EMBA Alum Reflects on Her Associate CMO Role in a Psychiatric Hospital during COVID-19

Headshot of Dr. SzulewskiDr. Susan Szulewski, member of the Class of 2020, recently transitioned into a brand new Associate Chief Medical Officer role at McLean Hospital. She has also kept her previous role as Medical Director of the Clinical Evaluation Center. She is an instructor of psychiatry at Harvard Medical School and trains psychiatry residents, psychology interns, and medical students. Below, she discusses her new role, how the EMBA has helped her, and the implications of COVID-19 both in psychiatric hospitals and on provider mental health.

Please tell us about your new role. What are you responsible for?

Since my Associate CMO position at McLean Hospital is the first of its kind there, I had a unique and exciting opportunity to help shape some of the responsibilities. The highlight of my role is being able to partner with the 500+ credentialed medical staff to ensure high quality, evidence-based care. When I thought about the vision for this role, I wanted to keep the focus on enhancing our unique diagnosis-based care models in behavioral health and fostering that further by providing strategic direction to the physician functions. It is exciting to think of the possibilities!

Some of the routine responsibilities include working closely with the Chief Medical Officer, oversight of the hospital’s clinical service budgets, recruiting and training physicians, provider performance evaluations and metrics, clinical process improvement, physician wellbeing initiatives, as well as ensuring that all staff adhere to safety standards while delivering the highest quality of medical care. The work often involves a mixture of tasks ensuring compliance with state health policy guidelines, regulatory requirements, and utilization management. As Medical Director of the Clinical Evaluation Center, I oversee psychiatric admissions for our nine inpatient units by collaborating broadly with the Mass General Brigham (MGB) network and community emergency departments.

How has the EMBA for Physicians program helped you in your new role?

The Brandeis program provided me with the tools I need to be nimble at my job each day. My role has a daily intersection of business, strategy, quality efforts, and clinical care. The curriculum exposed me to a wide range of these topics, and I am often referencing back to things I learned during classes or pulling out notes that I had taken during lectures. Despite beginning my new role during a time of crisis, I felt confident and prepared to take on challenges. I attribute this ability to the real-world applicability of the physician-focused EMBA where core concepts are taught with instruction on implementation and execution.

Has your work changed during the response to COVID-19? If so, how?

I was involved with and led a wide range of urgent change initiatives across the institution that were brought on by the COVID-19 pandemic. In order to maintain continuity of care, we had to adopt numerous changes in a very short amount of time. Our outpatient and partial hospital levels of care transitioned to a virtual care model at a record-breaking speed. These changes required training staff to perform work in an unprecedented way for behavioral health, while ensuring all proper regulatory and privacy requirements were met. In parallel, our inpatient services learned and adopted increased infection control abilities, such as the creation of isolation rooms, proper instruction on personal protective equipment use, pre-admission testing, and protocols of how to safely maintain a COVID-19 positive patient in a freestanding psychiatric facility.

How has the program influenced the way you have responded to COVID-19?

A theme that ran through much of the EMBA course study was the importance of being a present leader. Effective, transparent communication is essential in managing a crisis. Early in the pandemic things changed on a daily basis, so it was especially important for providers to be made aware of steps and actions being taken by their leadership team to remedy issues and maintain safety.

What trends have you seen at McLean Hospital during the pandemic?

In behavioral health, we initially experienced a drastic decrease in patients seeking treatment but this started to change approximately two weeks after the peak surge in Massachusetts, resulting in a secondary mental health surge. Our inpatient psychiatric beds across the MGB system have been filled at a 99% capacity. One benefit is that the surge forced us to work in close collaboration with internal and external facilities on daily capacity and to look at all patients waiting in emergency departments and match them to appropriate open beds across the state. This need for system integration has markedly reduced the wait times for patients seeking psychiatric treatment as well as ensuring appropriate placement based on medical needs.

Many people are aware of the pandemic’s impact on mental health in the general public. What do you think the on-going mental health ramifications will be for healthcare providers?

Healthcare provider wellness and resiliency needs to be a top priority. We know that frontline providers are experiencing higher rates of depression, anxiety, and substance use but often with a higher reluctance to seek care versus the general population. This has an even larger impact when combined with the increase in home stressors of schools closing, fear of contaminating loved ones, and guilt associated with greater patient deaths. This highlights the need for mental health programs that are specifically focused on healthcare provider burnout and proactive plans for wellness beyond traditional programs. There is a lot of opportunity to provide a stronger safety net to support that culture for caregivers. This difficult moment in time offers the opportunity to advance our understanding of how to provide prevention-focused, population-level psychological first aid and mental health care and to emerge from this experience with new ways of doing so.

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