Months into the coronavirus, Robert Jansen, M.D., chief medical officer and chief of staff at Grady Memorial Hospital in Atlanta, GA, continues to manage a hospital system that looks far different than it did in 2019: masks everywhere, fewer visitors, a stressed emergency department and empty clinic waiting rooms as more and more routine care switches to tele-health. The virus, he says, “changed the entire work environment, not only for people in units that have COVID-positive patients, but throughout the hospital.”
Q&A with the Chief Medical Officer and Chief of Staff of Atlanta’s top public hospital on providing care to the community’s most vulnerable
In this Q&A, Jansen shares how the 128-year-old institution is making the changes necessary to provide care to the community’s most vulnerable residents--now and into the future.
Q. Tell us about the communities and people Grady Memorial Hospital serves.
Our patients are some of the most vulnerable in the state, including many of the 3,000+ homeless individuals in the Atlanta area. About 30% don’t have insurance, and about 30% are underinsured. Since we opened in 1892, we have committed to providing the same quality of care to rich and poor alike. We are a major burn center, one of the largest stroke centers in the U.S. and a major HIV/AIDS research center. We have a broad mission to fulfill.
Q. How did the coronavirus affect the care you provide to your community?
We had two fronts to consider: the hospital itself and the community the hospital serves. Like all healthcare providers, we were paying attention to what was happening early on in Washington State, learning from that scenario and preparing accordingly—stockpiling PPE, ordering more ventilators, mobilizing our nurses and physicians to develop a model on how to take care of coronavirus patients. We put a lot of effort into testing at scale—we tested every admission and extended testing to our employees and to the medical schools. At one point we were even testing for other health systems until they were able to get their own programs up and running.
We also partnered with community organizations and nonprofits to get testing into the homeless shelters. We worked with the health department to find shelter for patients who tested positive and needed to be isolated but didn’t require hospitalization. Those kinds of precautions are very important to protect the most vulnerable, such as the HIV/AIDS population.
Q. How did all your planning help you through the most challenging times?
The preparations were critical to us and our patients. At one time, 25% or more of our patients were being treated for the coronavirus. The emergency department was stressed because of the influx, but because we put certain things into place, we were never overwhelmed. We were stressed, I'm not going to minimize that. The staff was stressed, supplies were stressed, but at no time did we run out of critical supplies.
Q. Do you expect some of the changes you’ve made to be lasting?
The biggest change has been the necessity to separate ourselves physically. Medical people take comfort from one another, and social distancing runs counter to everything we do in a hospital. But it's necessary. Distancing has become our new way of doing things—and it will be for the foreseeable future.
Even though we’re learning more every day, the coronavirus remains a bit of an unknown. That is stressful for both staff and patients. The psychology of providing care is almost as important as the care itself—making sure that our staff feel protected so that they feel they can take care of the patients safely. A lot of our resources have gone into supporting the mental health of our teams and our patients.
Q. What concerns do you have about what lies ahead?
We want patients to know that they can safely come to Grady Memorial for the care they need. Like other hospitals, fewer people are coming to the emergency department and are reluctant to have procedures done. It's understandable, but we may be one of the safest places for them to be because of our testing procedures and the precautions we are taking to ensure patient safety. We remain concerned that many people are not getting the healthcare they need, not getting prescriptions refilled, not seeing doctors.
Q. How do you sustain the work you are doing and meet the challenges ahead?
We’ve certainly been tested. But we have made it through from the support of our people, and from the generous support and donations from our community and private companies.
At the height of the spike in coronavirus cases, for example, our nurses, respiratory therapists and physicians did a miraculous job to rally and care for the very sick—even when we didn’t fully understand how the virus was transmitted. It was incredible to watch, and I could not be more proud of the people of this organization.
Still, with that said, we had intense challenges ahead of us. Just before the healthcare crisis hit, there was a flood in the hospital and we lost more than 200 beds and other important medical equipment. And, as we dealt head-on with the coronavirus, we were no longer able to operate as a full and functioning hospital—we did not do elective procedures and other critical care was suppressed. That hurt us financially.
We made it through, though, in part from support we’ve received from the community and donations we’ve received from companies like Bank of America. We have not had to lay off any of our staff or institute furloughs, and we’ve been able to continue to provide care to those who need it.
Thanks to generous support from the local community and beyond, Grady Memorial has continued in its mission of providing critical care to the city’s most vulnerable populations. A $500,000 grant from Bank of America, part of its $100 million commitment to assist communities in need, helped Grady increase acute patient care capacity and expand its testing program. Learn more about the bank’s commitment to helping underserved communities throughout the coronavirus.
Originally published 08/05/2020