President & CEO, Orlando Health

How I Heard

My first Orlando Health board retreat ended Friday afternoon, June 10, 2016. The retreat had been a great success.  It was the accumulation of nine months of focused work attempting to determine the best strategies to improve the organization’s performance. I was ecstatic with the delivery of the material, organizational involvement in the development of the plan and the board’s enthusiasm regarding the direction we would be headed in the coming months and years. As excited as I was, I also was exhausted and very much looking forward to a quiet, peaceful weekend. 

The quiet and peaceful weekend was shattered Sunday morning at 4:53 am. I rolled over, answered my cell phone and was quickly awakened by the sorrow-filled voice of Orlando Health’s chief operating officer, Dr. Jamal Hakim. Jamal had just received a call from Mark Jones, president of Orlando Regional Medical Center (ORMC), alerting him of a mass shooting and hostage situation in downtown Orlando. ORMC was the primary recipient of the victims. As we spoke, my wife turned on the television and news coverage of the shooting already had begun. Quickly getting out of bed, I debated if I should put on a suit or just slacks and a shirt. I skipped the suit, thinking that I would save time. I would wear the same slacks and shirt for the next 17 hours. I started the car and turned on CNN. I thought about how thankful I was that I had broken down and renewed the XM radio the week prior. My mind raced as I hurriedly drove on the empty tollway, listening to the CNN anchors trying to piece together an awful shooting that was unfolding in my hometown. I could see the lights from the countless first responder vehicles as I pulled onto Orange Avenue. I immediately drew a deep breath and prayed for wisdom and the protection of our team members and physicians.   

Synopsis

2,112 - 44 - 9 - 35 - 6 -78 – 550 – 460 - 13

Many times numbers tell a story. The numbers here have special meaning to Orlando Health because of what they represent. The front door of the Pulse night club was 2,112 feet from the front door of ORMC’s emergency department, the busiest Level One Trauma Center in the state of Florida. ORMC received a total of 44 victims, 9 of whom died either before or upon arrival. All 35 patients who arrived alive survived. Within an hour of the first patient’s arrival, 6 trauma surgeons were on site working. These same surgeons would perform a total of 78 surgeries on the victims. In the initial hours of this event, more than 550 units of blood were administered, including 200 units that went to a single patient (the average body has 7 units). ORMC did an amazing job, not only with the demands associated with the Pulse event, but also continuing normal operation for the 460 patients in house and performing 13 elective surgical cases on June 12th.

2:04 am - 2:14 am - 2:24 am - 2:44 am - 3:25 am - 5:02 am - 10:00 am

The first call regarding the mass shooting was received at 2:04 am. The first patient arrived 10 minutes later at 2:14 am. Ten minutes after that, at 2:24 am, the 10^th patient arrived and a call went out for back up. The final person to die from this horrible event was pronounced dead at 2:44 am. At 3:25 am, an active shooter code was called inside ORMC. It was believed that a gunman was inside the hospital. This suspicion, fortunately, was not true and never made it to the media. Even so, it created great trepidation and horrific memories for team members. At 5:02 am, SWAT cleared the Pulse night club and the second wave of victims started arriving. At 10:00 am, the ORMC trauma center was open again to care for others across the region with life-threatening injuries.   

Preparation

While several of the issues Orlando Health faced during and following the Pulse tragedy could not have been known or anticipated, there was no doubt that planning and preparation proved essential to performing well in the actual event.

Mark Jones, president of ORMC, activated and led the command center within an hour of the shooting.  All members of the command team quickly stepped into their assigned roles thanks to countless hours of mock drills and actual hurricane events requiring activation of the command center.

Response

The clinical response to the tragic event was nothing less than amazing. Every single person present during the initial hours and in the following days and months of this event is truly a hero.  The outcomes in every category bear witness to that excellence. From a system CEO’s perspective, the actions I needed to take were relatively simple:

• Make key decisions at critical times
• Trust, believe in and back the team
• Communicate frequently to all parties
• Be present and be real
• Own what you own

Lessons Learned

The Pulse event caused most of those outside the organization to correctly focus on the immediate clinical response. The associated work, however, continued for days, weeks and months. Some of this work was created by how the outside world responded to the tragedy. In many ways, it became an all-consuming set of reactions that the team managed with precision and grace.

One of my first examples of the outside world’s actions occurred early that Sunday morning when Orlando Health’s Director of Emergency Preparedness, Eric Alberts, looked at me and said that a gentleman had driven his pickup truck from Indiana and was placing 49 wooden crosses on the ORMC campus representing the individuals who had been killed. Eric asked, “Are we going to allow this?” My answer, “Yes.” The continued outpouring of gifts and kind gestures grew exponentially. Pallets of water, flowers, cards, banners, paintings, handmade blankets, gifts and pizzas – hundreds of pizzas! I will never forget after the initial pizza delivery, a law enforcement leader asking me if we should distribute the pizzas or not. Since it was early in the timing of the Pulse event, it wasn’t yet understood how far- reaching the terror act was. The officer’s concern was that the pizzas might have been purposefully contaminated to cause harm to our staff. What decision should be made?

