On the Record

How one of the nation’s leading health equity institutions responded to and became TRANSFORMED BY A GLOBAL PANDEMIC

By David Hefner, EdD I remember it as if it were yesterday: Our board room had turned into a makeshift war room, but the enemy was unknown … novel. It was early March 2020, and President Valerie Montgomery Rice had called her executive leadership team in an emergency meeting to discuss what we knew, what we did not, and how we were going to respond.

The World Health Organization had not yet declared the coronavirus a global pandemic, but we all knew it was coming.

One colleague even said, “Eventually, we’re all going to get infected,” a thought that, at the time, seemed hyperbolic.

But at Morehouse School of Medicine, with its vast array of extraordinary infectious disease, public health, and medical experts, the knowledge of such historic public health crises was well known, yet none of us had lived through anything quite like this.

The “War Room”

What followed that initial “war room” meeting was the execution with extraordinary precision of a widely successful campus-wide response to a global pandemic from one of the leading health equity institutions in the nation. Though there are hundreds of accounts of how institutions of higher learning and others responded to this public health crisis, it is perhaps insightful to understand how we at Morehouse School of Medicine responded. Just 48 years old, MSM is home to two U.S. Surgeon Generals, a secretary of the U.S. Department of Health and Human Services, and a director of the Centers for Disease Control and Prevention, not to mention the countless members of the National Academy of Medicine, former CDC experts, and countless other luminaries.

MSM has been committed to health equity since before the term existed in the contemporary vernacular. With our sister institutions, Meharry Medical College, Howard University School of Medicine, and Charles R. Drew University of Medicine and Science, MSM has helped produce a disproportionate number of the nation’s African American physicians. In concert, we have championed the need to address crippling health disparities that lead to people of color — regardless of income — living sicker and shorter lives. The pandemic exacerbated this reality and, perhaps unlike anything before it, opened the nation’s eyes to systemic inequalities in health and health care. And many of the physicians whom we have trained were caring for those COVID patients in the communities that our institutions serve.

It is against this backdrop that this account emerges. As MSM was tackling the pandemic in the hospital, we were also trying to care for and address the needs of our employees in a way undergirded by our deep understanding and sensitivities to this long-standing challenge. In our Summer 2021 issue of Primarily Caring magazine titled, “Boots on the Ground,” we told the story of how MSM physicians were on the frontlines of the pandemic, caring for patients at Grady Memorial Hospital and other clinical sites. This account provides a first-person look at how we responded as a business of more than 1,110 faculty, staff, students, and trainees. Indeed, our MSM family.

The MSM Executive Leadership Team at the start of the pandemic (from left to right): Monique Guillory, Bennie Harris, Michael Rambert, Martha Elks, Gregory Antoine, President Valerie Montgomery Rice, John Case, Alecia Bell, Goldie Taylor, Daniel Dawes, Sandra Harris-Hooker, and David Hefner MSM clinicians and volunteers prepare to administer the first doses of the COVID-19 vaccination in the Winter of 2021

THE DAYS OF MARCH 2020

Day 2

Ga. Gov. Kemp calls late evening press conference announcing the first two COVID-19 cases in Georgia

Day 3

MSM begins developing plans for students and employee cases, establishing a task force including infectious disease experts

MSM’s mobile security app is updated to include CDC COVID-19 updates

Day 6

Floyd County hospital reports preliminary patient case of COVID-19

MSM announces cornovirus grand rounds at Grady Hospital

MSM begins updating its emergency operational plan

MSM president sends first campuswide COVID-19 update to MSM employees and students

“Even during these scary times, beautiful and inspiring things are happening all around us.”

— Dr. Valerie Montgomery Rice

“Morehouse School of Medicine is a leading health sciences center, but we are more than that,” says President Montgomery Rice. “We are a family passionate about what we do and with whom we do it. We know that it’s the people at MSM who make this institution great. And our crisis response to this pandemic is indicative of the care we have for each other.”

The Five Rs

On March 23, 2020, soon after the WHO declared COVID-19 a global pandemic, the global consulting group McKinsey & Company pinned an article titled, “Beyond the coronavirus: the path to the next normal.” In it, authors Kevin Sneaker and Shubham Singhal listed five steps companies would invariably take in addressing the COVID-19 crisis, and how their businesses would be impacted. The steps were categorized by five Rs: Resolve, Resilience, Return, Reimagination, and Reform.

