one another—then we have a superb chance to repair the healthcare system from the bottom up.
OSN: What sort of precautions is your institution taking?
LS: Standardization is critical. The first thing we did was ban international patients. Then we said, “no patients from outside the tristate area,” followed by “no nonessential care.” Then we began screening patients, then screening visitors. That was followed by restricting visitors, then eliminating visitors, and screening staff.
Our main campus has 40 screening stations that go through a full set of questions about travel, how the person feels, etc. (this includes taking temperatures). The next big issue was social distancing. We began by eliminating all conferences. We were among the first facilities to state that our people would not be attending the AAOS conference this year.
As for the 25-person COVID19 leadership team, we are divided into three groups. We rotate through working on the main campus, working from main campus, but remote, and working remotely from home.
As for PPE we are standardizing its use, allocating it carefully, and educating our people on how it is used. I walk down the street and see so many people wearing them because they are (naturally) scared. The only way to alleviate some of this fear is to give people information. But it is inevitably a matter of time until someone you know tests positive…and then the fear only increases.
We have had nine residents exposed to an employee who tested positive for this virus, so we had to quarantine them. Fortunately, they all tested negative.
The people who work in supply chain are heroes. They are doing everything they can to determine how we can identify sources of PPE and ventilators. And this is not just for us, this is for other facilities as well. I recently spoke with someone who is involved in a large-scale effort to procure ventilators.
OSN: How do you see the situation unfolding in NY over the next month?
LS: The healthcare system will be overwhelmed. While people will rise to the occasion, according to the latest information I have the forecasted peak in New York will be around May 1.
OSN: Any forecasts as to how the overall orthopedic field might be impacted over the next 12 months?
LS: The pain of this situation knows no boundaries. When this crisis is over there will be an enormous number of patients in need of musculoskeletal care. We have to be sufficiently prepared to help those individuals, many of whom will be in great pain.
OSN: If the White House were to call you, what would you tell them?
LS: Do more—faster. There is not enough being done…period. It is imperative that any bureaucratic nonsense that is contributing to solving problems with supply chain, telehealth, etc., be removed. We are in a war…and government is crucial. Government and institutions have to formulate a totally different organizational structure in order to fight and win a war. I know people are working very hard in Washington, D.C., but change is hard in a bureaucracy.
We are trying to arrange things so that providers can care for non-COVID19 patients via telehealth, thus freeing up critical care providers for COVID19 patients. We need immediate action to make this easier.
OSN: Lastly, what gives you hope?
LS: When you are in a situation 24/7 then that is 100% of your view. For example, the soldiers who fought in Afghanistan, well, that is ALL they saw every day…that was their view until they got home. But the spirit, passion and intelligence that we Americans have will get us over to the other side.