All of the gifts were thoughtful, especially the banners from other healthcare systems. These signed banners with well wishes and encouragement were of great support for our team and sincerely appreciated. The plethora of other gifts raised questions of who should manage, receive, distribute and determine if these items were safe for staff and patients.  Some of those who made donations had expectations of exactly how their gift should be used and how they would like to be recognized for their gift. Orlando Health’s guest services and community relations teams jumped in and took responsibility for all of this and several other unique and essential activities.

Having celebrity anchors from every major news organization camped on the front lawn of one of our hospitals was something I never anticipated. Understanding that the events of the day were events that the entire world felt and experienced was an awakening and important level-setting point for me. Clearly, this was not a local story. We were in the middle of a U.S. presidential race. Anything one of our team said or did might be used as a political statement given the many potential issues that could be associated with this shooting. This fact was constantly on my mind. I am blessed and fortunate that our team focused our message where it needed to be: the organization’s response and the clinical status of patients. This world event caused elected officials ranging from city commissioners to the President of the United States to draw close to the patients under our care. That same draw brought Hollywood stars and major league athletes with the desire to visit and do their part to help. While these gestures were well meaning, it was additional work for the team to manage. They did a wonderful job ensuring that this activity did not affect the clinical care of our patients.

With law enforcement, elected officials, Hollywood stars and athletes plus reporters attempting to sneak into the hospital and every imaginable gift piling up, it was important that we continued to be in charge of our facility and honor our responsibility for the care and safety of patients, team members and physicians. An essential lesson for us was to “own what you own” and ensure everything that happened on our campus was controlled by us and not others. That’s not to say we didn’t desire to work with every party, but our top priority was the care and healing of the victims of the tragedy. No greater place was this ownership true for Orlando Health than in identifying each of the victims and connecting them to their loved ones. This is an area where Orlando Health’s persistence and diligence enabled  families to connect us with their loved ones hours and potentially days sooner than would have occurred had we not taken  a leadership position.

Eventually, the focus of the event turned to economics. Orlando Health spent millions of dollars in preparation, planning and responding to this horrific event. However, the health system was not reimbursed by the federal government, state government or Pulse funds raised for the victims. The organization did receive wonderful support from friends of our Orlando Health Foundation who understood the amazing response of our team members and physicians. These gifts, however, didn’t come close to the organization’s expenditures. Our decision to write off the patient bills of the victims was a conscious choice.  We reasoned that these individuals were part of the worst mass shooting to date in the U.S., and in our judgment, didn’t need the additional burden of the cost of their care. I did receive complaints from people who historically had received care at an Orlando Health facility and were requesting their bills be forgiven as well.   

An extremely important area for me was taking care of those who care for others. The mental trauma of an event like this on individuals cannot be understated. I believe Orlando Health did an excellent job in this area, offering hourly counseling starting that Sunday morning at 7:00 am. More than 2,000 team members and physicians decided to participate in this service. It continues to be available 18 months later and will need to continue going forward. One of the greatest issues Orlando Health team members faced was the feeling of guilt. Team members who were not on site physically wanted to be here to help. All would have come running if called. In truth, each of them was here, because the organization is an accumulation of each person’s expertise, skill and the systems and processes they helped design. I am convinced that the outcomes of the event would have been the same if the tragedy had occurred any other day. Every Orlando Health team member and physician was a part of the outstanding response. 

Conclusion

The caller on the other end of the phone said, “David, we all have M-days.” I thought to myself, “I really don’t have time to hear your cute thoughts,” but continued impatiently to listen. He continued, “Yes, we have days that are mundane, or those that are just average ole days. We also have memorable days, those that we remember because something special happened. Finally, we have milestone days. Milestone days are those that change your life, your perspective and that you’ll always carry with you. David, you and Orlando Health have just had milestone days.” The caller was right.

The events that surround June 12^th will never be forgotten and have been life-changing for many of us. What happened has become a part of our organization and now is a part of our lives. I couldn’t be more proud of the people who represent Orlando Health and create milestone memories and experiences for patients and each other on a daily basis. I am saddened, humbled and honored to have been a part of the Pulse experience.      

Key Takeaways

My personal take-aways:

• It takes a TEAM: Every team member, physician, board member and donor across Orlando Health is to be credited with the outstanding response to the tragedy.
  
  
  
  
• Be a great place for people to work: Healthcare personnel have difficult and complex jobs, and they deserve an excellent work environment.

   

• Expect excellence.

   

• Don’t ever confuse the business we are in with the real work we do: My daily business is about growing and improving a health system. The real work is what occurred the morning of June 12^th and continues to occur each day with the patient-facing activities.

   

• We are changed: Events such as Pulse will stay with me and the organization forever. Accepting it and determining how to personally and organizationally compartmentalize the event and its extended effects is essential to personal and organizational health.