The Bridge: Connecting Science and Practice

Apryl Brodersen, Metropolitan State University of Denver; Sarah Layman, DCI; & Erika Morral, Indeed

Efficiency in the Face of Uncertainty:
NYC Health Hospitals’ HR COVID-19 Response:
How Science Informed Practice

Danielle Caron

Carlos Martinez

Ivelesse Mendez-Justiniano

Overview of NYC Health + Hospitals

NYC Health + Hospitals is proud to have received an Honorable Mention from SIOP and SHRM for our human resources (HR) COVID-19 Response and Emergency Preparedness Initiative. This article provides a case study of our response to the COVID-19 pandemic, including best practices, tools, and lessons learned to help other organizations prepare for a successful emergency response.

NYC Health + Hospitals is the largest municipal healthcare system in the United States and provides comprehensive healthcare services to some of New York City’s most vulnerable populations and underserved communities, regardless of their ability to pay. We are a safety net provider for many NYC residents, providing inpatient, outpatient, and home-based services in more than 70 locations around NYC’s five boroughs, and serving 1.1 million patients annually, of whom nearly 415,000 are uninsured.

Our diverse workforce of more than 40,000 employees is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible.

Development of HR COVID-19 Response and Emergency Preparedness Initiative

In March 2020, New York City quickly became the U.S. epicenter in the COVID-19 pandemic, causing the NYC Health + Hospitals system to become overwhelmed. Our emergency rooms were full, our intensive care units (ICUs) quickly reached capacity, and our frontline staff worked tirelessly to care for our patients, some of whom were critically ill. In the first 6 weeks of the pandemic, we treated more than 108,000 COVID-19 patients, 4,000 of those as inpatients, approximately 960 on ventilators, and 1,100 receiving ICU-level care. With the increase in patient volume and staff testing positive, HR had to act quickly to respond to the staffing shortages and other critical needs that the COVID-19 crisis created.

Staffing shortages required us to immediately assess the staffing needs across the system and reassign staff to high-need areas. In tandem we had to recruit, onboard, and train thousands of additional staff and volunteers to meet the demands. There was an emergent need to fill positions such as nurses, doctors, and respiratory therapists. There was also a need to fill nonclinical positions such as registration staff for higher levels of intake, housekeeping for increased infection control, and mortuary technicians for the unfortunate outcomes of the virus. Given the increase in patient volume in such a short span of time, the challenge was to develop ways to expedite critical functions for our system.

Many critical functions such as onboarding and training had to be transitioned to online platforms, and immediately we had to prioritize online COVID-19 educational training for the safety of our patients and staff. We also had to identify staff who could work remotely and develop policies for telecommuting, a first at NYC Health + Hospitals.

At the same time, there was an immediate need to expand our available resources for staff to support them through the crisis. As our Chief Quality Officer and Emergency Medicine Physician Dr. Eric Wei said, “Healthcare workers are often seen as the healers, but we aren’t completely immune from the potential impact traumas and prolonged stress can have on our mental wellbeing.” This required developing new mental health support resources and expanding those already in place. We also had to find other ways to support our staff to help ease their burden, with resources such as childcare, transportation, and meal distribution.

As COVID-19 cases continued to rise, there was a need to increase testing—especially for the most vulnerable and hardest hit communities—to slow the spread and keep our hospital system from becoming further overwhelmed. In May 2020, we were directed to develop a contact tracing program by the NYC Mayor for New Yorkers to receive free and confidential testing and to trace contacts with possible exposure to COVID-19 to help reduce transmission. This required us to recruit, onboard, and train 1,300 staff in a 2-month period.

The pandemic in 2020 presented many challenges to the NYC Health + Hospitals public health system. HR’s role in the process was critical to ensuring continuity of healthcare services for New Yorkers.

Implementation of HR COVID-19 Response and Emergency Preparedness Initiative

The speed with which COVID-19 spread required our HR teams to quickly shift to new priorities, resulting in significant changes to operations and delivery system-wide.