These five Rs are a fitting format for detailing how MSM managed and eventually found its footing during the last two years. Here are a few highlights to consider and of which we are proud:

No MSM employee lost their job as a result of the pandemic. Though the early months of the pandemic were touch and go in terms of understanding how the pandemic would impact the financial solvency of companies, it was a primary goal of President Montgomery Rice’s that no one would lose their job. And that goal was accomplished.

RESOLVE RESILIENCE RETURN REIMAGINATION REFORM

MSM’s average COVID positivity rate was less than 5 percent throughout the pandemic. Amid multiple spikes in the positivity rates in metro Atlanta, MSM’s positivity rate averaged less than 5 percent throughout the pandemic. How did we do it? By implementing a campuswide — building by building and office by office — social distancing plan, enacting a robust employee testing cadence, and ensuring that no more than half of our employees were on campus on any given day during the height of the pandemic.

MSM scaled its telehealth program to continue critical patient care. Prior to the pandemic, MSM had begun a strategic focus on telehealth, launching a telehealth program and investing in a software platform. So when the pandemic hit, we were extremely well-positioned to expand the program as patients grew leery of in-person visits.

MSM hosted twice-a-week town halls to provide transparency and answers to employees anxious of the unknown. Before the end of March 2020, soon after the city ordered its shelter-in-place executive order, MSM began hosting twice-a-week town halls to ensure we addressed the concerns of employees anxious for answers. This was done in real time, even as questions were raised faster than answers were known. These town halls continued for several months, until uncertainty gave way to relative calm.

With its vaccination Saturdays, MSM was one of the early public locations for vaccination shots. Very soon after vaccinations were approved, MSM begin offering vaccinations on Saturdays in its

Day 9

MSM begins updating its business continuity plan

Fulton County becomes the first school system to announce school closing; other school systems will soon follow suit

Day 10

Grady Hospital, where MSM physicians provide patient care, confirms first COVID-19 case

Day 11

World Health Organization declares COVID-19 a global pandemic

The National Basketball Association suspends its season

The United States declares a national travel ban

“The financial impact of the pandemic in 2020 was the biggest unknown any institution had seen in years, if ever.”

— John Case, EdD, chief financial officer

parking garage and later in its new Lee Street clinic. We leveraged the expertise of our clinical faculty, students, and employees who volunteered. Moreover, as an academic health center, MSM was one of the early institutions of higher learning, in particular, and companies, in general, to require employees get vaccinated, with appropriate exceptions. Today, MSM’s employee and student vaccination rate is 98 percent.

Resolve: Determining the scale, pace, and depth of action required at the business level The pandemic caught everyone off guard. Businesses, of course, were not immune. One of the first actions we took was reviewing and updating our business continuity plan and determining exactly how it would be implemented if the state and city were shut down. One of our paramount concerns was the well-being of our clinicians and residents seeing COVID patients.

As it were, the timing was less than ideal. In the community of academic medicine, March is when fourth-year medical students find out where they will go for their residency training in a process called Match Day. We also had student exams nearing and were preparing for commencement ceremonies.

During this period, it became clear that the scale, pace and depth of necessary actions were vast and all-encompassing, impacting every aspect of the business. We quickly prepared ourselves for this reality by preparing our contingency plans for our students, faculty, and administrative staff. By the end of the month, after the city declared a shutdown and it was clear that we were in for a long road ahead, we had identified an intuitive educational platform for proctoring student examinations; had begun twice-a-week town halls via Zoom to communicate with our entire community; and had moved all our meetings to a remote format.

“Even during these scary times, beautiful and inspiring things are happening all around us,” President Montgomery Rice wrote in a March 27 letter to the MSM community. “I’ve been inspired by the solidarity of us as a community, a family. I’ve received countless emails from MSM faculty, staff, and students with ideas of how to cope, unite, and become stronger during this time of uncertainty. You’ve stepped up to ensure that the mission of this school continues, but most importantly you’ve stepped up to support each other.”

Resilience: Understanding whether a health crisis would turn into a financial crisis It took time to understand the financial implications of the pandemic. Our approach, however, was to prepare for the worst yet hope for the best. The president and the finance team quickly developed a number of contingency plans depending on a number of financial variables, none of which we could control entirely. Would enrollment drop? Would state funding and appropriations buckle as businesses and schools close and state revenues dramatically decreased? Would private support freeze until more was known about the virus and its impact on the financial markets? No one knew the answers to these questions but financial forecasting was required for businesses to persist.

After analyzing various scenarios, the president prepared the campus for the worst: A potential significant shortfall of funding from various sources that would require an across-the-board decrease in our pay checks. In addition, each unit was asked to prepare for reductions in their operating budgets, and each unit was asked to identify how they were going to accomplish their reductions. It was a frightening but necessary undertaking. The president took these steps to ensure that no employee lost their job.

