Patient Care During COVID-19, with Louis A. Shapiro of HSS | EDB 215


HSS CEO Louis A. Shapiro discusses maintaining high standards of hospital patient care.

(32 minutes) Louis A. Shapiro is President and CEO of the Hospital for Special Surgery (HSS). The Mission of Hospital for Special Surgery is to provide the highest quality patient care, improve mobility, and enhance the quality of life for all, and to advance the science of orthopedic surgery, rheumatology, and their related disciplines through research and education. We do this regardless of race, color, creed, sexual orientation, or ethnic origin. Under Mr. Shapiro’s leadership, HSS has experienced significant growth, expansion of facilities and recognition as the world leader in its specialty areas of orthopedics, rheumatology and their related disciplines.

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Introducing Louis A. Shapiro of HSS

DR HACKIE REITMAN (HR): Hi, I’m Dr. Hackie Reitman. Welcome to another episode of “Exploring Different Brains”, and today we’re so lucky we have one of my heroes here. This is the guy, Lou Shapiro, who’s the head of the world’s greatest Orthopedic Hospital, and is an orthopedic surgeon who accidentally got into neurodiversity. We’re going to find out from Lou where those two intersect. And how is it that you’re able to get everyone’s brain on the same page to run the greatest Orthopedic institution in the world, bar none. Lou welcome to Different Brains!  

LOUIS SHAPIRO (LS): Thank you! Nice to be here. Good to meet you.  

HR: Well I’m very excited about this. How did you get into running the world’s greatest Hospital?  

LS: That’s good, that’s a good question. So, I began my journey in this field 35-40 years ago when I decided I wanted to go into healthcare after I figured out, I couldn’t go into medicine to be a doctor. Chem 23 sent me the management route as opposed to the clinical route. I remember it like it was yesterday, but I started off a long time ago when the field was much simpler than it is today. I wanted to have an impact on healthcare, I think I wanted to do it through hospitals and I began that, part 1 was at a big hospital system in Pittsburgh, part 2 was at a big global consulting firm I called Mackenzie, chapter 3 was at a very large integrated delivery system in Pennsylvania called Geisinger and you threw, threw all of those parts of my career, it’s just about how, how can you as an individual have an impact if your organization that you’re part of, the people that you, you serve and it’s just, you know, it’s the same, it’s the same thing but your impact is measured differently and the people you serve maybe different. And then I got to a point where I thought I had learned enough, where I wanted to have more independent accountability for having an impact and you can do that, you’re mostly, when you’re in the most senior position, and when I was at Geisinger I just felt like I wanted to go somewhere that… I had a little bit of geographic preference for East coast as opposed to central Pennsylvania. And I just want to go to the organization that I felt I had some DNA associated with it, that was, that would, you allow it to achieve something that maybe, you know, most people would think wasn’t achievable and it had nothing to do with the size or shape of the organization, it had to do with, you know, something that was less tangible. So, I had no, unique, unique interest in Orthopedics, or anything in particular, it’s really about helping people and having an impact. And I came here in 2005 for my first interview, wasn’t quite sure, had met some people thought, oh there’s something going on here, and then met some more people, and before you know it, they invited me to join and I was, I was, you know, infatuated with what I saw as a potential of the organization and thought it was a place that I could stay for the duration whatever that whatever that meant, that was, that was 13, 13 and a half years ago. And came here to have an impact and that’s what we’re trying to do.  

Running the Hospital for Special Surgery  

HR: Wow. Well, you know, I remember when I started my solo Orthopedic practice down here in South Florida and then started recruiting sub-specialists all over the country, you know, and grow into kind of a big thing and we ended up in all three counties and ultimately got acquired by publicly traded company, but our mantra was in keeping one culture, was treat every patient like it’s your own family and you won’t have any problems. What is the one thing, the mantra that you’ve used at the Hospital for Special Surgery, keeping everybody on the same page.  

