The day began like any other for Dawn Rudolph, president and CEO of Saint Thomas Hospital in Nashville. She had a raft of meetings with various groups and a full calendar, as usual. All that changed within hours as the scope of a public health crisis that she had never seen became clear.
St. Thomas's emergency room is where the contamination of compounded steroid drug from a Massachusetts pharmacy was first suspected. That contamination, as has become clear over the past few weeks, can be deadly.
The fungus found in vials of an injectable steroid drug used to treat back pain caused some patients to develop an extremely rare version of fungal meningitis, and sick people are still being discovered. More than 17,000 doses of the steroid were shipped to clinics in 23 states. At least 15 people have died in six states. And at least 203 people have been sickened.
But none of that was clear at first.
Similar to military leaders operating in the so-called "fog of war," at the beginning, Saint Thomas had nothing to rely on other than their internal expertise and a surge plan developed for natural and public health disasters.
The hospital's first steps came from those drills, Rudolph says. "Once we knew it was happening, the general medical staff was informed, and we provided them with talking points," she says.
This was an effort of the communications department, not only to inform the public, but to inform the medical and hospital staff of the scope and nature of the problem as they currently understood it, she says. That was important when rumors took flight in the early stages of the crisis, even among family of caregivers at the hospital.
Subsequent testing by the hospital's doctors and the Centers for Disease Control and Prevention in Atlanta discovered that the illnesses were related to the drugs, and suddenly, Rudolph found herself and her hospital at the center of one of the biggest prescription drug scandals in recent memory.
Saint Thomas is far from the only hospital affected by the outbreak. It just happened to be the first to notice widespread problems with patients who had been injected. And it's at the epicenter of a whole new area of worry and potential liability for hospitals nationwide.
The clinic that unwittingly injected the contaminated drugs, the Saint Thomas Outpatient Neurosurgery Center, is not affiliated with the hospital, even though it is located within the building.
But Rudolph says the majority of the patients who were sickened were initially treated in Saint Thomas's emergency department. Once the connection was made to the tainted drugs, the clinic took the responsibility to notify all its patients who might have been exposed. That left Rudolph and her clinical and administrative leaders and to deal with the rest.
She quickly found out that the public doesn't necessarily make distinctions about the ownership of an unaffiliated clinic, especially one that carries the hospital's name. The public knew it happened on Saint Thomas's campus.
To try to get ahead of the situation, Rudolph organized coordination calls with the clinic outlining who was responsible for what, and tried to determine the best course of action as it became evident that the crisis would grow larger.
The clinic took care of notifying patients, but the hospital was responsible for doing what it could for infected patients. At one point, Saint Thomas was treating up to 45 patients a day who had received the injections—not a small feat for the 29-bed ED.
As a CEO in a crisis situation, Rudolph says it's most important not to be in the way, especially as far as the clinical care teams were concerned. Her role, as she saw it, was to be involved in all the conversations going on about the crisis, so that she could have an up-to-date global view of the situation.
"We have wonderful leaders in infectious disease who could work with the Tennessee Emergency Management Association and the CDC, so I stayed out of the way there," she says. The COO and CNO coordinated ER and ED and internal support, "to make sure we're keeping our daily operations running and anticipating how this might evolve."
Being at the center of a mushrooming public health scare wasn't something she expected, but she says "being in hospital operations for 20 years, we're certainly familiar with operating in the face of a disaster. Still, this was a fairly unprecedented situation around care protocols, so we had to figure out how that might affect our already developed emergency plan. I had to be the person who is observing."
Not only was she observing, but she was also making herself available to anyone who had anything to do with managing patient care in the face of the crisis.
"Certainly, in hospitals and health systems, we have to be able to surge, meaning that you have to know where your entry points are in the hospital and develop an incredible amount of teamwork," she says.
"That starts before any crisis and you're always trying to surround yourself with good people—people who know their operations resources and can think creatively in the moment, articulate their concerns, and look ahead."
That ability to anticipate challenges is hugely important, she says, because every crisis is so different, and always unexpected.
"We have our manuals and whatnot, but when you have an event, you have to bring the team together, scope the problem, and give them accurate information on what we're dealing with in the immediate future," she says.
It's important to plan for the short term—"the next four hours, for example," she says. "What am I missing? That's a question I always ask in meetings," she says, opening the floor up to anyone involved. "People can offer a lot in the problem-solving process."
Among first things everyone in the hospital did was check their supplies. "Our hospital does not use compounding pharmacies," she says, "so there was no need for a stopgap measure" regarding revised care protocols.
One the immediate crisis was contained, however, Rudolph had to deal with bruises the hospital had sustained to its own reputation following a time of intense national media scrutiny.
Remember: While it is true that the hospital does not use compounding pharmacies, the general public makes no distinction between shots administered within the hospital and shots administered by a similarly named, but unaffiliated clinic situated on the same campus.
"We needed to get the story right over time, but that didn't overwhelm us because we knew in the halls we were doing the right thing in preparing daily for what we needed to do," she says. "Still, don't be surprised by the psychological effect when the institution goes through any event like this."
By that, she means erroneous reports by local media, for example, which initially tied the crisis to a viral meningitis case in the area, suggesting that the hospital—and its staff—may have been at fault.
"The staff knew it wasn't accurate, but that was a psychological blow," she says. "There's an adrenaline rush when these things happen, and it does affect staff. They need to talk about it."
Several meetings were scheduled with staff to make clear the facts of the story.
"You need the ability to say here's the talking points you can address with your family, who might be worried about you," she says. "People were picking up pieces of the story and they needed to feel confident."
While Saint Thomas has regained its footing and Rudolph says a sense of normality is returning, patients are still being treated at the hospital for meningitis associated with the injections and will be for some time.
In hindsight, which Rudolph says she can afford right now, she would have made at least one major change to the way the administrative team, including herself, handled the crisis.
"I would have immediately grabbed an administrative person and had them pull a chronological list of what had occurred that day relating to the crisis," she says. "We did that in spots, but things evolve fast. I would have said, ‘you're designated to be the record keeper and check in several times a day with team leads,' because it was so multidimensional."
That's because accurate communication is of the utmost importance, behind only patient safety and care, during a crisis, she says.
"I'm still spending more time walking the halls, talking with people and being able to hear their side of the story," she says, noting that her calendar is still cleared. "You clear your calendar and can be anywhere you need to be to make connections. Make it your priority."
Philip Betbeze is the senior leadership editor at HealthLeaders.