How Ingenuity and Innovation Helped a Hotspot Hospital Save Lives During COVID Surge
Just a few weeks ago, COVID was ravaging hospitals across the country as cases were surging following the December holidays. St. Francis Medical Center is already one of Los Angeles County’s busiest trauma centers. During the surge, St. Francis was up to 120% capacity – and still caring for every patient that came through its doors. With the ER turned into a COVID unit, some emergency services were moved to tents in the parking lot. Chip spoke with St. Francis’ CEO Dan Jones who explained how the hospital was able to meet the challenge with their extraordinary staff, how they are working with staff to mitigate burnout, and how Prime Healthcare is investing in the hospital and the community it serves.
Speaker 1 (00:05):
Welcome to Hospitals in Focus from the Federation of American Hospitals. Here’s your host, Chip Kahn.
Chip Kahn (00:14):
COVID hospitalizations have declined significantly and vaccine distribution is beginning to take off. We can see light at the end of the COVID tunnel.
But just a few weeks ago, the trajectory was quite different. COVID reached its highest infection rates we have seen. Hospital occupancy in much of the country was surging, with infections on the upswing. The state of California was especially hard hit. St. Francis Medical Center, home to one of the busiest trauma centers in Los Angeles County, experienced a peak during the surge with hospital census reaching 120% at the highest point. The hospital’s, frontline caregivers were treating COVID patients while continuing to care for traumas and other emergencies as well as the other needs of the community, never turning away a patient. The hospital also did a tremendous job of rolling out the vaccine as soon as it was available to all staff and first responders.
Today, we explore what it was like to care for patients during the height of the COVID pandemic. Joining me is Dan Jones, the CEO of St. Francis Medical Center, which is a member of Prime Healthcare, one of the largest health systems in the United States with 46 hospitals and more than 300 outpatient locations in 14 states. Really appreciate you being with us today, Dan.
Dan Jones (01:31):
Well, good afternoon, Chip. It’s a privilege and a pleasure to spend the afternoon with you.
Chip Kahn (01:35):
Dan, as we get started, for our audience, would you please tell us a bit about Prime Healthcare, St. Francis Medical Center, and your role there as hospital CEO?
Dan Jones (01:46):
Absolutely. And again, it’s a pleasure to spend a little bit of time with you this afternoon. But Prime Healthcare and Prime Healthcare Foundation’s hospitals are really an award-winning health system. We have 46 hospitals, more than 300 outpatient locations spanning 14 States, as you mentioned in the introduction, and nearly 50,000 team members across those hospitals. Prime is nationally recognized for our award-winning quality and care. We’ve been named top 10 health system by IBM Watson and our hospitals have been named top 100 hospitals over 53 times, which is more than any other patient safety excellence awards across health systems in the past five years. But Prime’s mission is to save and improve hospitals so we can continue to deliver compassionate and quality care and improve the communities that we serve. St. Francis is the newest member of the Prime family. We are a 384-bed tertiary safety net hospital in Southeast Los Angeles County. We are one of the busiest trauma centers in all of LA County, and it’s an honor and a distinction that we carry with pride.
But it was Prime’s intervention that ensured St. Francis celebrated its 75th anniversary this past fall, which now allows us to continue our rich tradition of community service and high quality care. As CEO, my role has been to orchestrate the assimilation of Saint Francis into the Prime family and help lead the turnaround of the hospital on multiple fronts. Clearly, financially, that was a historical challenge for the organization, but culturally and clinically, as well as operationally, we’ve got great support from Prime, our corporate office, our chief medical officers, and our medical staff. And we’ve really done a yeoman’s job in the last several months with the transition as well as the surge. And I’m pleased that we’ve assembled an amazing team that’s up to the challenge of putting St. Francis on its journey for its next 75 years.
Chip Kahn (03:59):
Dan, it must’ve been very difficult to take over the hospital almost in the midst of this pandemic. And as I mentioned in my introduction, at one point you were operating at 120% inpatient occupancy. Can you tell us, on a typical day, how many patients do you care for on the in and outpatient side of the hospital? And how does this compare with what you experienced during the recent surge of COVID?