Our centralized HR office provided the structure to quickly partner with our hospitals’ local HR sites for critical support to the frontlines during the surge. In March 2020, central HR moved to a remote work environment, increased from 5 to 7 days a week of coverage, and deployed a number of emergency response strategies.

First, to address staff shortages, we centralized recruitment and created an online dashboard to track all open positions. Initially we recruited locally, but then extended outreach engaging private staffing firms and the Department of Defense. We generated volunteer leads through New York State databases, social media, Medical Reserve Corps, and the Society of Critical Care Medicine. We recruited college students for high-need titles like respiratory aides. We centralized onboarding, held large-volume, individualized onboarding appointments, and executed a disaster credentialing process, all of which expedited background processes to onboard staff in 24–48 hours versus 4–6 weeks. Prior to COVID-19, we had implemented standardized end-to-end onboarding, allowing for an easy transition to remote operations. In 2020, this allowed us to onboard 31,000 contingent staff and 8,000 employees to meet the demands.

At the same time, we focused on the reassignment of incumbent staff to high-need areas, such as our ICUs and emergency departments, utilizing the Society of Critical Care Medicine’s tiered staffing model to safely reassign doctors and nurses. We created ventilator training simulation videos with Emergency Medicine and our Clinical Simulation Center to train doctors for reassignment to ICUs.

We created interdepartmental partnerships to quickly collaborate and strategically address system needs. For example, we partnered with nursing, information technology (IT), and occupational health to reassign nurses and with ambulatory care, medical and professional affairs, and IT to recruit physicians. With emergency management, we created flexible work hours and telecommuting policies.

We centralized training enrollments, enrolling surge staff into just-in-time required training, monitored completions, and made all existing training virtual. We created online COVID-19 role-specific educational training for patient and staff safety. We developed an emergency virtual new employee orientation for all surge staff and an online resident new employee orientation to onboard medical residents. To support remote work for telecommuting staff, we held training on working from home and managing remote teams.

We expanded telephonic language interpreter services for remote providers, allowing for the increase of telehealth visits for our patients who speak 200 languages and dialects.

We implemented many new online tools and platforms to expedite critical processes. For example, we created a standardized online surge staffing request process for a more efficient response in preparation for the second wave of COVID-19.

We created free employee resource programs such as childcare, taxi services, lodging, and meal distribution, and aided in providing weekly crisis-response training webinars. We developed and implemented a communication strategy for staff and contributed essential information to the online COVID-19 information hub on our intranet, such as psychological support resources, COVID-19 testing information, education and training, and COVID-19 policies and guidance.

In May 2020, we developed the NYC Test and Trace Corps to help NYC receive free testing and trace contacts with COVID-19 exposure to reduce transmission. The 7 days a week coverage structure enabled us to rapidly recruit and onboard 1,300 staff in a 2-month period. For this, we created a learning strategy, a suite of eLearning modules, a targeted new employee orientation program, a bridge program to prepare new hires for their roles, and supervisor training. The NYC Test and Trace Corps has since become the largest and most successful testing and tracing operation in the country.

Throughout 2020, we continuously monitored our emergency response. We assessed our strategies making changes to increase efficiency and developed new tools and processes standardizing our emergency preparedness protocol.

Using the Science and Research to Inform Our COVID-19 Response

Human resource management plays a significant role in any organization’s emergency preparedness plan. In a healthcare setting, lack of an efficient emergency response can affect patient health outcomes and delivery of healthcare services. As such, in order to ensure an effective response, we implemented many research-based approaches.