LS: You know, I think there, whether, whether it’s the mantra, the mantra changes, to keep things fresh, the things that, there’s a, there’s a few things that don’t change. One is to be eternally dissatisfied with your, with what you’ve accomplished so we’re on a journey, we’re on a journey to be the best in the world at what we do. We’re on a journey to be better than we were yesterday, or last year, or the year before. And remembering that there are a few ingredients and that there are few ingredients as part of that journey. One is that culture, it is a strategy that allows organizations to attain a level of performance that is otherwise unattainable. So, what is it about the culture of an organization that allows you to attract and retain the very best people and you create an environment that gives them what they need to do their job? Allows them to participate in leading the organization alongside of you. And I think being purpose, being purpose-driven and that’s, either we’ve been lucky and have been consistent with our performance over a long, you know, before I got here and since I came here or I think we found some of the ingredients that work whether you’re at a Orthopedic Hospital, a General Hospital or any kind of any kind of organization that is interacting it with the public in some way.  

Battling Burnout  

HR: You know we’ve read a lot in a doctor’s literature lately about burnout and mental health issues with Physicians. Do you have any kind of support system or is that a problem at the Hospital for Special Surgery or what can you comment about that?  

LS: Yeah, it’s a problem. I don’t like the characterize things as a problem, but burnout is an issue anywhere. If you talk to someone and they say it’s not an issue they’re just not aware of it. So, burnout comes from a lot of things, one of the things that it comes from is losing control over what’s important to you. So, people, some of the literature talks about is the electronic health record or talks about the insurance companies or you’re spending time on things that are different than what you came into the field for, you know, documenting, your medical records, or whatever, whatever it maybe, or money, economics. So, those are, those are realities. Forget about, forget about crisis, we’re in the middle of continuous crisis that’s rocking the world and everyone that’s in the country and everyone that’s part of it, but I think one of the things that we have tried to do is cause people to not lose control of their environment. So, this concept of leadership by all and shared leadership, which we try to embrace, is something that gives people a voice and give them a sense that they’re not at the mercy of the external environment and they have some control over their destiny at the same time that’s not enough. And under, under Bryan Kelly’s leadership. Bryan is our Surgeon-in-Chief and Medical Director. Last year we put a renewed emphasis on wellness and resiliency for the medical staff.  

We had a lot of programs for the general employee population, we’ve got about 6,000 employees here and then just to fast forward, your wellness and burnout, it got shielded a little bit because you had this massive rush of adrenaline that allowed you to power through this but we recognized that this was a problem. We brought in this individual, name was Steve Fortay. Steve was a Green Beret, turned critical care nurse and we brought him to the crisis management and then we recently, in fact we just really, we announced it internally, I think this, it was either last week or this week. We appointed, Brian and I appointed Steve as the, our first Chief wellness and resiliency officer and are now seeing this week the creation of the wellness and resiliency council, so that we have a coherent set of programs that are together focused on helping our workforce or medical staff, and organization to pay attention to wellness at the level we need to pay attention to, and to make sure that our individuals whether, regardless of whether you’re a surgeon, a scientist, a nurse, or anyone else who’s part of the team here, is resilient to the pressures and stresses of the external environment. And again, it’s a part of this never-ending journey that we’re on. Whatever we’ve accomplished in this area, great, not good enough. What’s our game plan for the next 6 months, for the next 5 years and that’s part of our strategic roadmap to 2025, to make sure that we remain focused on those most important things that will allow it to fulfill the purpose of the organization which I talked about before, which is to help people get back to what they need and love to do better than any place in the world. That’s our purpose, if we don’t fulfill that purpose then we have no purpose, so we need to be constantly identifying things that the organization needs to do on that journey.  

HR: Wellness and resiliency. That’s a brilliant approach because, everything going on now with coronavirus, it’s on steroids.  

LS: You know, it’s, again the stress from the pandemic created an adrenaline rush that allow people to power through this. Without the adrenaline rush, you feel, you feel the drain, and you wouldn’t be unexpected for individuals or groups of individuals, or even organizations to suffer symptoms that are in post-traumatic stress disorder related. And, you know, ignoring it will not make it go away and the problems that are going to result from this are problems that we may not have necessarily seen yet. So, intervening early, is better than intervening late and that’s what we’re trying that’s what we’re trying to do.  

The Patient Experience  

HR: Could you walk us through the patient experience at HSS and I know it’s probably a bit different now in these coronavirus times, but as one who’s marveled that your super website and the organization. Take us through the patient experience at HSS.  

