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The Evolving Role of Hospital Support Services in the COVID-19 Pandemic

Teams responsible for cleaning, feeding, and supplying hospitals have had to adapt rapidly, says BMC's senior director of support services.
The role of support services staff such as dietary and custodial staff is also rapidly changing in the coronavirus pandemic
Matthew Morris

While clinical operations have had to adapt rapidly to respond to the coronavirus pandemic and its influx of COVID-positive patients into makeshift ICUs in all areas of the hospital, support staff have enabled the life-saving efforts of front-line providers by supplying critical needs such as patient transport and custodial services.

David Maffeo is the senior director of support services — a broad team that encompasses environmental services, dietary and food services, patient transport, interpretive services, and more — at Boston Medical Center. He recently sat down with Boston Medical Center Health System President and CEO Kate Walsh to discuss the changing logistics, teamwork, and coordination in support services to ensure that the hospital and its employees remain fully supported in their efforts to fight the infection.

Watch or read their conversation below.

Kate Walsh: Because we're in Phase C of the Hospital Incident Command Structure, your role has taken on additional dimensions — you are the Logistics Chief, and much of our response to the coronavirus pandemic has been about logistics. What do you do in that role?

David Maffeo: The Logistics Chief's role is really to make sure we have supplies readily available, people deployed when operations need it, food, so on and so forth. This whole event is very supply-driven, so we're making sure that we're vetting companies, making sure products are ready and available to the floors when they need it.

KW: When we get emails that say, "I've got a guy and he's making masks," how do you decide whether the masks are fit to go into our supply chain?

DM: What we do first is we vet all the companies. Scott Rutledge and his supply chain team have made over 250 calls to these companies that “had a guy that had a mask.” Then when we bring the masks in, I make sure that I bring them to Infectious Disease to vet them, like we did for the surgical mask we're passing out every day and N95 masks. Bob Whitfield, the Executive Director of Environmental Health & Safety and his team look at the mask and they fit test accordingly. There have been some masks that we haven't accepted just based on the efficacy.

We have vetted all masks, face shields, any other PPE. And we've also changed the process a little bit. It comes through transport, which is under my domain on a regular basis anyway. I keep a close contact with them.

KW: So staff don't have to go looking for it, you're supplying it.

DM: We're delivering it.

KW: Could you talk about environmental services and how they’re working differently in the COVID-19 pandemic to support our staff and our patients?

DM: This is an environmental disease that we have to make sure we stay ahead of. I'm so proud of the work that they do every day, staying ahead of the cleaning protocols, being vigilant and diligent. The management teams worked extremely hard to make sure we stay ahead of it.

KW: The cleaning protocols and our guidance to staff change fairly regularly. How do you get that information out?

DM: We're working closely with Infectious Disease on how this is ever-changing. They come to our huddles, as well as clinical educators. So they're teaching our staff, they're supporting our staff, they're letting them know how to be vigilant in the work that they do. There are certain chemicals that kill COVID and we stay ahead of what those chemicals are and we educate on contact times for our staff and the efficient cleaning of the patient rooms.

KW: My dad would say “an army marches on its stomach” — talk to me a little bit about the team in dietary, because their work has totally changed.

DM: On a regular day, we'd have 10,000 meals flowing to our cafeterias and really busy retail operation. They've changed, obviously, and we've had to close a couple of our locations, so they've been more of a supporting staff. We've had a lot of food donations. They've fed the staff, nurses on NICU, emergency room staff, and other caregivers across the organization. They're adapting to their new role of being more supportive in feeding people when they need it.

Even with donation, we make sure sandwiches or individual pizzas are individually wrapped. We deploy the food service team — they're doing a great job to make sure they delegate to those in need. It's really changed. Even social distancing in our cafeterias — we had to pull out some chairs and make sure there's separation.

KW: What is happening with transport and some of the other support services?

Transport's changed a lot. What we've decided early on is we had to conserve supplies, so we changed the process to all caregivers use Epic to order through transport, and then we deliver it. If you need an N95 mask, a yellow gown, gloves — we take care of that through transport. They've done a great job. Also, we’re keeping the metrics behind that, how we're doing in conserving those supplies as well as in their regular job transplanting patients and equipment.

In terms of interpreter services, I'm really proud of them and how they’re handling evolving into more telehealth. On a given date we have 65 interpreters going across the organization. Now they're making more calls over the phone and video, so they're more of a call center operation and guest support. Early on, when we came out with our visiting policies, they did a great job mandating those protocols at our front desks, and they're doing a great job moving forward.

KW: Well, Dave, I want to thank you and your team. And I personally want to thank your teams who have really been on the front lines of this battle along with the doctors and nurses and respiratory therapists and social workers. I'm really proud of the work you've done, how much change has gone on.