A year inside COVID-19 Incident Command at Sanford Health

Planning for the most challenging year in health care is a team effort

Sanford leadership gathers in a room for Incident Command meeting

March 2020 was just the beginning.

It was when leaders of Sanford Health gathered for what would be the beginning of an organization-wide approach to fight the fast-spreading novel coronavirus on all fronts.

“I can guarantee nobody in that room was alive to remember the last global pandemic of 1920,” chief physician Jeremy Cauwels, M.D., said. “I think it’s safe to say that everybody who walked into that room had truthfully no idea about how long they would be in there day after day, making consistent decisions about the right way to move.”

For the first time, leaders pulled together a meeting to include every part of the organization, and there was only one topic at hand.

“We weren’t going to try to solve anything other than how we respond to COVID-19 and how we do it as quickly and efficiently as possible,” Dr. Cauwels said. “That was laid out on the first day and set the ground rules for us to move through making those rapid decisions.”

Ready for COVID-19

Sanford Health’s emerging threats task force started meeting a few times a week, then daily, to stay ahead of the novel coronavirus.

It’s a practice the health system used during the Ebola outbreak in 2014. During the meetings, leaders and providers from across Sanford Health assess the current situation and anticipate issues before they become problems.

When it was clear COVID-19 was a pandemic, the task force shifted into COVID-19 Incident Command. It brought in teams from supply chain management, medicine, communication, Sanford Laboratories, Sanford Research, data and modeling, among others.

Chief operating officer Matt Hocks said most incident command centers occur after a natural disaster or event for a defined period of time.

“This was undefined,” Hocks told Sanford Health News. “This was something no one’s ever gone through before.”

Hocks’ primary concern early on was to make sure they had the right leadership at the table so every part of the organization was represented to ensure a successful fight. Thankfully, he says, that was done.

“We knew what our mission was and we needed a strategy,” he explained.

It didn’t take his team long to encapsulate top strategies, including the ability to stay six to 12 weeks ahead by learning what’s happening — clinically — on the coasts. Then they assembled supply chain research, data analytics, and testing, among others, so patients can continue their care and caregivers can focus on giving it.

As researchers and infectious disease experts learned more about the dangers of this virus, other teams were getting ready to go on offense.

One important task was, quite literally, predicting the future: determining what the next days, weeks or months could look like. Data analytics vice president Doug Nowak was that guy.

“My mind went from ‘why am I here?’ to quickly find out I was being asked to come up with a model to project COVID-19 inpatient volume,” Nowak told Sanford Health News. “Seeing all of those people in one room really started to hit home just how serious this whole thing could be.

“I realized how quickly we needed information and how important it was to know what we were in for regarding inpatients, ventilator numbers and PPE supply. My team and I wanted to do whatever we could to help prepare Sanford Health.”

COVID-19 testing a ‘key component’

Testing for COVID-19 became a massive effort for the entire organization.

“It was such a key component of the country’s response to COVID-19, and also our human desire to know and understand what was happening,” said Rochelle Odenbrett, senior executive director of Sanford Imagenetics and Sanford Laboratories, who oversees much of Sanford’s testing efforts.

“It was evident in the first few days of those meetings that Sanford had to stand up testing as soon as possible.”

At first, Odenbrett’s team was sending out tests to a reference lab with turnaround times averaging 10 days.

“We knew that was not acceptable or sustainable,” she said.

As testing supplies became more readily available and Sanford Health began procuring the needed supplies, Odenbrett’s team strategized how they could get testing started. The team not only jump-started a massive testing operation in all regions but also sent three mobile labs to rural areas.

The Reference Lab, where tests were processed, opened in Sioux Falls on Feb. 13, 2020, nearly a month prior to that first leadership meeting.

In March, Sanford Health was the first in the region to launch in-house testing using an FDA-approved method under Emergency Use Authorization and processed at the lab in Sioux Falls. Patients received results in 24-48 hours.

“We built on-the-fly, established testing algorithms that were very complex, routing testing based on patient risk and status,” Odenbrett said. “The work that happened behind the scenes in conjunction with our IT and (clinical informatics) teams was incredible. Everybody had the same goal in mind and executed efficiently.”

She says if Sanford didn’t have the reference lab in place, it would not have had the space or ability to stand up COVID-19 testing in the system.

“Timing is everything and we are so fortunate that our organization supported the idea of establishing a reference lab when we did. … At one point during the pandemic we were performing 3,000 tests per day in that lab.”

Will we have enough supplies?

Dr. Cauwels admits some of the toughest moments and biggest “emotional rollercoasters” early on included making sure all caregivers were protected.

“There were so few masks and so few gowns … things you need to feel protected when you go into a patient’s room,” Dr. Cauwels said. “We wanted to deliver on the promise every day that you would have the personal protective equipment (PPE) you need.”

Dean Weber, vice president overseeing corporate supply chain management, says global supply struggles became very real, very quickly.

“When you’re having problems as an organization, as a globe, having the other executives understand the factors and the things we needed to mitigate, those are things that what we know today, we’re a stronger organization because of it.”

The supply chain team needed to build up stockpiles and look into conservation methods as national and international PPE manufacturers tried to keep up.

Looking back, Weber calls it a “night and day difference” between the insight the organization has into the supply chain process now and what they were dealing with at that time.

Leading with research, clinical trials

Sanford Health paved the way with its comprehensive clinical trials to better understand, study, treat and prevent COVID-19.

Sanford Research and Innovation vice president Sharon Hunt recalls early March 2020.

“I was listening to our physicians’ hunger for treatments to help our patients,” Hunt told Sanford Health News. “It galvanized our determination to open studies throughout the COVID disease pathway so that we’d have options for our clinicians when they needed them.”

Over the next 12 months, her team evaluated more than 100 clinical trial opportunities for patients.

“I am impressed by the dedication and perseverance of our staff, by the cooperation and collaboration to just get it done — and by our outcomes,” Hunt said. “We treated all of the patients in need, opened complex trials for very ill patients with novice physician-scientists in record time, giving our patients access to treatments on the cutting edge.”

Today, Sanford Health has enrolled more than 90,000 patients in its registry, where researchers collect data and specimens from COVID-19 positive cases and those who have recovered from COVID-19.

The registry enables researchers to track the progression of the disease through the recovery process and answer questions regarding immunity, reinfection, severe illness and long-term health complications.

‘Going to take all of us working together’

Incident Command was the first time many of these leaders came together for the same reason.

“For me, it’s been absolutely inspiring to see members of the health care team in the biggest sense of the word, all jumping together to say, ‘We can solve this and we can move it forward,’” Dr. Cauwels said.

As head of operations, Hocks said it was a nice work environment as titles were left at the door.

“Everyone was expected to participate and bring ideas forward regardless of their title,” Hocks said. “We knew we had to do this together and it was going to take all of us working together to do it.

“That was probably the moment where I was most proud of the whole team and the organization. We were here as colleagues, as friends and as partners.”

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Posted In Coronavirus, Immunizations, Physicians and APPs, Research, Sanford Stories