Dan Jones (04:26):
That’s a great question, Chip. And we laugh and joke about it at the corporate office and here in the executive office that we went into this with our eyes wide open. We acquired a bankrupt hospital in the midst of a pandemic. So we knew exactly what we were getting ourselves into, and the challenge really was the surge. As we did our due diligence and looked at the history of the hospital, it’s always been a very busy medical center pre-COVID. We had multiple services both post-acute, acute, and ancillary outpatient services, but our acute ADC ran in the 180s for historical perspective. When COVID came along in March, clearly it had an impact on the early days across the entire health system, and our census dropped probably about 20% out of the gate. And then as things started to mitigate, we saw it started to come back up right about the time of the acquisition.
And as we focused our efforts on the transition and onboarding, we really kept COVID in the rear-view mirror, so to speak, or at least on the back burner as we continue to operate the hospital. But when the surge hit, it really affected a number of issues. The outpatient volume and the COVID time had dropped well over 50% across the board. But when the surge hit, we saw outpatient experience drop precipitously. Our ER non-emergent volume really started to drop. But what we saw is the acuity in the emergency department skyrocket. And our overall ADC jumped back up. As you mentioned earlier, we were at 120% of physical capacity at the high watermark, but our acute ADC jumped up into the low 200s and vacillated as high as 220 at times, just on the acute side.
But the real telling statistics was in our critical care areas. We’re licensed for and operate physically 36 ICU beds. Well, we far exceeded that capacity in the first few days of the surge, which were coming out of the Christmas holiday. We ended up opening up an additional eight beds and our PACU area to dedicate them to critical care. And then we had dozens of hospital beds in the ICU that were designed to hold and manage critical care beds. So one point at the peak in early January, we were at 150% of ICU capacity. And then when you look at our physical beds in the hospital, we turned one of our pediatric units into a med surge unit. And we expanded one of our… well, decommissioned, if you will, our psych beds and turned them into med surge. So we added another, I would say, 40 acute beds to our portfolio.
And on the acute side, we’re exceeding 110% of capacity at the height. And I went back and looked at our COVID numbers. And at the peak, we were over 160 COVID positive patients in-house. And when you look at the number of days that we had over 100 COVID patients in the hospital, it spans over seven weeks that we had over 100 patients COVID positive, and all the while managing our trauma center and our ER and continuing the throughput and supporting our EMS agencies. But with over 2,000 traumas a year, we are one of the largest trauma centers. And we were able to keep that opening and operating now throughout the pandemic. So it’s a testament to our team and their flexibility and ingenuity.
Chip Kahn (08:24):
That’s really impressive, Dan. You described some of the modifications you made in terms of converting portions of the hospital. What are the kinds of modifications in terms of workflow and other kinds of changes both to protect the staff and enable the staff to take care of these complicated patients did you make because of COVID?
Dan Jones (08:45):
In the healthcare industry, since 2011, even before in California with the advent of hospital emergency incident command centers, we plan and prepare disasters and emergencies. We drill regularly, but it never ceases to amaze me the ingenuity and the innovation that comes out in a crisis. We had our plans. We have our surge policies. But one of the things that was so telling about this surge … And it affected all of us. None of us were immune. I actually came down with COVID before the Thanksgiving holiday, and was back in the office, and it literally took out my entire executive team and then subsequently probably half of our frontline leadership were out at any given time during the surge. And so we were calling on a number of different folks to step up into leadership roles.
And the ingenuity that came out of that really came from many of our frontline leaders. How do we expand beds? How do we turn physical space into capacity that’s first safe and then capable of managing the care? Some key additions. We already talked about the PACU to ICU beds. With support of our ER medical director. At one point, we had to designate the ER as a COVID unit. So there were no clean and dirty areas, so to speak, but the entire emergency department was turned into a COVID unit. We took our emergency services to the streets literally with standing up tents in the parking lots to triage patients and manage, again, continuing to provide basic care to the community during the crisis, but also to ensure that we kept them safe. We partnered with EMS. We were the first hospital, the pilot, with LA County EMS to stand up a joint EMS hospital triage tent process.
Several other hospitals joined into that. Shortly after we stood that up, we were able to partner with the state to get staffing waivers, which was a key for our staff and our ability to expand. The biggest challenge is probably one of the ones that I least like to talk about, and that’s the management of our decedents. And I chalk this up to our engineering team, but we have a morgue that’s capable of handling 12 decedents. At the height of the surge, we had over 64 decedents that we were managing and caring for. And we did that through partnerships in the community who had to bring in external trailers to support efforts on that front, but with the support of the coroner’s office and our engineering team, we really, really were able to care for them appropriately and effectively during that time.
