The four leaders of Oklahoma City’s healthcare industry — Dr. Cameron Mantor, Oklahoma Children’s Hospital OU Health chief medical officer; Dr. Kersey Winfree, SSM Health St. Anthony chief medical officer; Dr. Chad Smith, Mercy Hospital OKC chief medical officer, and Dr. Julie Watson, Integris Health chief medical officer – recently united (most notably) during the Omicron variant surge through joint messaging, news conferences and social media pushes to speak as one voice to the OKC community about current public health measures.
Now, as we pull ourselves past the two-year anniversary of COVID-19, this band of four healthcare experts talk about how OKC’s healthcare industry has changed because of the impact of COVID, what we need to do to bring relief to a strained industry and what OKC healthcare will look like in in the next two decades because of the past two years.
First of all, how has COVID shifted healthcare in OKC in the last two years?
WATSON COVID has left a permanent mark on healthcare everywhere, and OKC is no exception. It has disrupted and destabilized the healthcare labor market, caused patients to stop seeking care, which led to disease progression, worsened already significant mental health conditions and exhausted caregivers and physicians who reported record burn out before the pandemic. Despite all of the disruption and exhaustion, we experienced how much we could accomplish in short order, out of necessity. I’ve never been more proud of the caregivers and physicians I work with.
WINFREE More than a shift, COVID has knocked our health care delivery system off balance. With that has come a loss of focus on the priorities that we’ve set in the past for advancing the health of Oklahomans. That loss of balance has allowed situations and conditions we already knew could happen from a public health standpoint to worsen. The three top areas we can’t ignore include access to basic health care services, treatment of advanced diseases (such as heart disease and cancer) and health maintenance interventions that we know are opportunities for prevention and education.
SMITH COVID created a shift in the workforce. The concept of traveling nurses is now much more mainstream. Traveling or contract nurses existed prior to COVID, but they made up a small percentage of our workforce. COVID also magnified the need to identify and develop alternatives for the delivery of care, largely advancing telemedicine offerings for patients.
MANTOR It has shown us that there are many jobs that can be performed remotely and has proven that we can provide much more care via telemedicine than we have done in the past. It has pushed us to become more operational in how we perform patient (care) throughout and has resulted in the creation of multidisciplinary teams to help manage this crisis.
What temporary measures put in place as a part of COVID mitigation will remain part of the permanent structure of OKC’s healthcare? In other words, what worked and what’s worth keeping?
WINFREE The attention to the basics of infection prevention – which we’ve always had – will remain more in the forefront. Examples of what I’m talking about include the importance of hand hygiene practices, source control (such as masks), the practice of staying at home and getting tested when sick as well as adherence to CDC-recommended vaccination schedules. If we abandon these, we do so at our own peril. There is no denying all the COVID prevention matters have had collateral benefit with regard to other contagious diseases such as influenza, common cold and resistant staph infections.
WATSON COVID unquestionably catalyzed virtual and digital health solutions. In July 2020, we implemented remote patient monitoring and a home oxygen program that allowed us to safely discharge patients from the emergency room who were appropriate for the home setting with oxygen if they could be remotely monitored by care managers connected with a physician. This allowed us to keep beds open for more severely ill patients. We are now looking to expand remote patient monitoring for a number of chronic diseases. We had already been working on a strategy for a Hospital at Home program, which provides inpatient-level care to qualifying patients in their homes. The second surge in 2021 prompted us to move more quickly and we launched INTEGRIS Health @ Home on Jan. 31, 2022, and it is going very well. This is a game changer for our patients.
How can telemedicine work in tandem with traditional care? When is it a fair replacement and when should we see providers in person?
SMITH It is a both/and scenario. Patients should be seen with a combination of traditional medicine and telemedicine. Doing so creates more capacity for more patients to be seen in the ambulatory setting. Through telemedicine, rural healthcare providers can extend their services which can decrease the need to transfer patients and keep patients closer to home. It is a supplement, not a replacement.