LS: As you know, we’re a very large musculoskeletal health provider that has a strong academic foundation of teaching research and innovation and we’re located in, our main campus is located in Manhattan, with Outpatient Centers throughout the tri-state area. And a new significant inventory facility in Florida. So, one needs to come here. There is not one individual that must come here. Everyone who comes here makes an active decision that this is where they want to come get their musculoskeletal health care. If you, if we only took care of patients that came from the Upper East Side where we are the closest hospital, that would be around 6% of our activity. So, 94% of our patients pre-COVID and now post COVID-19, now that we’re up to 75% of where we were before, it was driving by or flying over another really good place to get here.  

So, the patient, the patient needs to understand that they’re going to come here and they have a pretty good chance of getting the outcome that they want, that they need, that the right care, is being delivered, that the likelihood of something going awry is lower here than anywhere else, and that, you know, the patient experience speaks for itself. So, word of, our website could be great, and it is. It gives people lots of information from which they can process a decision and then you know other physicians, you know, people like yourself may say, it’s time, when I hear, it’s time for you to go to HSS. So, patients will decide on their own to come here and they’ve heard about us, word-of-mouth, being informed consumers in one way or another. And or someone tells them that they have to come here. So, every step of the process needs to be excellent and without friction. And we’re nowhere near as good as we need to be, we’re getting better every day, and you go to our website, you call a number, there’s many ways to get in, you come here early in your musculoskeletal problems or late in your musculoskeletal problems. And, you know, everyone from the beginning to end, even though we take care of thousands of patients every day, in beginning, first impression, is it your website or making a phone call, to last impression which is when you don’t need us anymore.  

Everyone you interact with is treating you like an individual, is caring, is listening, is attending to your needs, is doing the right thing and minimizing the number of times you get any of those things wrong. It’s not a rocket science, it is, you’re paying attention to the details and it goes back to something that I think a lot of organizations could pay more attention to, with a lot do, with the culture of an organization and how the individuals who work in the organization feel about being part of the organization and the role they play in allowing the organization to do what it does for patients.  

Pediatric Care  

HR: You know, can you talk a little bit about the pediatric aspect of things where there’s so much overlap with developmental abnormalities and genetic problems. I remember one of the best years ever spend my life was at the Shriner’s Hospital, what was then called the Hospital for Crippled Children in Springfield Mass, but there was so much tremendous overlap with support that was needed on so many levels. Can you comment on that at the Hospital for Special Surgery?  

LS: Yeah, yeah. HSS was founded 157 years ago, in 1863, largely, largely as a children’s Hospital. It was called the, it was founded by an organization called The Society for the Relief of the Ruptured and Crippled. And they founded the hospital for the Relief of the ruptured and crippled. It was largely taking care of children, so you know, over the course of those 150 years, that core mission has been maintained, but obviously we’ve gotten much bigger. So, we have the Lerner Hospital for Children and that’s sort of a hospital within a hospital and we have a core group of pediatric orthopedic surgeons and pediatric rheumatologists and pediatricians that provide the core of the care. And then just like we do on the adult side we have some subspecialists, but importantly, importantly as you indicated it’s a complex set of specialists who care in all kinds of different things. So, pediatrics is self-contained here, but also, we’re part of its important wider medical community that is through our relationship with Weill Cornell medicine which is the medical school that we have a partnership with, as part of our education mission. So, that’s a key part of it as well.  

Mental and Emotional Wellness  

HR: Shifting now for a bit to the emotional and mental health issues, as well as neurodiversity in any population, when people come for very, very complex surgery, let’s say your adults there you have psychiatrists and psychologists on staff only as needed and consultations. Can you speak a little bit about that?  

