David Putrino is on the front lines of the coronavirus pandemic. As the Director of Rehabilitation Innovation of New York’s Mt Sinai Health System, and the 2019 Advance Global Australian Overall Award winner, he spoke with 33 members, partners and sponsors of Advance.org about his work in responding to the crisis. His insights provide lessons for other organisations and industries about the opportunities that a crisis presents to reset practices and prepare for the next inevitable pandemic.
In a virtual roundtable hosted by Gilbert+Tobin Lawyers John Williamson-Noble and Tim Gordon, Yasmin Allen (Chair of Advance.org) introduced David noting his achievements, fearlessness, willingness to share what he has learned, mentor the next generation and stay connected with Australia.
David painted a vivid picture of the realisation of the pandemic in early March 2020, the sudden escalation of the crisis, and the changes it induced in a very large health system. While his lab of 60 staff was accustomed to supporting the most vulnerable in society (such as patients with stroke, spinal and traumatic brain injuries), they had to quickly adjust to providing acute care and wanted to repurpose their projects to support the Covid19 response.
In spite of a traditionally rigid healthcare system, David shared examples of radical pivots to existing services.
- Telemonitoring of patients – David’s team previously developed a telemonitoring program called “Precision Recovery” to enable rehabilitation staff to engage remotely with stroke patients. In an environment where expertise and experience with telemedicine for routine care is limited, David’s team re-purposed the system to enable healthcare providers to remotely track and monitor patients with suspected positive Covid diagnoses. By emphasising the importance of ongoing daily interactions (instead of one-off assessments), the team has gathered valuable insight about the progression of the disparate and unpredictable coronavirus symptoms, while reducing the burden on the frontlines by carefully monitoring patients until (if/when) they require hospitalisation.
- Supporting frontline workers – In a collaboration with Studio Elsewhere, David’s team delivered decompression/relaxation rooms for high performance athletes. This knowledge was re-purposed in March to quickly build and open “recharge rooms” to help medical staff cope with the anxiety, stress and trauma they are facing everyday, amidst the surge in patients, lack of supplies, and daily experience of death. The recharge rooms now provide support for around 300 healthcare workers daily, and have been rolled out at other hospitals. Early data indicates that just 15 minutes in the recharge room at the end of a shift can reduce stress by up to 60%.
- Addressing digital needs – Drawing on long term relationships with tech providers, such as Logitech, David’s lab is identifying and connecting with vulnerable patients and children to deliver tablets / devices for remote learning, working and health appointments.
- Providing ongoing support for spinal patients – While many of the rehabilitation staff from David’s lab are now working on the frontlines providing acute care for Covid patients, the needs of the rehabilitation patients have not been forgotten. Through a collaboration with Red Bull for high performance athletes, some of Red Bull’s athletic trainers are now providing online sessions for patients with stroke, spinal cord and brain injuries.
What might change?
David reflected on the traumatic toll that New York is experiencing, as shared in these moving remarks by former US Ambassador to Australia, John Berry. While still in the midst of the crisis, David noted the motivation he gets from operating in a healing environment, and feels empowered by the unprecedented freedom and opportunity to find patient-centric solutions. In conversation with the roundtable participants, David highlighted several areas where the pandemic provides an opportunity for individuals and organisations to reset their thinking and operations.
- Organisations need to ask “Are we mission-oriented or compliance-oriented?” As a lawyer noted, well-intentioned compliance can create its own ecosystem. This leads to policies and risks being cited for why something is not possible. Yet a crisis enables employees and leaders to focus on what’s in the best interests of the patient, or the customer/client. This is equally relevant across industries, but healthcare is an ideal setting to assess the balance of risk mitigation versus patient experience.
- Healthcare workers are motivated to help patients. The healthcare system has evolved with an intense focus on assessing and justifying the cost of a healthcare provider’s time or service. This has been a demotivating force for staff, and the crisis has led to staff asking, why can’t patients always be the focus? David’s experience shows that successful care for patients is consistent with a better bottom line. The Precision Recovery service for Covid patients has been offered free-of-charge for anyone unable to afford it, and yet, 95% of patients have paid for the service, and the service has generated further philanthropic donations.
- New innovations can be assessed within shorter timeframes. The typical time for assessment of new products has been reduced from 1-2 months to 1-2 days, with smaller compliance teams. While remaining cautious, it promises faster approval times for new innovations.
- Building resilience requires organisational commitment. While individual variations in resilience have been widely studied, the organisational attributes that support resilience have not been emphasised. The Covid19 crisis has highlighted sources of resilience that are well-known in military circles, but have been unacknowledged within healthcare. David shared the concept of “moral injury” whereby healthcare workers feel angry, resentful and let down by the hospital system in which they work. Employees must trust in their employer to provide the right equipment and conditions (for safety and comfort) as well as gratitude. Employees must also be valued for their ability to operate as a team. David has observed that those with a ‘helping’ spirit are faring better than individuals with a tendency to seek ‘control’ in their daily work. These contributing factors for resilience need to be valued and prioritised from the top.
The pandemic provides useful lessons for all industries on how to prepare individuals for the next crisis, as well as the opportunities to prioritise the patient/customer over compliance, and teamwork over individual success. In a sober reminder of the importance of collaboration, David noted how Covid19 has exposed the tragically different outcomes for countries depending on their collectivist or individualistic cultural tendencies. The crisis has also led to nationalistic responses and actions, in the absence of a coherent global response. Organisations like Advance.org have an important role in connecting individuals from different countries to ensure we respond collectively to crises.
- Angela Catterns introduces David’s work to the 500 people at the most recent Advance Awards
- This is a recording of his acceptance speech for the Healthcare Award 2019 and then the Global Australian of the Year Award for 2019
- You can listen to him being interviewed, where he’s talking about his aspirations and motivations.
- Coronavirus Recovery Program Helps Doctors Monitor Patients After They Return Home
- Technology Expanding the Borders of Hospitals in the Coronavirus Fight
- ‘Recharge rooms’ help ease health care workers’ stress
- We Don’t Treat Patients, We Train Superheroes
- How Not Impossible Labs’ Wearable Translates Music for Deaf People
On the inside
Photography by Anna Finocchiaro