by Elizabeth Hofheinz, M.P.H., M.Ed.
The United States Army Special Forces, aka, the Green Berets, live and die by one proverb: de oppresso liber—to liberate the oppressed.
Since long before the Coronavirus-19 pandemic, the challenges of stress were escalating across the medical profession. As March 2020 rolled by, the leadership of Hospital for Special Surgery (HSS) recognized that supporting New York City’s Covid-19 response would challenge even the most experienced frontline caregivers. So they accelerated implementation of a strategy including a dedicated multidisciplinary council and facilitated by a new role: Chief Wellness & Resiliency Officer. 
Enter Steve Forti, who served over 23 years in the United States Army Special Forces, eventually earning the rank of Master Sergeant. Armed with a B.S. in nursing and with a Critical Care Residency at Yale New Haven Hospital Systems. As HSS transformed into a multispecialty facility providing also surge capacity from other hospitals, the former consultant to Johnson & Johnson’s Orthopedic Trauma Division took up the challenge of providing at-the-elbow wellness support to HSS frontline staff through New York’s historic virus outbreak.
“In the heat of the moment of the pandemic, Steve was able to personalize our commitment to wellness with support our caregivers found to be effective and reassuring,” said HSS Surgeon-in-Chief and Medical Director Bryan T. Kelly, MD.
“In Steve Forti we found rare depth of expertise in helping highly skilled teams achieve wellness before, during and after complex, unpredictable and consequential circumstances,” said HSS President and CEO Louis A. Shapiro. “Coupled with the experience of his contribution through the outbreak, he was the obvious choice for the formal ongoing role of Chief Wellness & Resiliency Officer.”
“For approximately 16 weeks we as a nation have been under assault from Covid-19,” says Forti. “To be able to play a helpful role at a time like this is truly a gift. The leadership at HSS is very forward thinking and always strives to do its best for their people.”
Dealing with the moving target that is Covid, Forti had to first proceed with a baseline assessment of needs. “Initially I had to determine what was most distressing to people. The heroic efforts undertaken by HSS meant that virtually everyone was forced outside of their comfort zone. So, the stress of the virus was compounded by the anxiety of being in unfamiliar territory.”
Forti says that if you measure heroism by how far you will go outside of your comfort zone, then HSS has been incredibly heroic.. “They closed down elective surgeries before anyone asked and they dug deep to envision the needs of their patients, patients who needed care from other neighboring hospitals, as well as their staff. I knew I wanted to be part of this noble effort.”
Doing astonishing things with few resources is a hallmark of the Special Forces. They find a way.
Steve Forti: “Special Forces teams are small compared to the massive tasks they are asked to perform. A frequent sentiment is “find work” or “do more with less.” I witnessed that on many occasions where staff frequently sought out work outside their comfort zone to get a job done either to improve patient care or lighten the load on a coworker.”
As for who exactly is able to move outside his or her comfort zone, Forti says, “Those who are able to do this can manage it because they have faith in their leadership. HSS’ strong leadership and clinical competence worked in concert to anticipate the needs of a swelling patient population.”
Systemic stress reduction
“We needed to determine the best ways to reduce stress on the frontline people from a structural point of view. HSS closely monitored how patients were being triaged, how many times a day they were being seen, and how the staffing matched up to the acuity of the patient. I spent a lot of time as a peer listener, walking around talking to employees. I rounded multiple times a day, sometimes as early as 3AM. I would make contact with the overnight crew and then at 7AM be available to the next shift. Our goal was to create as many venues as necessary for people to say, ‘I need some help.’”
HSS was already ahead of the curve when it comes to caring for its employees, states Forti. “The hospital had a very robust virtual mental health program in place, which was developed by Laura Robbins, DSW, Senior Vice President, Education Institute & Global Affairs at HSS. With the onslaught of Covid, things were ratcheted up. Immediate access to a psychiatrist or counselor was made easy via Zoom—and provided for by HSS. My role was to raise awareness and be approachable so that everyone could have their concerns addressed.”
“Permission” from a Green Beret
Many people won’t ask for help…or don’t know how to. Steve’s omnipresence sent a message: “Here is this guy who has been in some challenging situations and he is saying, ‘Asking for help is normal. It doesn’t mean you are deficient in any way’.”
They were, after all, in a battle.
“The similarities between a deployment and the Covid crisis are extraordinary…isolation, strain on the family, fear of your conduct impacting the family, uncertain timeline, the day-to-day unforeseen risk and ultimately, the strain on mental health.”
“Stress came from many quarters: marital strain, financial, the possibility of exposing your newborn, elderly parents, transportation, etc. To help with that last issue, buses were set up for employees that ran multiple times a day to different campuses and centralized areas near homes. And in the off-hours, the hospital paid for the Uber rides home.”
“There was the case of an employee, a young man living with two immunocompromised parents. He had lost a family member to Covid, so to mitigate his work-related stress the hospital allowed him significant flexibility, shifting him from nights to days and giving him temporary housing in the city.”
“This is not familiar to me I witnessed unbelievable humility as everyone rose to focus on the task at hand…the delivery of compassionate care at great risk. The finest orthopedic surgeons and anesthesiologists in the world stepped in at the bedside to do everything from proning to admission notes. This professionalism set the tone for leadership throughout the entire medical staff and it was an amazing thing to see.”
“The virus is very isolating, and I think I provided living proof that from Lou Shapiro to Bryan Kelly on down the chain of command, that this institution cares about its people. They go far beyond the textbook ideas of leadership.”
In the end, says Forti, a rather low tech—though rare—type of help may have been the most effective. “Listening with an empathic ear is so often the most we can do for someone else. I could not solve anyone’s fear and anxiety about the future. I didn’t have those answers. But what I did have was the willingness to look at them directly in the eye and say, ‘This is awful. I’m so sorry. What can we do to help?’”
Reflecting on his formalized role as Chief Wellness and Resilience Officer at HSS, Steve says, “Throughout my military career I have heard, ‘If not me, then who? If not now, then when?’ I try my best to live by those words of wisdom.”
So the proverb, de oppresso liber, is quite fitting. Thank you, Steve Forti, for helping to liberate the Covid warriors who call HSS home.