key: cord-0048692-pqf899k7
authors: Smith, Shaun; Woo Baidal, Jennifer; Wilner, Philip J.; Ienuso, Joe
title: The Heroes and Heroines: Supporting the Front Line in New York City During Covid-19
date: 2020-07-15
journal: NEJM Catal Innov Care Deliv
DOI: 10.1056/cat.20.0285
sha: c21d1a410323fc9021054ababe334fd3b0f552ca
doc_id: 48692
cord_uid: pqf899k7

NewYork-Presbyterian used a multi-pronged strategy to preserve the mental and physical health, and address urgent practical and economic needs, for more than 50,000 employees during the Covid-19 crisis.

Our efforts to address employee needs outside the clinical care realm are described in Figure 1 , where we "map the employee journey" and identify their specific needs at each point.

Our overarching goals were to keep employees informed about the latest developments of this evolving crisis and to protect their physical and mental health to the best of our ability.3 , 4 To address employee needs in a time of social distancing and widespread closures, we expanded, adapted, or added multiple services.5 ( Figure 2 ) To the extent possible the offerings were virtual.

The rapid pace of Covid-19 required comprehensive communications early and often to manage the continual developments and evolving employee policy and service changes. 6 We added a Covid-19 employee service page to our internal Infonet. We recognized the need for bi-directional communication, and three solutions emerged: daily video updates from senior leadership; a dedicated email address for employees to send questions to and receive updates from; and two phone hotlines: one for employees and one for the general public.

To implement video updates, we leveraged an existing NYP Town Hall series led by the NYP Chief Operating Officer (COO) to expand bi-directional communication with a trusted leader through daily video updates to the entire NYP enterprise. Videos initially focused on hand hygiene, personal protective equipment (PPE) use, and clinical guidance.7 , 8 Employees came to look forward to these videos for updates on state and federal policy developments, clinical information, and changes in employee policies and services. The videos also presented a daily opportunity for the COO to respond to employee questions.

The email address for Covid-19 information was managed by the Communications team, who ensured that every message was seen by the COO and routed to appropriate departments for timely responses.

Prior to Covid-19, each campus had its own Work Force Health and Safety (WFH&S) site with phone lines that could be called during regular business hours. In March 2020, a centralized hotline for WFH&S was created. The NYP WFH&S hotline served as the anchor for facilitating Covid-19 testing for employees, connecting employees to virtual health visits, and receiving input from employees. Additionally, we created a phone line for the public to answer questions about Covid-19.

Early essentials: childcare, physical health, and food

We moved quickly to address basic survival issues.

In partnership with Columbia and Weill Cornell Medicine, NYP responded to employees' need for childcare services. These services included additional backup childcare days, waived copays, and crisis care reimbursement provided by a relative or a friend. Later, we added home virtual resources and expanded linkages to childcare resources. From March 13 through April 28, over 4,800 employees used these childcare services amounting to over 1,100 days of backup childcare and almost 33,800 days of crisis care use.

To support employee physical wellbeing,9 we expanded WFH&S capabilities. The hotline, which had previously operated mostly within normal business hours, expanded its operation to 6 am to 11 pm, seven days a week, and was a well-utilized resource, receiving up to 2,000 calls per day. Volunteers from other clinical settings were redeployed to WF&S help staff the line to accommodate the high call volume. We also revised our paid time off policy by implementing a Support Care Time program. Employees received an additional 4 weeks of paid leave to cover quarantine or isolation periods if they had suspected or confirmed Covid-19 or to care for a child or dependent with confirmed or suspected Covid-19. A total of 9,858 employees used Support Care Time through early May 2020.

Immediate concerns for protecting employee health included the need for access to PPE and Covid-19 testing.10 Challenges in addressing these concerns included rapidly evolving PPE guidelines from Centers for Disease Control and Prevention (CDC) and supply chain challenges.11 , 12 We implemented multiple strategies for conserving PPE and supplies; for example, having one physician (rather than an entire team) round on each Covid patient. These strategies conserved PPE enough so that we could provide frontline workers with a surgical mask and N95 mask for personal use outside the hospital in the event they had symptoms, because employees were particularly concerned for their family safety in the event that an employee contracted Covid-19. WFH&S provided linkages to testing and care, and ensured that employees with symptoms of Covid-19 understood conditions for return to work, including a mandated minimum seven days self-isolation per NYP policy.

