The following is an edited transcript of an MDAdvantage podcast with Steve Adubato and Dr. John Bonamo that was recorded on April 9, 2020. Dr. Bonamo is Executive Vice President and Chief Medical and Quality Officer at RWJBarnabas Health. He spoke to us about the challenges of planning for a pandemic and supporting physicians in his health system during this unprecedented time.
ADUBATO: Those of us on the outside do not understand, could never understand, what you and your colleagues on the frontline are dealing with. You said right before we began this podcast that it’s unprecedented. Please elaborate.
DR. BONAMO: Basically, our entire facilities have become huge intensive care units. Where a hospital might have had one or two intensive care units of different types, now we have seven to nine intensive care units at each hospital. Floors that were medical-surgical floors are now floors for patients on respirators or ventilators trying to battle this terrible disease.
ADUBATO: What is it like to fill the role of Chief Medical Officer of RWJBarnabas Health during the COVID-19 pandemic?
DR. BONAMO: My role actually started before it really heated up, probably back in the last week in January. We started having planning meetings and deciding what we would need in all of our hospitals in order to do this correctly and take of the people who were going to be coming to us. I made sure people started to identify negative pressure rooms—special rooms where we have to treat these patients. We started thinking about converting units into intensive care units, because we knew these patients were going to be very sick. We started to think about putting tents up at all of our facilities in order to do a different kind of triage and separate the patients as they came in. We started to order all the supplies that we would need. We started to look at all of our personal protective equipment (PPE) as well as ventilators. I started planning probably almost two months ago, but now, although I’m still coordinating, it’s in the hands of the caregivers, because that is where all of the activity is now taking place. Saint Barnabas Medical Center in Livingston alone has more than 300 patients with COVID-19 as we speak. We have more than 1,500 system-wide currently in our hospitals, so it’s a major undertaking to care for these very sick people.
ADUBATO: Let’s talk a little bit about the emotional needs of the doctors you work with every day, the needs beyond the personal protective equipment, beyond everything that they need to protect themselves clinically. You wrote a column for MDAdvisor about this topic recently. Please tell us how you are supporting the physicians in the system during this very challenging time.
DR. BONAMO: The article that you’re referring to was about something we do called Schwartz Rounds, which is an opportunity for caregivers to come together and discuss a case, not just the medical side of the case but also how the case involved them emotionally. These caregivers, these doctors, nurses, respiratory therapists, pharmacists and down the line are people. They have problems in their lives, and they can identify sometimes with the sick patient as being a loved one. They feel it emotionally very much. In the past, we’ve never had a chance for people to share those emotions, and now we do. Now we’re much more cognizant of that, and Schwartz Rounds is a way for people to come together around a case and talk about how it felt, and what it did to them, and how they took it home at night, and how it disturbed them if we lost a patient. That’s particularly important right now because, unfortunately, during this pandemic we are losing patients—so many more patients than a hospital ever saw passing away before. Yes, people pass away in hospitals, it is what it is, but never at the rate that we’re seeing now. That’s very, very hard for our caregivers to be dealing with—fighting so hard to give life to these people and yet still having to face so much loss. It’s a very trying time for them.
ADUBATO: I am sure you have experienced firsthand the difficulties with purchasing supplies. How challenging has it been to get those supplies, particularly for the frontline physicians?
DR. BONAMO: It has been a real chore for lack of a better word. We have had a lot of people working on this literally around the clock, sourcing products from all over the world to get what we need for our caregivers. I’m happy to say that we have not, at this juncture, run out of anything. We have gotten close; we have carried items from hospital to hospital to make sure people have the things they need. They have had them up to this point, and we’re confident they will as we get through the rest of the crisis, but it has been at extraordinary expense. We have trucks running around the state, bringing things to people that they need, working with our distribution suppliers as well. That has been incredibly trying. One of the really disconcerting issues is that we have been overpaying now for five or six weeks, in some cases 10 or 15 times the price of an item. But we don’t really care right now; we’ll worry about the money later. We have to take care of the frontline caregivers who are taking care of the patients. We also have to sort through the noise of the literally 20 to 30 to 40 solicitations that the system gets every day—people selling masks, gowns, everything you could imagine at exorbitant prices. Unfortunately, the black market is in full swing trying to get in the middle of this need for PPE, which they have successfully done.
ADUBATO: I had a conversation recently with your CEO, Barry Ostrowsky of the RWJBarnabas Health System, about leadership and collaboration. Tell me about the collaboration that has taken place between providers and health systems, within New Jersey, among other states and perhaps even internationally. Have you ever seen this level of cooperation and collaboration?
“It’s just been an absolutely remarkable display of professionalism and collaboration with colleagues working together for a common purpose.”
DR. BONAMO: I have not. That’s why I used the word unprecedented earlier; in every way, it’s unprecedented. We have physicians who traditionally work out of offices and who have not done intensive care work who are now volunteering in our hospitals every day, working alongside our intensivists and the people who do this normally every day as their backup and their extra set of hands. The only way we’re getting through this is with all hands on deck. We’re just-in-time training nurses to do things that traditionally they didn’t do. But, again, they work with one of their colleagues who is an intensive care nurse or an emergency department nurse, learning from those who are more used to dealing with the very sick, critical care patients. We have formed care teams. We have always talked about the use of care teams as the right way to deliver care even in normal times, but necessity being the mother of invention, we now have care teams working at every one of our units in all the hospitals. Everybody is working at the top of their license, doing their thing, working together to get us through this. It’s just been an absolutely remarkable display of professionalism and collaboration with colleagues working together for a common purpose.
Quint Studer talks about the “why of healthcare,” which is about connecting to purpose and doing meaningful work, and making a difference in people’s lives. Never has the “why of healthcare” been more apparent to me than these people who come in every day and put themselves at risk, and go in there and take care of the patients. They do it because they understand why they’re there, and they just soldier on. They’re exhausted, and they’re frightened, and they are shell-shocked, but they just keep doing it, because they’re resolved to save as many people’s lives as they can, and they’re doing it. They’re absolutely doing it. We have discharged more than 1,400 people from our hospitals who came in positive [for COVID-19] or sick. We hear the bad stories, but we have to hear the good stories, too. We are making these people better and sending them home, and that is a win because this is a terrible disease.
ADUBATO: Will we ever be able to go back to “normal” after recovering from COVID-19? Or do you expect to see significant changes in the way medicine is practiced?
DR. BONAMO: I really think that we’re going to see significant changes because we have pushed ourselves to do things that we have always talked about (getting into telemedicine platforms, working in care teams, doing lots of things that we plan for), but you know, not every health system was there. We were all in bits and pieces getting there. Now the circumstances pushed us there, and I think we’re going to see an entirely different paradigm of how people access care and the way we deliver care secondary to what we’re going through.
ADUBATO: Along with the folks at MDAdvantage, I have talked about leadership many times and conducted many leadership seminars. This COVID-19 pandemic has forced many to find out what kind of leaders they really are. What is the most significant leadership lesson you have learned in dealing with this COVID-19 crisis to date?
DR. BONAMO: You have to really listen. You have to listen to what the people on the frontline are telling you. You have to hear their angst, and you have to give them a sounding board. You have to tell them what to do and guide them, but they know what to do. They’re professionals; that’s why they’re in that work, but they need to talk to people about it. We are listening to them. We are listening to the sites; we are helping them. We’re getting them everything they need, and we are there for them. We are leading by trying to be servant leaders to these folks who are on the frontline and doing the hard, hard task of working with these sick people.
ADUBATO: Well said, doctor. On behalf of the team at the MDAdvantage, particularly Chairman and CEO Patricia Costante, I want to thank Dr. Bonamo, Executive Vice President and Chief Medical and Quality Officer, RWJBarnabas Health.
DR. BONAMO: Thank you, Steve.