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Human Understanding award finalist creatively inspires staff and patients

It’s often said that people don’t care how much you know until they know how much you care.

When it comes to caring, Jay Kaplan, M.D., FACEP, Emergency Physician and Medical Director of Care Transformation at LCMC Health in New Orleans, knows it’s all about the relationships we foster:

“Connection to our colleagues, to our work, to our patients—and, if you will, to something greater than ourselves.”

Dr. Kaplan’s life work has been partnering with physicians, hospital leadership teams, medical groups, and hospital staff to provide them with tools and tactics to improve patient care while changing the work environment’s culture to inspire and motivate everyone to succeed. He is a catalyst who focuses on countering negativity to improve teamwork and facilitate change even among individuals who are usually “no/can’t/won’t” people.

In the trying days, weeks, and months of the COVID-19 pandemic, Dr. Kaplan has found himself in another much-needed capacity: caring for those who care for patients. The pandemic has created a stressful time for everyone in healthcare. Even doctors and nurses who are used to seeing patients die don’t generally see six pass away in one night—often without their families at the bedside. On top of that, these patients are sick from a disease for which there is currently little treatment other than supportive care, and healthcare workers are worried for their patients, their families, and themselves. Dr. Kaplan now finds himself serving as a counselor, acknowledging staff members’ feelings and offering messages of resilience.

Dr. Kaplan visits all five adult hospitals and the one children’s hospital in the LCMC Health system and has developed a “Be Well” program for the organization. He and his program coordinator visits frontline units to deliver hope amidst tragedy and confusion. He also keeps teams updated on the latest information about the disease, understanding that the work done in healthcare now is “life and death” in real time. He encourages his teams to get through it by acknowledging their feelings and taking it one step at a time.

NRC Health recognizes Dr. Kaplan’s level of care as a Finalist for the Excellence in Human Understanding Award. This article is one of a series celebrating the achievements of healthcare workers who have had a transformative impact on patient care; Dr. Kaplan recently sat down with us for an interview.

Q. What does Human Understanding mean to you?

We happen to be in a culture that’s very success-oriented and very task-oriented, and the same goes for healthcare. And particularly with the electronic health record and the pressures that folks sometimes feel regarding productivity and issues like that, people get very task-oriented, asking, “What do I have to do? Who do I have to see next?”

In some ways, that really defeats the purpose of healing, which is about connection; it’s about holding someone’s hand or looking someone in the eyes. To me, when people come to us, they don’t come to us with their joy. They come to us with their pain, anxiety, and fear, because they don’t understand what’s going on with their body, and they need some help. And so, our job is not just to throw things like medications and diagnostic tests at them—our job is to say, “Okay. I’m here for you.”

Empathy and compassion are really about, “I’m here for you. Now let’s find our way through this.” Because in my experience, the one thing people don’t want to feel is alone and helpless. COVID is the ultimate in being out of control when something is attacking your body. The same goes with diagnoses like cancer and similar illnesses—but COVID just happens much more quickly.

And it’s even more important because when people come into the hospital these days, we can’t allow their family members to be with them. And so, doctors, nurses, and others in non-clinical services like environmental services have become patients’ confidants and held their hands as they are dying.

It’s also unfortunate for the healthcare workers now, because it places a substantial moral strain on them. And so that’s really where I see a significant part of my role now, which is to help my health system focus on the well-being and support of our staff. Unhappy doctors and unhappy nurses don’t make for happy patients, and it doesn’t make for good clinical outcomes either. And so, while there needs to be a focus on the patient, there simultaneously needs to be a focus on creating an efficient and fulfilling work environment for the people who are giving that care.

Q. COVID accelerated a lot of burnout in the medical field. How have you helped your health system overcome these challenges? What is the feedback?

I’m somewhat known for connecting with folks, and they’ve known about my interest in clinician well-being. I got a call from a CNO saying, “I really need you,” and then she talked about the difference that I made with her staff to the other CNOs. And then my boss, who is the CMO of the system, basically said, “I want you to stop doing this other stuff.” I was doing work with employee health and trying to get adequate testing, and this was early on in the pandemic.

I got a note today from a physician who works at a children’s hospital, who said, “Jay, I’ve been watching some of your talks and just wanted to let you know how inspirational they are. I’m trying to learn from you to improve my skills. Thank you for sharing them online. I appreciate your outstanding work to improve the health and well-being of all.”

Another piece of feedback I received was a note from a nurse that read, “I’ve been a nurse for over 16 years, and I’ve received awards and been recognized as great 100, a great 39 at one hospital, and a Daisy award winner at another hospital. It’s an honor to be recognized by your peers and patients like that. Still, what you did and your persistence and ensuring you got in touch with me, and how you went out of your way to do so, surpassed anything I’ve experienced in my 16 years as a nurse; I’ve never felt so cared for and genuinely appreciated for my work in the leadership role as I did today. I was really at a breaking point mentally with personal stress and struggles, financial struggles, and everything associated with my role as a director. I broke down in tears as you walked away, and it took me a little while to stop. I want you to know that I can’t say thank you enough for all of it. And making me feel like I’m important. No one’s ever shown this amount of gratitude and appreciation towards me. And I will never be able to say thank you enough.”