Limited food access emerged as a concern in light of store and restaurant closures.13 Additionally, rising patient acuity and volume created stressful clinical shifts, and employees sought locations for moments of respite. To help provide those moments, NYP opened sixty-one Recharge Rooms across the enterprise stocked with snacks, soothing music and TVs displaying notes of gratitude from the community. As for food access, offers of support came from every corner, leading us to develop the Healthcare Heroes fund which accepted donations through an online portal. Through an outpouring of generosity from the Heroes fund, businesses, trustees, organizations, grateful patients, and community members, patient-facing workers at each hospital began receiving four on-site meals daily free of charge. A challenge in the rapid development of this meal service was the level of coordination required. Thus, our food services vendor helped receive and deliver the donations to limit disruption of deliveries. Through these efforts, we brought food and respite to busy employees.

In anticipation of potential mass transit disruptions,14 NYP leadership partnered with its academic affiliates to develop an array of strategies for a safe and efficient commute. By examining journey to work data, we determined that buses or shuttles alone could not fill the gap, as they had to run at 50% capacity to meet social distancing needs. Additional transportation options were necessary.

To meet these needs, we first expanded parking availability and waived fees where possible (for example, when the parking site was owned by NYP or its affiliates). As non-emergent visits declined, hospital visitor restrictions were implemented, and more employees telecommuted, there was more parking available for on-site staff. We also secured approximately 2,000 health care worker parking permits from the New York City Department of Transportation for emergency parking. These parking services supported approximately 6,000 employees who drove to work.

Second, we expanded existing intercampus shuttle service and added 28 new bus routes picking up at 44 new locations, including shuttles from each hotel housing NYP employees, resulting in roughly 40,000 rides from March 23 rd through May 9 th . (Figure 3 ) We also collaborated with Hospital for Special Surgery to add 12 additional shuttle locations.

Third, we connected employees to donated Citi-Bike memberships, funded Lyft rides, and negotiated employee discounts with Avis, Budget, Revel Rideshare, Zipcar, BP, and Amoco. These collaborations provided a breadth of options to meet NYC metropolitan commuter preferences, which tended towards bikeshares and shuttles, and regional setting needs, which relied more heavily on commuting by car.

Housing needs also emerged relatively early on. Some essential employees could not make their long commute or had concerns about spreading Covid-19 to loved ones at home. Housing was also necessary for the non-local clinicians who volunteered to join our team. NYP housing combined with now vacated student housing at Columbia University campuses provided 360 units. An additional 3,000 hotel rooms were secured across the region in proximity to NYP campuses. Providing this housing required substantial effort with a significant cost, with NYP running one of the largest hotel operations in New York City during the surge. The NYP hotel operation allowed much-needed volunteers to join our patient care ranks.

NYP housing combined with now vacated student housing at Columbia University campuses provided 360 units. An additional 3,000 hotel rooms were secured across the region in proximity to NYP campuses."

As the pandemic continued, we offered employee financial assistance for those experiencing hardships and as a sign of gratitude.15 Frontline staff received one bonus pay in mid-April, with a second in early May. Additionally, we established a Covid Support Care Fund for financial hardship to provide up to $5,000 for employees in need. The Covid Support Care Fund provided financial support to those with lost income related to family member illness or job loss, and for expenses related to the death of a family member.

We also undertook an elaborate and complicated endeavor to provide laundered scrubs daily to frontline workers. 16 In this service, any employee in any role that involved potential exposure to patients could wear their own clothes to work, change into a pair of scrubs available for them onsite, deposit the used scrubs for laundering at the end of the workday, and then return home in their own clothes. We increased our scrub supply from under 15,000 to over 191,000 sets. There were a couple of challenges with this service: scrubs did not arrive as sets and we did not have a sufficient number of scrub machines at each site to automatically dispense them. Thus, a large number of employees and unpaid volunteers stepped in to unpack, sort, and roll sets both at initial acquisition and after each laundering. This was a 24/7 operation made possible by the dedication of all team members, from neuroscience researchers to Linen Services support staff. (Figure 4) "

As the pandemic escalated, we recognized the potential toll on our employees' emotional wellbeing.4 Our pastoral care department provided spiritual messages and virtual support, and we ensured our established counseling program, Healthy Minds, was available. We also moved our traditionally on-site wellness-coaching program, NYP BeHealthy, to virtual sessions, which helped maintain continuity in a chaotic time for employees. We added multiple other online and app-based resources for fitness, yoga, meditation, and nutrition.

Both Weill Cornell and Columbia University Departments of Psychiatry have world-renowned teams with expertise in post-traumatic stress disorder (PTSD). As the crisis unfolded, we drew on their experience with team-based crisis support services and launched CopeColumbia and CopeWeillCornell. These team-based meetings typically occur in-person,17 , 18 but given the need for social distancing, we transitioned to virtual sessions. To date over 700 meetings have been held touching well over 5,000 of our employees.