So the biggest issue though, came down to supply chain, and Prime’s team at our corporate office were always ahead of the curve with respect to equipment supplies, PPE respirators.
And it was really interesting. Some of the ingenuity that came out of one of our biggest challenges was how do we get patients that are ready for discharge home? And what we found is that the home health agencies, DME agencies in the county and the region didn’t have portable oxygen systems, O2 concentrators. So we were able to orchestrate through our relationships ways to bring in portable home oxygen and partner up with our DME to safely get our patients discharged to home. And for a while, I thought I was going to go into the home health business, but it really worked out well. And with the Prime corporate support and our ingenuity and frontline leadership, we were able to come through effectively.
Chip Kahn (12:24):
Dan, I understand as well as all the other assistance from outside agencies you just described that you got support from disaster medical assistance team, a DMAT, and that they spent two weeks at your hospital. How did they assist your caregivers, and how did that work out?
Dan Jones (12:43):
It was one of the amazing aspects of the surge. And we had so many community partners that were involved through that duration. LA County EMS was a wonderful support. We had our emergency management operations center, and we really created a nice communication feedback loop that really escalated the challenges and the crises across the entire region. And as we continued to talk, federal Department of Health and Human Services has disaster medical assistance teams. And they’re just an amazing group of folks. And they were deployed with just a few hours notice. And through the weekend, we did a lot of logistics planning with their advanced team and they showed up on site on a Tuesday morning, and it was amazing to see them come in. Our entire team was out front, had a kind of a parade welcome for them. And it was a far team that had been two weeks into the surge.
It was like the cavalry coming over the hill. And a lot of the staff got emotional and you could see the energy peaking in everybody during that time. But it was really a wonderful augmentation of our existing staff and support. They came in to support the emergency department, which was clearly well underwater with the burden of influx. So they set up a special team just to help manage our tents. And then our ICU team, the critical care team, they were able to deploy the balance of their resources to our ICU just to provide our nurses and our physicians some much-needed downtime and reflection. But it was just that whole emotional uplift beyond the resources that really helped the team through that really two-week peak.
And what came out of it, what I was really proud of, is the feedback we got from the DMAT team and the leadership at the Department of Health and Human Services. And they continued to comment about how welcoming St. Francis was and that of all their deployments, it was one of the most exciting, welcoming, engaging. And as a result of that two weeks, several members of the team have developed lifelong friends, and we stay in touch, and it’s great to see that that service exists within our great country.
Chip Kahn (15:04):
It’s clear from what you just said that there was incredible stress on your frontline caregivers, the staff, the physicians. What are the manifestations of these stresses on the staff and what are you as a manager trying to do to mitigate these challenges, both when they occurred at the height, but I assume there are ongoing issues that are raised from the stress level that the staff had to work under.
Dan Jones (15:31):
That’s the underbelly of the surge and the duration of the surge, and it’s great. Just in the last several days, we have regular CEO town halls and breakfast with frontline staff members. And to a T, they were all talking about how positive everybody is now and how excited they are about the future. And we look back and reflect on that time in late December through January and early February. And it feels like it was eons ago, but it was just a few short weeks ago. But it was really a challenging time, the emotion, the energy drain that affected everybody from our executive team to most importantly, our frontline staff and physicians. And we really were sensitive to the impact. The executive team, led by myself, we were here around the clock, doing everything we could just to recognize and thank them for their efforts.
And that pat on the back goes a long way, but we communicated constantly. We stood up our incident command system. We were communicating multiple times a day the status throughout the institution, and that communication and visibility really helped rally the troops.
But we went further and tried to augment with employee assistance programs, giving people an ear, a way to express their stress, their challenge. We’re blessed at St. Francis, as the name would convey, with an amazing spiritual care team led by Brother Richard. And he and his team were on 24-7 providing support and just an ear to listen and let people vent and get out their stress. And then on top of that, we were augmenting with everything we could from just additional food and support to creating additional augmentation of clinical support where we could. Again, the county was very supportive in that. The state was very supportive in that. Prime led the way with additional nurses, additional doctors from all walks of life. And we all ended up picking up different tools and resources to help with either moving patients or moving supplies or mopping floors. Seeing people work side by side really kept everybody energized. And I’m really pleased with what I’m seeing around the hospital today, that everybody’s just very excited about the future.
