[Podcast] How Cleveland Clinic Helps Employers Create a Safer Workplace During COVID-19

With

By Stewart Gandolf, Chief Executive Officer

Dr. Jim Merlino, Chief Clinical Transformation Officer, Cleveland Clinic

Despite having entered the U.S. more than eight months ago, COVID-19 remains a health topic enshrouded in confusion, conflicting information, hyperbole, and even conspiracy theories. Everyone, informed or not, seems to have an opinion about the Coronavirus pandemic.

Fortunately, healthcare systems, hospitals, and medical services providers are uniquely qualified to fill the educational void and assert a healthcare leadership position within their communities.

In this week’s healthcare podcast, my friend and frequent guest, Dr. Jim Merlino shares how Cleveland Clinic’s free advisory service, COVID-19: Creating a Safe Workplace, helps employers and employees, “return to work, safely and confidently during the coronavirus pandemic.”

Listen to the 'How Cleveland Clinic Helps Employers Create a Safer Workplace During COVID-19' podcast or read the transcript to discover:

Why educating the public is such a vital responsibility for providers to embrace
How Cleveland Clinic was able to leverage its expertise and preparation for COVID-19 into an effective educational program for employers
Why executive leadership is essential for larger missions like these
Surprising new insights about how the coronavirus spreads
How large and small institutions can take similar leadership positions within their communities

Finally, please help educate the public by sharing Cleveland Clinic's COVID-19: Creating a Safe Workplace website with employers, patients, coworkers, colleagues,
Good: friends, family, and on social media.

Cleveland Clinic Safer Workplaces during COVID Podcast Transcript

Note: The following 'How Cleveland Clinic Helps Employers Create a Safer Workplace During COVID-19' podcast transcript is computer generated and edited for clarity.

Stewart Gandolf, MBA:
Hi everybody, Stewart Gandolf here with another podcast featuring absolutely one of my favorite guests and personal friend, Dr. Jim Merlino. He is Chief Clinical Transformation Officer with Cleveland Clinic, now back at the Clinic after some excellent time with Press Ganey. Welcome Jim, first of all.

Dr. Jim Merlino:
Thanks, Stewart. Always great to talk with you.

Stewart Gandolf, MBA:
In preparation for this meeting, we spent some time talking about, catching up how the world is very different than the last time Jim and I spoke. Last time we talked was pre COVID, pre-Jim moving over to Cleveland Clinic. Things have changed quite a bit since then, obviously. And I think today we're going to talk about a topic that I think is really, really important, which is getting the word out, leveraging the pulpit of healthcare providers. As the most trusted people in America, doctors, hospitals, health systems have a unique opportunity to educate the public. And I was talking offline with Jim prior to doing this, how during the very, very early days of the pandemic, some of our blog posts were about this topic. Back when everything was absolutely uncertain, and the world was going crazy. Our firm went virtual about a week or two ahead of everybody else, right about the same time that Stanford went virtual before it became mandatory.

Stewart Gandolf, MBA:
I was telling Jim, we have some friends that sent us predictions on what this pandemic was going to look like. So we went virtual really mostly for the public good at that stage, even though some of my employees thought I was crazy, and we spent a lot of time writing in our blogs of how you can, as a provider, be part of the solution, get the word out. Can you post on social media? Can you talk to your patients? Can you send emails? How can you be a voice? And that was before any of this stuff had widely happened within our surrounding communities. We just had a sense there'd be a need for authoritative information to supplement what's happening in the more official channels.

Stewart Gandolf, MBA:
So anyway, Jim and I were talking about this and in true fashion with Cleveland Clinic, with the leadership role that the clinic takes in terms of public health, began an advisory service. And so that's what we're going to talk about today. And Jim, I'd love to hear from you, how this all began, the mission. This is your format. Let's just talk. Tell me about the advisory service and maybe the history of it to start.

Dr. Jim Merlino:
Sure Stewart. Well, again, it's really great to be doing a podcast with you again, and I really always enjoy our conversations and the insights that you bring to the industry through your work as well. It's interesting. Healthcare obviously is on the front lines with the pandemic response and taking care of people who are affected by COVID. But we actually, I think, have a bigger responsibility and that is to help society reactivate and also function safely in the era of COVID because we clearly are in an environment now where COVID is with us. Whether you believe it or not, it's here. It's not going away until there's a treatment or an effective vaccine. It's just going to be a part of what we do.

Dr. Jim Merlino:
I think one of the things that we've learned in healthcare, and it's not just true for Cleveland Clinic, it's true for healthcare across the world, is that we understand how to keep people safe. And for the most part, I think healthcare has done that and you see different statistics on healthcare worker infectivity, but there are a lot of organizations across the country that have kept their workers safe. We had over 1100 caregivers infected with COVID. We're confident, because of the contact tracing that we've put in place, that we can say we don't believe any of those caregivers received COVID from taking care of a COVID positive patient, but that's not without effort. It's because of the safety measures that we've put in place, the teams of people that we've had together since the beginning of this pandemic that have really studied these issues and really debated about what are the best things that we need to do, or the safest things that we need to do.

Dr. Jim Merlino:
So with all of that in mind and understanding that the tsunami was coming towards us very quickly, we did a lot of preparation. We were very fortunate, in Northeast Ohio, that the tsunami didn't hit us like it did in other parts of the country like New York or Washington. But nevertheless, we did see COVID, we did take care of a lot of patients, we're still taking care of a lot of patients, but we learned a lot.