While team-based support was made available quickly, we also recognized that some employees needed individual crisis counseling. To accommodate this, we created CopeNYP, a service for immediate individual crisis counseling for all NYP employees. Through CopeNYP, free virtual visits became available 12 hours per day every day of the week and weekend. On occasion, an individual required psychiatric care for a pre-existing or a new onset mental health disorder, and CopeNYP directed the individual to appropriate resources for follow-up psychiatric care. Continual leadership announcements and widespread communication about the Cope services led to an openness for the role of crisis support among employees.

The three Cope services have been run through volunteerism. An army of providers across a range of disciplines with prior training in crisis debriefing and intervention reallocated time and volunteered to staff Cope services on nights and weekends.

In Wuhan, as infection incidence declined, more than 40% of frontline workers experienced depression, anxiety, or other psychological burden. 19 In tandem with addressing the continued clinical demands of Covid-19, the next steps in recovery for our employees will focus on coping with trauma and recognizing the sacrifices that our heroes and heroines have made to care for patients who at times were not just patients but also colleagues. The workforce will need to rest in order to shore up their inner strength.

We plan to continue the Cope services for as long as employees need them, and may make some of them permanent depending on demand. We also will use an early warning system to alert employees when they may need to seek help. We will provide this service through Psychiatric Symptom Tracker and Resources for Treatment (START), a periodic brief self-assessment tool that provides immediate feedback on anxiety, mood, and sleep. If an employee's score signals that they should seek help, they will receive linkages to available resources. Given the large number of employees in our system, we will use this service to expand our reach to employees for prevention and treatment of PTSD and other disorders during this vulnerable period.

We are devastated by the loss of life related to Covid-19 among our employees. Along with their families and loved ones, we grieve. To help the families of those we have lost, our mental health clinicians offer counseling services, and we are providing as much financial and medical coverage as we can under the terms of our benefit programs. We are rethinking ways to provide the space for our community of employees to remember their colleagues who have died in this battle while social distancing continues. We held a virtual memorial service in late April 2020 to come together as an institution and remember those lost, and we anticipate holding more as we continue the healing process. We are also considering how to create a permanent memorial at each campus to recognize and remember those who sacrificed so much in the name of saving others.

Battling the rapid onset of a large volume of critically ill patients with an infectious disease inflicted a physical and psychological toll on health care employees. Several key lessons emerged that can be leveraged as the healthcare industry thinks about supporting our workers during a pandemic.

Communication strategies in place prior to the onset of the pandemic were familiar routes of reliable information that we rapidly adjusted and scaled to disseminate information during the pandemic. We used multiple avenues to communicate early and often with the goal of ensuring that employees were aware of and could access available resources.

2. Entrepreneurial spirit and tight decision-making are required for rapid, innovative responses: Leadership and employees at every level exhibited flexibility to expand and adapt their housing, commute, and workplace environs. Functions that we thought could not be done remotely can be done so, such as new employee onboarding and WFH&S. As the future trajectory of Covid-19 is unclear, leaders will need to make quick decisions to try new strategies and adapt along the way.

3. Collaboration is key across small decision-making groups: At steady state, group decisions are the norm and require widespread buy-in. During the pandemic, clear decision-makers working in smaller groups allowed for rapid expansion of services. Collaboration across decision-making groups is imperative to ensure forward momentum towards a unified goal. In certain settings, this experience could lead to a reimagining of decision-making. 4 . Re-thinking the work environment demands virtual employee services: During the Covid-19 pandemic, healthcare employees have busy, stressful schedules. They require access to services at their fingertips. Programs must be available on-demand. Virtual employee services are a requirement, such as virtual counseling and telehealth.

A spirit of volunteerism made many services possible: Many employees and community volunteers emerged to donate their time and energy in the name of supporting colleagues on the frontline. Organized opportunities for non-frontline employees and external community organizations can drive service expansion and implementation.

A note on costs: We are still evaluating the full costs of supporting our employees through the pandemic, though they will certainly run into the multi-millions. NYP has been extremely fortunate to benefit from generous donations of money, time, services, and goods throughout this crisis period and these efforts would have been impossible without that generosity.

Our employees are certainly among the heroes and heroines of this pandemic. Providing them with communication, physical health, and mental health services are imperatives. Employee services are a vital component to preserving a healthy workforce. The sooner these services are offered, the better. Covid-19 is a formidable enemy. It has changed the face of health care delivery and the way we imagine support for health care employees. 

Covid-19: Data -NYC Health

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Communicating Through the Coronavirus Crisis

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Where the U.S. Stands Now on Coronavirus Testing. The New York Times

Emergency Executive Order No. 100

The Unemployment Rate Is Probably Around 13 Percent. The New York Times

Cleaning and Disinfecting Your Home

Group critical incident stress debriefing with emergency services personnel: a randomized controlled trial

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Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease

We would like to acknowledge the following individuals for their leadership and contributions to the development and implementation of our innovative employee supports and contributions to the formulation of this article: