Mobilizing to Meet Challenges and Improve Survival for COVID-19–Positive Patients and Health-Care Professionals

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Recognizing the COVID-19 crisis “as an opportunity to mobilize the organization to rise in the most difficult challenges” allowed The University of Texas MD Anderson Cancer Center, Houston, to keep mortality rates low for COVID-19–positive patients with cancer and its employees. So said Peter WT Pisters, MD, MHCM, President of MD Anderson Cancer Center during the virtual edition of the 2020 Society of Surgical Oncology (SSO) International Conference on Surgical Cancer Care. The following data points reflect information available at the time of the symposia on August 17.

Peter WT Pisters, MD, MHCM

Peter WT Pisters, MD, MHCM

“The 1.9% crude fatality rate for our COVID-positive cancer patients,” Dr. Pisters noted, “is simply extraordinary. It represents what we believe may be the safest environment for COVID-positive cancer patients in the world.” The 3.6% employee COVID positivity rate “has translated to a 0.1% crude fatality rate for our 805 employees who have tested COVID-positive,” a single fatality. (The total number of employees exceeds 22,000.)

Unprecedented Times

“It is accurate to say these times are unprecedented in our world,” Dr. Pisters noted. “We are dealing with a once-in-a-century pandemic. We are focused on economic headwinds that have not been seen since the Great Depression. And we are challenged by equity, inclusion, and social justice issues that have not been seen in the United States since the Civil Rights era.”

Dr. Pisters noted the need to maintain a “delicate balance of crisis management during the pandemic, as we were looking at the realities of the pandemic response, understanding the commitment we had as we were accepting patients from outside MD Anderson to help our community,” while working to “protect and prevent infections among patients and our workforce.”

“On the other side of the balance is the commitment we have to our mission,” Dr. Pisters continued. That mission is “to provide continuously available lifesaving treatments and trials for patients and families who are counting on us.” Research operations “are now back to 95%, with a substantial proportion of our clinical trials reopened,” Dr. Pisters reported. “We are back to over 80% of clinical operations,” and there is “significant improvement in our overall financial results.”

Planning and Teamwork

At the beginning of 2020, “we were looking closely at the global data that were available, indicating the scope and scale of the pandemic and thinking about the vulnerable population at MD Anderson, which we believe may the largest and densest immunocompromised patient population in the world,” Dr. Pisters recalled. “Our responsibility as one of the largest employers in Houston, and the economic impact that this could have on our workforce and on our community,” also weighed heavily.

For Dr. Pisters, it was “important to interface with health leaders across our region” concerning personal protective equipment (PPE) supplies and the ability to test for the virus. “This involved personal actions, like the commitment to read and stay on top of the literature, to understand what emerging best practices were, and to be able to understand the pace at which these changes were occurring,” Dr. Pisters said.

Three teams were created. A core leadership team brought together faculty, administrators, and content experts including representatives from infection control, patient safety, and technology. This team focused on short-term, 1- to 3-week, responses. Decisions could be communicated “almost daily” via all-employee e-mails from Dr. Pisters and on the intranet site or an app for handheld devices.

A parallel team of leaders focused on topics of importance for the research community. A third team focused on business resiliency, “looking out from 3 weeks to 3 years and thinking about how we were going to navigate through the longer-term aspects of the pandemic,” Dr. Pisters related. “All of this was channeled through the President’s Advisory Council, which enabled us to bring stakeholders together once a week and to receive input from these teams as they focused on their unique issues and time horizons.”

Protecting Patients and Employees

Actions toprotect patients and employees included “limiting access points, reducing the number or individuals on site at our main Texas Medical Center locations by 10,000 individuals, screening and masking for all, and securing PPE” and instructing everyone on how to use it properly, Dr. Pisters explained. Multiple redundant testing platforms allowed testing for all employees.

“We spread out our operations in terms of time and space, with extended hours and weekend hours,” Dr. Pisters reported. More than 30% of the workforce now works from home.

Medical practice changes included adopting “an accelerated approach to map goals of care, so we could improve our focus on the patient and their family and, simultaneously, optimize the use of our intensive care unit,” Dr. Pisters said. “We implemented virtual care over a 3-week time frame,” he added, and the number of virtual care visits has exceeded 40,000.

Surveys were conducted to assess “the stress we knew our employees were experiencing,” Dr. Pisters said. Results showed that employees believed that MD Anderson considers employee health a top priority (88%) and is doing what is necessary to support its patients during this pandemic (94.6%).

These findings were backed by testimonials. One employee wrote: “I am especially pleased that we are not rushing back into business as usual, but you are leading us cautiously, with a watchful eye for changes, good and bad, in the days to come.” Patient testimonials were shared with employees “to inspire our workforce and enable all of us to see the impact we were having on patients during an incredibly stressful time for them and ourselves,” Dr. Pisters remarked.

Community Commitment

Among themost important aspects of community commitment “are our external relationships, those with fellow chief executive officers from the Texas Medical Center; elected officials at the state, city, and county levels; business and religious leaders; and the connections we have to peers around the nation,” Dr. Pisters noted. A public dashboard with data from the Texas Medical Center and other hospitals in the region provided a “transparent display of the impact of COVID on our community” and was used by health officials, elected representatives, and local and national news outlets.

“The key principles for ensuring effective crisis communication,” Dr. Pisters noted, “included the frequency and supportive nature of the communication, complete transparency on all aspects of our response, a fact-based response, and always acknowledging the contributions of others in the response to the pandemic and our institutional efforts.” 

DISCLOSURE: Dr. Pisters reported no conficts of interest.