So, at the beginning, it was clear that the health crisis could very well turn into a financial one, and we prepared ourselves for that possibility.

Day 12

MSM cancels all in-person classes and cancels its annual Hugh M. Gloster fundraising dinner

Day 13

MSM president and executive leadership team hold meeting to discuss business continuity plan in anticipation of impending viral spread

MSM announces first virtual COVID-19 town hall meeting on March 16, which led to virtual town halls twice a week — Mondays and Thursdays — for the next several months

Day 15

MSM begins daily MSM @ Grady and MSM @ the VA campuswide COVID-19 updates

MSM provider administers vaccination shots to Atlanta residents while President Montgomery Rice and CNN medical correspondent Sonja Gupta get vaccinated live on CNN as a way to promote the safety of the new intervention.

“The financial impact of the pandemic in 2020 was the biggest unknown any institution had seen in years, if ever,” says John Case, EdD, who served as chief financial officer at the time and is now executive vice president of operations. “MSM quickly developed scenario modeling so the executive leadership team could review all the options. That was a painful process, and it led to data-driven financial decisions, which was critical to success.”

In the end, our worst projections did not occur, thanks to the significant response from the federal government and the U.S. Congress. By June 2020, the U.S. Congress had authorized roughly $3 trillion in coronavirus relief in four separate bills. They included $217 billion to state and local governments; $312 billion in public health, including hospitals, clinics, and research; $513 billion to all businesses; and $810 billion to small businesses.

Moreover, as the nation began to see stark disparities in coronavirus infections and deaths within communities of colors, coupled with the firestorm in the aftermath of the killing of George Floyd, MSM’s value as a health equity leader became clear and undeniable. Consequently, MSM was awarded millions of dollars to help address the pandemic both then, now, and beyond, and our partnerships with some of the nation’s leading companies expanded. By Fall 2020, it was clear that we would remain financially solvent, so much so that the president paid all MSM employees back the money they lost as a result of the pay reductions.

“We were extremely pleased to be able to provide this good news to our employees at a time when anxiety was high and good news was perhaps far and few between,” President Montgomery Rice says.

Return: Reassessing the business system and plan for contingent actions to return to business at pace and scale By June 2020, just three months into the pandemic, MSM’s employees returned to campus under a meticulous plan that we loosely called a “social contract” with ourselves. The contract was simply our commitment to one other and our collective health during the pandemic. Undergirding the contract was a plan in which every room was labeled with occupancy limits; social distancing requirements were implemented by roping off chairs and tables; a mask mandate was issued; a COVID testing

Day 16

MSM begins transitioning to remote meetings

MSM announces campuswide its business continuity plan, workplace policies and processes, and flexible work arrangements

Day 17

Morehouse Healthcare, MSM’s physician practice plan, begins robust transition to telehealth services

Grady Hospital announces the immediate withdrawl of 3rd and 4th year medical students, including MSM med students

Day 18

MSM announces campuswide Covid-19 protocols and symptom checklist

MSM announces guidelines for its residents, fellows and resident programs

MSM officially cancels Match Day, announcing that Match letters will be announced at noon on March 20

President and executive leadership team meet to discuss potential campus closure and shelter-in-place protocols

MSM closes campus to all visitors

An MSM staffer prepares patients in the predominately Latino community to receive their vaccination shot.

protocol was established, which eventually included an automated daily symptom tracker that all MSM community members had to take; and only half of our employees were on campus at any given time. MSM was the first institution of higher learning in Georgia to return its employees back to campus, albeit in a hybrid format. And we enrolled another class of students in our then 12 degree programs with an increased total enrollment.

“I think it went very well,” says Tony Collier, executive director of campus operations and auxiliary services at MSM. Collier’s team was responsible for placing occupancy and 6-feet social distancing signage throughout our main and off-site campuses. “We had buy-in from the employees because it was personal to everyone. We were all in it together.”

In returning to campus, we instituted two committees: the return to campus committee, and the COVID science committee. The return to campus committee was charged with developing the policies, protocols and processes to safely bring employees back to campus; and the COVID science committee was charged with staying up to date on the latest COVID data and science to advise the president and other leaders on decisions, based on science, that they deemed were best for our community.

“It was important to establish these committees to determine where we were and where we were going in the future,” Marla Thompson, who coordinated the work of the committees, says. “Consequently, it seemed like we were always one step ahead. And that’s because the right people were at the table.”