Chip Kahn (18:01):
Dan, that’s very inspiring. But now as we move away hopefully from the COVID surge at least, and maybe away from the pandemic as we have the proliferation of a vaccine beginning, what do you have in your plans for St. Francis as Prime has, in a sense, save the hospital for the community, but obviously wants to improve the hospital and better fit it for serving the people in the area around the hospital?
Dan Jones (18:29):
We haven’t lost sight of our future goals. We continue to manage the day-to-day, but we know where we want to be as organization, as a company, as a community. And it’s really, first and foremost, assembling the leadership and the team necessary to get us where we need to be. And Prime has been amazing with our corporate support and expertise, but we’ve assembled a wonderful team. We were successful in retaining most everyone associated with the prior organization, and we’re really focused on structure, education, and operating processes. It’s those processes that ultimately help us drive the quality and clinical care that we want, and all the while partnering up and affiliating with our medical staff. They’ve been through a lot of challenges over the last several years, every member of the team with this perpetual bankruptcy that the hospital had been under.
But our focus is really around, first and foremost, safe and quality delivery of care. And that starts with making sure we’ve got the right team at the bedside, that they’re trained and competent. And our human resource team has been amazing. The recruitment and retention initiatives were focused on elevating and assimilating the Prime operating processes throughout the facility. And it’s really been a joy to see the metrics move, one of those being our ability to manage patients safely through the continuum and achieve the geometric length of stay for our community. But the next big step outside of the operational aspects is really reengaging with our community. And one of the first steps is we’re proud to announce that we’ve been enrolled in the Vaccinate All 58, which is California’s initiative to roll out the vaccines to the community even during the surge and through the pandemic. We’ve been offering vaccines and had a great rollout of our vaccine clinic for our staff and our physicians.
But now we’re teeing up the logistics to work closely with Blue Cross on my turn and state of California to vaccinate our community. It’s an underserved community, safety net community, extremely diverse, unfortunately low-income, and those that are in the most and greatest need for health care services. And we’re going to be standing up our vaccine clinic here in the next few days, and we’ll be bringing that to the community. And it’s just another way for us to engage and celebrate the 75-year history of St. Francis and really, really focus in on our mission to support the community.
Chip Kahn (21:07):
Dan, it’s just been a great pleasure speaking with you. I want to extend my gratitude to you and your extraordinary staff and physicians for caring for every patient at St. Francis with compassion, dignity, and respect. Thank you for being our guest and just for all you do.
Dan Jones (21:23):
Thank you so much, Chip, and we really appreciate your leadership at the Federation. Federation does so much for our hospitals and we’re pleased to be a member and support your efforts, and thanks for all you and your team do for us.
Speaker 1 (21:42):
Thanks for listening to Hospitals in Focus from the Federation of American Hospitals. Learn more at fah.org. Follow the Federation on social media @fahhospitals, and follow Chip @chipkahn. Please rate, review, and subscribe to Hospitals in Focus. Join us next time for more in-depth conversations with health care leaders.
Dan Jones, CEO, St. Francis Medical Center
Dan is a seasoned healthcare executive who initially joined Prime Healthcare as a consultant to assist with the acquisition of St. Francis. Since his arrival, Dan has demonstrated a strong commitment to the mission, hospital, associates and physicians of St. Francis, providing steady leadership during the transition process.
Dan brings over 20 years of experience leading operations in both large-scale hospital networks and community hospitals. His particular expertise includes mergers and acquisitions, service line development, physician partnership models and the transformation of business units. His most recent experience includes serving as CEO of St. Francis Hospital in Columbus, GA (a member of LifePoint), CEO of Abrazo Central Campus in Phoenix, AZ (a member of Abrazo Health) and CEO of Nueterra Health Alliance. Earlier in his career, Dan worked with Oschner Health System, Tenet and HCA in senior leadership roles.
Dan is a Fellow of the American College of Healthcare Executives, and he earned his Master of Health Services Administration degree from Virginia Commonwealth University.