Q. We understand that you wrote several poems during the pandemic to share with staff, permitting them to feel, providing hope and help in getting to the other side, and encouraging them to continue to connect with their patients and their colleagues. Will you share one with us?

I think people needed permission to feel. Many of us in healthcare have a “Superman syndrome,” which is about keeping it together. And there’s a culture of silence. I’ve been keeping a journal since 1970, but I carry around a journal with me everywhere. After I went and visited Touro [one of the hospitals in LCMC Health], I had to transform the feelings that I was feeling myself because I could feel people’s pain. And that’s when I wrote my first poem, “When Corona Comes Knocking.”

I found that people really appreciated my sharing [my poems]. When I would share the poems as we’d round on the units, people would say, “Can I have a copy of that? Or can you post a copy of that?” Because that again allowed them, I think, to connect to themselves, which is how we heal ourselves. When we connect to our patients, we’re going to pick up some of their pain and anxiety; there’s no way around that if we connect with them. And then we have to figure out a way to transform that, so it doesn’t stay inside and make us sick.

Q. Has there been a ripple effect on the work you have been doing?

I’ve been interested in clinician well-being for a long time in supporting staff. So, it was kind of a natural fit to create a well-being center for our health system, which we now have done. As we do rounds, we say, “We’re listening, we care about you, we support you, we’ll prepare you, and we’ll care for you.”

Our well-being center has a number of virtual programs. We’ve rebranded our employee-assistance program to be a place where people go to get resources to stay well, rather than just a place to go when you feel distressed and in crisis, because there are many resources available. We’ve seen an uptick in utilization, and we’ve created a very robust webpage. We are putting together a peer ally support program pilot that will go live in the middle of September at our children’s hospital, with plans to expand the peer ally support program to our other hospitals in 2022. We’ve also put together a small pocket-sized handout called “10 ways to refresh and destress,” which is so necessary for the healthcare workers in this pandemic. It also has our webpage address, and when we round with folks, we give them this as a reminder. More than anything, I encourage people to listen to their inner self and listen to others.

We also are creating a well-being committee with well-being champions and ambassadors, because our health system is really about heart and soul.

The things I tell frontline workers are:

  • We see death wherever we look, and so we must steel ourselves to protect our own humanity.
  • There is no magic bullet, and there won’t be in the near future.
  • It is okay to feel grief, fear, and anxiety, and sometimes you have to find an empty room and cry.
  • I acknowledge that I have those feelings too.
  • We will get through this by being a team and by having faith and hope.

When Corona Comes Knocking

Death has always been around us
on a bad day we felt it seize a patient from our care
many good days we could feel victorious and look the other way
Now death is our greeter as we walk in to work
sometimes we see it walk in the door
other times it is wheeled in
sometimes death announces itself upfront
other times it’s more subtle giving us the hope of being able to defeat it
then crushing our dream with irreverent gusto
My friends
my colleagues
I see your sadness through your goggles and masks and face shields
I sense your grief through your isolation gowns
I feel your fear even as you try to hide it
And I feel my sadness
my grief
and my fear
which I too try to conceal
and still
We journey on
True soldiers of healing
this is rough terrain we’re in
and there are no foxholes to hide in
and no way to take cover
we have no tanks and no big guns and scant armor
Our only ammunition is our caring hands and our searching minds
as we try to devise strategies for survival
of our patients
and ourselves
Reinforcements for our side are few
And we know that our casualties will rise more than we could ever fathom
This time we have no magic bullets

So what to do
We can look into each other’s eyes and see our strength and determination
We can speak with hope and faith that we will get through this together
We can hug each other even if we are 6 feet apart
We can be grateful for and celebrate every battle won and take that in deeply
and know that our actions have made a difference

Drafted without warning
We are on the front lines
fighting with every ounce of strength we have
Not knowing how long this fight will last
Victory must be redefined
if fewer people die than expected we will know we have done well
And if that doesn’t happen
we will take solace in having fought hard and given everything we could
We will find our way through this wilderland
We will guide others to the other side of this tragedy
We will know that we are a band of brothers and sisters connected forever
by our spirit and our passion for helping others live

~ Jay Kaplan, MD 03/26/2020

There’s another poem coming…it just hasn’t come out of me yet, because sadness, grief, fear, and anxiety are allowed emotions, but anger is not. And there are a lot of angry healthcare workers. They’re mad that this is happening again, because it didn’t have to. If masks and vaccinations were not politicized, we wouldn’t be in the situation that we’re in now.

But we’re going to keep on supporting our staff and hopefully find our way through this.

Dr. Kaplan also serves as Clinical Associate Professor of Medicine, LSU Health Sciences Center, and an attending emergency physician and academic faculty for the Emergency Medicine Residency at University Medical Center in New Orleans. He is a past president of the American College of Emergency Physicians and current national faculty for ACEP and a member of the National Academy of Medicine Action Collaborative on Clinician well-being and resilience.