WINFREE When we hear of telemedicine, most of us think of a remote alternative to going to your doctor’s office. However, there’s an additional benefit that expands health care access to rural hospitals, for example. Telemedicine also enables hospitalists and specialists to care for inpatients at these sites without distance being a factor.
What infrastructure does Oklahoma City’s healthcare industry need to grow?
SMITH We need people above all else — people to fill all types of roles within healthcare. During COVID, we were most limited by a lack of people to provide care.
WINFREE Our health care industry needs to reestablish resiliency through redundancy. We should never globalize critical supply chain production again. For example, one of the worst things we could do is continue to outsource production of surgical masks to other countries and, in effect, risk losing access to critical PPE when we need it most. The military has reserve corps models that are designed to remain prepared for some of the predicted challenges we would face in national threat scenarios, and these last two years should serve as a hard-learned lesson for our health systems that we need a similar, more robust medical reserve model for pandemic scenarios.
WATSON Truly, any infrastructure that emphasizes health and wellness. Several examples come to mind including broadband in rural areas, knowing that so many of our OKC healthcare systems serve as the resource for rural health systems and many have regional catchment areas; reliable broadband services throughout Oklahoma will be necessary for successful technologic solutions to access as well as chronic disease management. I would also love to see OKC businesses focusing on wellness and physical activity, incentivizing their workforce to be healthy. For children – we need more services, technology and person-power in schools that address mental and physical health.
Moving forward, how do we relieve our healthcare workers in a way that allows them to regroup after such a hard two years?
WATSON This is a million-dollar question. Few of us alive have ever lived through a pandemic, and there are no easy answers. We are seeing an alarming rise in workplace violence in health care settings and that should receive serious focus and attention. Health care workers are and have been proud to be public servants, and they deserve to come to work without fear they will be harmed by patients or visitors.
SMITH We must return to the basics and allow them to experience the joy of providing healthcare. This ultimately takes more people to share the load. Currently, healthcare workers are stretched too thin, and they have been in survival mode for two years. The patient volume doesn’t seem to be letting up. We need to get back to appropriate patient ratios so healthcare workers can do what they love the most, which is caring for patients.
Like all industries, lack of workforce is an issue, but healthcare has to contend with burnout and fatigue from recent struggles. How will you attract and retain new talent?
WATSON Also, a million-dollar question. Actually, a billion-dollar question. There has been unprecedented spend by health care systems during the pandemic for temporary labor as staff left the workforce, sometimes to travel and other times out of exhaustion or inability to work and homeschool children and so on. We are taking a multi-pronged approach to address not just compensation but continuing to enhance the experience of being a caregiver at INTEGRIS Health – being innovative with shifts, scheduling, care team design, leadership training and appropriate span of control. I’m privileged to work with a fierce Chief Nurse Executive, Kerri Bayer, who eats, breathes and sleeps this and is working tirelessly on this issue. We face similar challenges with our physician workforce. We have established a Physician Leadership Institute that will kick off this summer, so that we can develop our in-place leaders and create a pipeline for new leaders who can help address not only quality and safety, but also lean in to helping recruit and retain top talent, among other myriad challenges in health care. Great leaders create great culture and an environment that others want to be a part of.
I’m sure you never foresaw such partisan politics playing such a role in healthcare between a patient and a provider. Do you foresee this going away as we learn to live with COVID? Or are politics and healthcare intertwined now? Either way, how do you combat it?
SMITH Unfortunately, I don’t see politics leaving healthcare easily or soon. Politics crept into healthcare to the detriment of our society. Sadly, politics has created a wedge between patients and healthcare workers. We will have to be very intentional going forward to strengthen the trust of our communities in science and medicine. It’s critical for the health of our patients and our community to trust medical providers.
WATSON I wish desperately that I could answer yes to partisan politics around COVID going away. It has been one of the most heart-wrenching parts to watch and experience. Doctors and other clinicians who have dedicated their career, requiring years of training, to advise patients on how to stay healthy or recover from an illness, suddenly were questioned and doubted. It has been a roller coaster and watching how extreme it has become is unnerving; doctors and other health care workers have gotten death threats. My hope is that as COVID becomes just another part of our lives, the vitriol will wane. I think it helps, though, to shine a light on what is going well in health care, and the tremendous, life-changing work that happens every day inside the walls of our hospitals and clinics. We should be talking about the good, more than the divisiveness that has been fueled by misinformation.