For example, in March 2020, the Society of Critical Care Medicine provided crisis staffing model guidelines for reassigning staff during the pandemic. They recommended a tiered staffing model to avoid the rationing of critical care services by integrating experienced ICU personnel with reassigned hospital staff. To implement this model, we required all hospitals’ chiefs of service to determine provider tier assignments, suggested safe patient ratios, recommended ICU providers be available for urgent consultation 24/7 to surge units, and provided just-in-time training to better integrate reassigned staff into surge ICU teams. By partnering with emergency medicine and our clinical simulation center, we created online ventilation management simulation training for reassigned doctors. To augment this, ventilator simulation sessions were held at our sites.

We increased strategies to improve our workforce’s adaptive performance, a competency that is critical to a successful emergency response. Adaptive performance is defined as an individual’s ability to adapt to new conditions or job requirements. Our efforts parallel Pulakos et al.’s (2000) eight dimensions of adaptive performance as a model to address the components of our workforce’s adaptability through the crisis. These dimensions include

• handling emergencies or crisis situations;
• managing work stress;
• solving problems creatively;
• dealing with uncertain and unpredictable work situations;
• learning work tasks, technologies, and procedures;
• demonstrating interpersonal adaptability, cultural adaptability, and physically oriented adaptability.

As the COVID-19 pandemic created constant change, increased stress, new job responsibilities, change in job roles, and the need for creative solutions to respond to evolving and constant challenges, adaptive performance proved a critical competency to our success. Many of the training initiatives we implemented supported adaptive performance, such as crisis-response training to address the impact of the pandemic on emotional and psychological health and training on remote work to support changes in work environments.

Research has shown that certain organizational characteristics can promote adaptive performance (Park & Park, 2019). These characteristics are organizational support, climate for innovation, clear vision, and an organizational focus on learning. To improve adaptive performance, we promoted learning and created communication strategies to provide a clear vision of how we were responding to the crisis and supporting our workforce, and we implemented many new initiatives and resources. Resources such as crisis response training were implemented to address psychological and emotional stress to help staff cope with the impact of the pandemic. Training for remote work was implemented to support the changes to work environments. Forming interdepartmental partnerships to address system needs promoted new and creative ways to address critical needs such as recruitment of surge staff. Developing COVID-19 role-specific e-learning provided critical information for staff to adapt to changes in safety measures for themselves and for patients.

The American Medical Association’s (AMA) Caring for Our Caregivers During COVID-19 (2021), states that the way in which we support healthcare staff during a crisis can greatly impact their ability to cope, which can mean the difference between recovery or adoption of unhealthy mechanisms leading to burnout, depression, or post-traumatic stress disorder. Additionally, alleviating stressors can increase retention and staff’s effort on the job. In line with the AMA’s guidance, we expanded mental health resources (contributing to a virtual, weekly, crisis response training) and incorporated many free resources to support our workforce.

Aligning with Occupational Safety and Health Administration’s (OSHA) Guidance on Preparing Workplaces for COVID-19 (2020), we established telecommuting policies, identified staff who were able to work remotely, and created flexible work hours to increase the physical distance among employees.

Finally, we used the plan-do-study-act (PDSA; Taylor et al., 2014) model of healthcare improvement—a structured data-driven rapid-cycle method for testing changes in complex systems—to evaluate our emergency response iteratively. The PDSA model is a 4-step approach to improving processes and resolving problems. This framework helped us evaluate our strategies, processes, tools, and resources in response to the COVID-19 crisis, increasing our efficiency in preparation for the second wave of COVID-19 and standardizing our emergency preparedness plan for large-scale emergencies moving forward.

Best HR Practices for a Successful Emergency Response

The best practices listed below are approaches we found valuable to a successful emergency response.

1. Creating interdepartmental partnerships

Creating interdepartmental teams allows for creatively and collaboratively addressing organizational needs, expediting critical functions, and creating strategic alignment during a crisis. Ongoing communication within these teams, along with flexibility of the staff, are essential to the effective implementation of emergency operations and new systems and processes.

