A new book about the COVID-19 pandemic highlights RUSH’s decision to accept hundreds of critically ill transfer patients from safety net hospitals.
In The Big Fail: What the Pandemic Revealed About Who America Protects and Who it Leaves Behind, co-authors Bethany McLean and Joe Nocera ask and attempt to answer “how the most powerful nation in the world could not adequately protect its citizens."
For a project curtailed by the pandemic, McLean had started to research how and why RUSH University Medical Center became one of the first hospitals in the nation to formally establish addressing health equity as measurable organizational priority.
McLean asked RUSH leaders in April of 2021 to compare how Chicago differed from New York, where multiple media reports described well-resourced hospitals that seemed unwilling to accept transfers of critically ill — and typically uninsured or underinsured COVID-19 patients — from smaller hospitals that were at capacity.
Based on interviews with RUSH leaders, the book says that “as part of RUSH’s commitment to health equity, it became, in the pandemic, the rare well-off hospitals that accepted transfer patients from safety net hospitals.” The leaders included David Ansell, MD, senior vice president of community health equity, Paul Casey, MD, MBA, FACEP, senior vice president and chief medical officer, and Darlene Hightower, former vice president of community engagement.
'The right thing to do'
The book says that examining why RUSH’s “rare” decision can help people consider that while hospitals are revenue-dependent businesses, morality must be part of the equation because lives depend on the decisions they make.
“A bottom-line emphasis may be right approach for most businesses, but putting profits over people isn’t the right thing for people, and not the right thing for the country,” McLean said in an interview
Regarding the decision to accept transfer patients despite knowing it would cost tens of millions of dollars, the book says: “From a moral standpoint, it was obvious that this was the right thing to do. But from a financial standpoint, it was a losing proposition. RUSH decided it would ignore the economics during the pandemic and act the way hospitals used to act the way hospitals used to act before the hospital industry became obsessed with maximizing profits.”
‘RUSH is taking them!’
McLean uses first-hand accounts to help, as she says, “put the reader in the room” to more clearly understand how business decisions by organizations play out for individuals. In the Big Fail, interviews with safety net hospitals and a RUSH transfer nurse capture the emotional discussions between hospitals.
The book first recounts frustration and anger from safety net hospitals in other cities where thousands of people likely died because they did not get the lifesaving care they needed, even though the larger hospitals had capacity. But Dr. Airica Steed, then chief executive officer of Chicago’s Sinai Health, told McLean that “We’d hold daily huddles with them. It was as if RUSH was becoming an extension of us.”
Helen Park, a RUSH transfer nurse, describes the telephone conversations transfer nurses had every day with hospitals that ranged from heartbreaking to joyous. But they took an emotional toll, she says, because the callers would make clear that if RUSH didn’t take their patient, that person would die.
While those calls could be a “gut punch” when she and her colleagues had to say “RUSH didn’t have the room to accept a transfer,” she describes the relief and joy when they could say “yes.”
“We were their last hope," Park says. “When we said we were accepting a transfer, we’d sometimes hear people shout back at their co-workers, ‘RUSH is taking them. RUSH is taking them!'”
Restoring trust in healthcare
In a recent interview, McLean noted that RUSH staff should be “very proud to work at an organization that has and demonstrates very human values” and hopes that the example set could help people regain trust in healthcare.
While the country’s hospital staff were famously celebrated as heroes early in the pandemic, McLean writes that recent public opinion polling shows that more than half of Americans feel hospitals put profits over people. “Hospitals were becoming another institution Americans were doubting,” McLean says.
Ideally, Congress would be the means through which the nation could examine the failures the pandemic revealed, McLean asserts, acknowledging that the polarized political system makes that very unlikely.
Instead, she feels that “to restore trust, people need to know and feel that their organization has more at stake than their own profits. But it has to be authentic. It has to be real. ‘Putting people first’ loses meaning unless it is backed up by action.”
McLean’s past works like The Smartest Guys in the Room about the ethical practices at energy corporation ENRON.