As was the case with all education sectors, our entire 2020-2021 academic year was hybrid, with most first- and second-year MD classes being taught remotely. As conditions allowed, MSM researchers and their students returned to their labs. And, through it all, MSM clinicians and residents remained fully engaged in care delivery.

By January 2021, after the FDA granted emergency use of both the Pfizer and Moderna vaccinations, MSM launched vaccination Saturdays, inviting Atlanta’s most vulnerable populations to come to our campus to get vaccinated. The first shots were conducted in a drive-in format in our parking garage, and the second shots were conducted in our newly minted Lee Street clinical site. We later expanded vaccination shots to other groups as approved by the CDC.

Day 19

MSM moves all non-essential employees to flexible work plan, allowing employees to work from home

The City of Atlanta closes bars and reduces restaurants to only carry-out orders

Day 23

U.S. Sentators Cory Booker and Doug Jones urge support for $1.5 billion in support for HBCUs and Minority Serving Institutions (MSIs) amid COVID-19

Day 25

MSM releases funds to expand its telemedicine program amid fear of in-person patient visits

MSM launches fundraiser to support families at its adopted elementary school, Tuskegee Airmen Global Academy

“We had buy-in from the employees because it was

everyone. We were all in it together.”

— Tony Collier, executive director of campus operations and auxiliary services

At the same time, we partnered with our Atlanta University Center institutions to help bring their faculty, staff and students safely back to campus. Using our Return to Campus model, Morehouse College, Spelman College and Clark Atlanta University opened their campuses back up in January 2021, and we expanded our automated daily symptom tracker to include their campus communities.

Reimagination: Making the most of better insight and foresight to succeed amid change Remarkably, the business of MSM was fairing well as the nation came to grips with the reality of decades of health disparities that were now made abundantly clear. The value proposition of MSM in particular and HBCUs in general began to crystalize in ways that it had not before. By March 2021, MSM launched a subcommittee to examine the lessons learned during the pandemic to determine, as the McKinsey article termed, its next normal.

Also in March 2021, we underwent the reaffirmation process for our regional accreditation from the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC). In higher education, the 10-year accreditation process is as arduous as it is high-stakes. Institutions that lose their regional accreditation invariably must close their doors. Thus, amid all the stress and anxiety of the pandemic, MSM faculty, staff and students were also preparing for our March 2021 virtual site visit.

Remarkably, at the end of the two-day site visit, the SACSCOC site committee recommended MSM receive full reaffirmation with no findings. In other words, we effectively received an A-plus score in our education, research, clinical, financial, and administrative operations. It was an astonishing feat that few institutions enjoy and made clear the excellence of the MSM community (read: family). SACSCOC later officially reaffirmed our accreditation status for the next 10 years.

“Of all the successes we’ve had over the last several years, this was perhaps the most rewarding and significant,” President Montgomery Rice says. “You can’t achieve this level of excellence by accident. It requires tremendous work and dedication at all levels of an institution. As president, I could not have been prouder.”

By this point, MSM had effectively transformed. Our research awards had tripled; we signed a $115 million partnership with CommonSpirit Health, expanding MSM’s footprint across five new regional medical campuses and 10 new residency training sites; our online degree programs were in high demand; and we had begun partnering with some of the nation’s most profitable and influential fortune 100 companies. And we did all this during the nation’s worst health crises in a century.

Reform: Anticipating popularly supported change to policies and previous norms A few things have become clear in the last two years: First is that teaching and learning within medical school education are best done in person, particularly during critical components of the medical school curriculum. Second is within the graduate school, the appetite for hybrid learning and online degree programs is skyrocketing and can and has been done effectively over a number of years. Third is that patient care is evolving, and telehealth is here to stay. Fourth is that technology and automation are critical to understanding what’s next in medical education, patient care, and healthcare analytics. And last is that the way companies operate having learned the lessons from the pandemic will vary based on the company, industry, and business model. At MSM, we are working through these and other key lessons, committed to our students, patients and employees — both faculty and staff. It will be that delicate balance among those key stakeholders, driven primarily by the needs of our students, which will define the scope and scale of our next normal. M

Day 26

The U.S. Senate passes $2 trillion emergency COVID-19 stimulus package

MSM holds faculty seminar on managing stress

MSM delivers groceries to 11 families of Tuskegee Airman Global Academy elementary school

Day 30

MSM celebrates Doctor’s Day 2020, providing lunch to MSM physicians and fellows on the front lines of the pandemic

David Hefner is vice president for strategy and institutional effectiveness at MSM and editor of Primarily Caring magazine.

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