MANTOR This a very unfortunate consequence that has occurred. This will continue to be a difficult problem as long as healthcare practice decisions are seen to conflict with business opportunities.
If you had a crystal ball, what would OKC’s healthcare industry look like in 10 years? In 20?
SMITH Higher emphasis is going to be placed on improving quality of care. I suspect in 10-20 years, most of healthcare will be based off value and fee-for-service will be near non-existent, at least in the acute care setting.
MANTOR We will have made an impact on population and preventative health, continue to utilize telemedicine to its fullest extent and make an impact on healthcare access disparities.
Looking around, is this the new normal? Are we better prepared if another pandemic emerges or if another variant surges?
WINFREE It is interesting what lessons from history and storytelling have already told us about pandemics. This is a story that has been in our history and our literature throughout what would be considered modern times. From lethal contagions like the Bubonic plague, to Yellow Fever, to the Spanish Flu, to Diphtheria, to Polio, public health efforts have played a central role in saving our civilization. From many of these we were rescued by vaccines! It is ironic that stories that are so similar to the present scenario with COVID-19 have been published over and over. So, why would we not use this very hard-learned lesson to position ourselves to do the best we can in preventing this from happening again?
WATSON We are better prepared from the perspective of knowing how and what to do to stay safe, flex and problem-solve. The unknown has much to do with how unstable the workforce is. Despite all of our desire and efforts, if we don’t have healthcare workers to take care of patients, we won’t be able to provide the same level and amount of services we have had in the past.
MANTOR This will surely become an endemic problem and move away from a pandemic, and yes, we will certainly be better prepared for what another pandemic will be like. However, it will be challenging for us to come through it if we are not able to decrease the speed with which healthcare workers have left our professions.
How will OKC healthcare address healthcare disparities based on factors like income, insurance or rural location in the future?
WINFREE We, as a community of health care providers, should continue to position ourselves as doorways to exceptional health care delivery for those in need. Our ministry with the Franciscan Sisters was founded in the midst of the Yellow Fever outbreak of the late nineteenth century, and they opened St. Anthony Hospital in 1898 to be there for Oklahoma. We continue to live out that mission every day.
WATSON This is a huge focus in healthcare now. COVID shined the light on inequities in access to care. At INTEGRIS Health we are committed to identifying and addressing the known and unknown inequities in care that exist in our communities. This work will require health systems, private businesses and non-profits, and both the state and local government working together to address access to care. We are participating in the ACO REACH Model with CMMI (Centers for Medicare and Medicaid Innovation), which holds us accountable for the total cost of care and requires a health equity plan. That recent change is welcomed as it is consistent with our mission, vision and values.
What is the one thing you’d like to see changed in the future of OKC’s healthcare industry?
SMITH Healthcare workers are called to this profession of serving others and what we do is challenging, at best, and near impossible if the community doesn’t trust us. Healthcare workers took an oath to provide the best care possible. While we are not perfect, we do our best. We are seeing more and more mistrust of healthcare workers because of misinformation and disinformation. We need that trust back.
WATSON I would like to see a stronger public private partnership. State agencies, organizations and healthcare systems can do great things together to create integrated systems to care for all Oklahomans – we cannot do that alone or in siloes. The pandemic showed us that in spades. This concept of collaboration is well stated in our mission – Partnering with people to live healthier lives.
WINFREE After two years of the COVID-19 pandemic, Oklahoma City doctors, nurses and other caregivers have given their all. They have been stoic in the face of loss, resourceful when confronted with supply chain shortages, worked long hours, picked up shifts for sick coworkers and, most importantly, they have strived to provide compassionate patient care at every turn. Once the dust settles, I hope we can all find ways to honor these individuals who comprise the health care industry, so they may remain strong both in numbers and in spirit.