2. Leveraging technology

Technology allows for expediting critical emergency processes, effectively tracking information, communicating information quickly, and enabling collaboration across people and places. Videos and e-learning communicate critical just-in-time training, and emails and webinars cut down on the need for in-person gatherings and enable timely dissemination of information.

3. Providing support for staff

The COVID-19 pandemic has added many new challenges and stressors to people’s lives that have led to emotional, physical, and mental stress. In the work environment, staff have had to adapt to new ways of working, perform added responsibilities, deal with stressors, and experience an increase in health concerns and fears. During a crisis, employees need support from leadership more than ever. Emergency response plans should include increased wellness and mental health support, and additional resources should be made available to staff to support them through the crisis.

4. Implementing emergency processes

A crisis inherently disrupts normal operations, and pivoting to emergency operations is critical to ensure business continuity during a crisis. An emergency preparedness plan should include standard emergency processes and protocols that can be implemented in the event of a disaster or crisis.

5. Creating standardized processes

Developing and implementing standardized emergency processes allows for streamlining operations, improving effectiveness, increasing efficiency, and addressing organizational needs cohesively. It keeps processes consistent across the organization and allows a faster emergency response.

6. Effective communication strategies

Emergencies increase stress, cause uncertainty, and often create fear. Emergency preparedness plans should include communication strategies to provide guidance, direction, and information to staff in clear, concise, and timely ways. Emails, virtual town halls, and live webinars are effective communication formats, as they reach a large audience at once and can be accessed virtually.

7. Monitoring and evaluating your response

Creating a framework to continuously monitor and evaluate an emergency response is crucial to its success. Measuring the impact of newly implemented operations and processes and making changes when necessary improves the efficiency and quality of your response.

8. Improving adaptive performance

Finally, in order for an emergency response to be successful, there needs to be room for flexibility. Of course, having an emergency plan in place is essential to being prepared in the event of a crisis, but equally important is allowing for flexibility to improvise and adapt to the circumstances that are unique to each crisis. As emergencies create constant change, new job responsibilities, changes in job roles, and the need for creative solutions to respond to evolving and constant challenges, adaptive performance is a critical competency in a successful response.

Summary

The COVID-19 pandemic required us to make rapid changes to operations and to adapt in the face of evolving challenges. The success of the HR COVID-19 Response and Emergency Preparedness Initiative was due to the best practices referenced above. However, we would like to also highlight that flexibility and adaptability were paramount at each step of the way, the use of technology was crucial to expedite operations and ensure business continuity, and communication was essential to our successful response. Monitoring and evaluating our response was imperative to refining our efforts and improving efficiency. Finally, although a crisis such as COVID-19 is both tragic and traumatic for staff, it also presents an opportunity for employees to develop adaptive competencies that will help them become more resilient.

References

American Medical Association. (2021, January 25). Caring for our caregivers during COVID-19. https://www.ama-assn.org/delivering-care/public-health/caring-our-caregivers-during-covid-19

Halpern, N., & Tan, K. S. (2020, March 3). United States Resource Availability for COVID-19. Society of Critical Care Medicine. https://www.sccm.org/Blog/March-2020/United-States-Resource-Availability-for-COVID-19

Park, S., & Park, S. (2019). Employee adaptive performance and its antecedents: Review and synthesis. Human Resource Development Review, 18(3), 294–324. https://doi.org/10.1177/1534484319836315

Pulakos, E. D., Arad, S., Donovan, M. A., Plamondon, K. E. (2000). Adaptability in the workplace: Development of a taxonomy of adaptive performance. Journal of Applied Psychology, 85, 612–624. https://doi.org/10.1037/0021-9010.85.4.612

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety, 23, 290–298. http://dx.doi.org/10.1136/bmjqs-2013-002703

U.S. Department of Labor Occupational Safety and Health Administration. (2020). Guidance on preparing workplaces for COVID-19 (Report No. 3990-03 2020). https://www.osha.gov/sites/default/files/publications/OSHA3990.pdf