LS: I can speak a little bit about that, there’s probable other member of our team that could speak more, but the, I would say over the course of time, things that we were more dependent on the community to deliver to our patients have been brought into the organization. So, there is people’s incoming status their health, including their Mental Health influences their outcomes. So, we do have psychologists and psychiatrists on staff as part of our team to deal with those issues. Obviously, you know, the epidemic that preceded COVID was the opioid epidemic and people who have a dependency on opioids for one reason or another, that is significantly, sometimes that drives them here, because some of those issues may have been the result of a track record of pain that was dealt with, with opioids, and they’re coming here for care to deal with their original pain problem. So, those things needed to be identified upfront, detected, treated and then cared for through the surgical, through the, through the acute phase and in the post-acute phase. So, those kinds of resources have been added to the organization and just other things that relate to people’s mental health status, has an impact on their commitment to investing in their treatment and recovery. It has become more, more mainstream in the organization, probably lots more to do in that area.  

More About the Hospital for Special Surgery  

HR: Lou, if there were one thing that somebody like me forget our medical, orthopedic surgeon or anything, just a lay person, if there’s one thing somebody like me would not get about HSS the Hospital for Special Surgery, what might that be?  

LS: That we’re not about surgery, we’re about taking care of your musculoskeletal health care, before you have a problem, when you have a problem, and through whatever you need to get back to what you need and love to do. And that’s the underlying, underlying purpose. Don’t be confused by our name.  

HR: Well, and you know, that is so well said. When I commuted from here in Fort Lauderdale for 30 years up to Boston University, my alma mater, to give the first-year medical students their first clinical anatomy lectures, it was, you got to look at the whole patient. It’s a whole patient, it’s not just a bone, or a wrist, or a foot.  

LS: We do, we operate on about 35,000 people a year, and almost 200,000 people come to us for care it’s only 15% of the patients that we interact with that ultimately need surgery.  

Connecting to the Public  

HR: Well there you go, those are real doctors and that’s a real hospital, and so many of us really admire what you and your great team have built there. I’d also like to say a word a little bit about your excellent media, you know, that terrific powerful video that HSS made on the COVID. You know, could you comment a little bit about the importance of organizations being able to communicate, especially in today’s social media and multimedia world?  

LS: I mean, you know, the world is complicated and there’s a, there’s a lot of noise out there, and everyone is living there their life and you only have the opportunity to interact with them when they’re ready to interact with you. So, whether, whether we’re talking about what is HSS about from a consumer point of view, or whether we’re talking about you with HSS is about from a employer point of view, doesn’t matter. Whatever, whatever it is that we’re trying to communicate to whoever we’re trying to communicate you have to be able to tell the story in a way that is, that captures their attention, depends what you want as the as the outcome. And, you know, the crisis, it was a moment and I don’t know that HSS was, everyone has a story to tell, that is a story worth telling during the crisis. For us, it was a moment of truth for us, about how HSS viewed its responsibility to society. And we saw something happened here that we weren’t expecting and it was a complete transformation of what we were doing, not how we did things, but what we were doing to serve the community and we saw this, we saw this transformation happening before our eyes. Yeah, it was intentional, it was designed, it was planned but when you saw it happening, it was, it was remarkable, so we wanted to document it. And we wanted to document it for historical reasons, and we wanted to document it because you always need to tell your story, for whatever reason you want to tell it. And that’s, that’s what we did. It’s easier to tell a story when you have a good story to tell.  

Focusing on Patient Care  

HR: Lou is there anything we haven’t discussed today that you’d like to discuss about HSS?  

LS: No, I think I just want to maybe, just thread the needle through this, it’s obviously we’re in a, in a stage of evolution, the world where technology is driving change at a very rapid rate, and the rate that organizations are changing is exponential, because of technology, whether it’s going outer space, or artificial intelligence, or robotics, the pace of change because of technology is extraordinary. But don’t forget about the importance of people, and talent, and culture as the engine for that. And that’s the engine in HSS that allows us to do what we do and it should be the engine and that’s part, part of anything as the world goes forward, dealing with whatever it is that we’re dealing with.  

HR: That is very, very well said. Very well said. Well, Lou Shapiro, thank you so much for taking time out of your busy schedule, here at “Exploring Different Brains”. How can our audience learn more about you?  

LS: [Laughs] I’m not that interesting, you should just learn about HSS, I’m just here to help us do what we need to do.  

HR: Well, you’re doing a great job and I know you’re humble and modest and I look forward after this coronavirus is over, maybe coming up to the visit you and your great HSS in person sometime.  

LS: Welcome anytime. Thank you!