Dr. Jim Merlino:
And as we saw that the tsunami wasn't going to hit us as hard as we thought it was going to, we were able to now take the information that we'd prepared for our organization and actually retune it or reformat it so that we could push it out to the public; to businesses, to churches, to educational institutions, so that others could use it. We started getting a lot of incoming early from different businesses and other organizations that needed help, and we wanted to be helpful. Cleveland Clinic has four cares, care for community, care for the organization, care for caregivers and care for patients, and we very much see this as part of our responsibility to help care for the community.

Dr. Jim Merlino:
And I'll just add one more thing, and that is that it's interesting that if you think about managing diseases, for most diseases, we've had decades to study them. For COVID, everything we know about this disease has really come in the last six months or less, and we're learning new things every day. We're clarifying things every day. And so the most important resource that we've been able to provide to partners outside of healthcare is really interpreting what's going on and translating that information to what they do every day so they can keep their employees, their customers safe. It's been interesting work. It's been fascinating to be a part of, it's been an honor to be a part of it, to help others. We think it's really meaningful and impactful.

Stewart Gandolf, MBA:
The Cleveland Clinic, as I mentioned earlier, the idea of being in your community, a thought leader, healthcare thought leader, and Cleveland Clinic clearly does that not just in its community, but from a world scope. Is that part of the clinic's DNA? How has that evolved, this idea of we're trying to be something more than just the provider? We want to really be a thought leader. How did that evolve and how does that sustain?

Dr. Jim Merlino:
Cleveland Clinic has always prided itself on being an organization that's innovative and trying to do things that benefit others, and that's just part of our DNA. We're actually coming up on a 100 year anniversary this year. It's interesting the last pandemic was 100 years ago. We're 100 years old, but it is really in our DNA, and it's also part of the focus of our CEO, Dr. Tom Mihaljevic. He believes that we should be doing things as much as we can to really push hard and trying to figure out ways to evolve healthcare. And I think the work we're doing with COVID response is part of that. And again, we don't have the license on best practices. I think one of the benefits of COVID, if there's any benefit, because there aren't many for sure, is how people have worked together across the country. Other healthcare organizations across the world have come together to share information. And what we've been able to do is really just help package that so that we can help others understand what to do and be safe.

Dr. Jim Merlino:
It is interesting, one thing about the Cleveland Clinic, one of the things I think that makes the Cleveland Clinic unique, there's a lot, I'm certainly biased, is that we have a network of hospitals and healthcare institutions across the world. And what was striking about COVID ... And we were meeting every day. During the heart of the pandemic, we were meeting twice a day, and all of our sites were dialed in. It was the ability to learn from each other. So a truly integrated network where you're getting information from Abu Dhabi, you're getting information from London, from Florida, from Las Vegas, from Toronto, and all of that's feeding into your decision making. And what was most fascinating is everybody was experiencing this a little differently. So for instance, our operations overseas was able to give us some early warning into some of the things that they were seeing and also how they were responding to it, and that directly impacted our responses in the States, both in Cleveland and Florida. So it was a very interesting time to be a part of such an important integrated delivery system.

Stewart Gandolf, MBA:
Jim that totally makes sense. I feel like obviously Cleveland Clinic has some amazing resources with multiple locations and a hundred year history and an incredible medical team and support teams. At the level of maybe a community hospital or a group practice or any level, but let's maybe take a step, just one step down, a single hospital or a couple of hospitals, or just a large group, what would be important if they too feel like, "Okay, we're not Cleveland Clinic. We can't be, but we want to be that kind of a thought leader here in Topeka or Poughkeepsie or wherever." What kind of recommendations, before we get into the specifics of your advisory service, but what have you learned they can use to ... What would be the couple of things that you'd really want to have in place so that yes, raise your hand, be a colleague with us, help us get the word out? What kinds of things do you think would be important for that?

Dr. Jim Merlino:
I don't think you have to be Cleveland Clinic to be helpful to your community. I think if you likely look across the nation and talk to healthcare providers in other systems, I've certainly talked to many of my colleagues around the country. For the most part, we're all coordinating. We're all driving the same things. When we think about changing a policy, for instance, around visitors, we reach out to our colleagues, my friends. I reach out to my colleagues, reach out to their friends. We really are trying to bring information together. I think that's probably true for a lot of providers.

Dr. Jim Merlino:
But what I would say to smaller organizations, regardless of where they are and whether they're a hospital or a practice, or a couple of docs or a provider group that's providing care, you know what to do. Likely you've been delivering care in COVID, and the information that you have available to you, how you think about this, the clarity that you bring to that process will be helpful to partners that are in your community, because this is complicated and it really requires a thoughtful approach to keep people safe, but an approach we know we can do.

Dr. Jim Merlino:
And I think that what I would say to anybody that's listening that may be practicing in a smaller environment is talk to people in your community and ask them how you can be helpful, ask them how you can translate what's going on around COVID to impact how they can keep themselves, their employees and their customers safe. They need us. They don't just need us to take care of sick people. They need us to provide guidance. And this is such an opportunity for healthcare in the United States and across the world to really step into a role, to do much more than we've probably done in the past, relative to things going on in the community.

Stewart Gandolf, MBA:
You mentioned your CEO, and that's so often the case, the idea of ... Because I could see how you're a busy hospital located in whichever town you are and you may not have the resources, but I think it's more than just resources. It's more of your vision of how you fit in the community because it'd be really easy and certainly forgivable. We're just treating patients here. We don't have time to do this high fluid and visionary stuff. We just have to take care of patients and I totally get it. But I guess it comes down to maybe the vision of the CEO and the leadership of what role, maybe a larger role than just treating patients. Does that make sense Jim?

Dr. Jim Merlino:
Absolutely, and it also comes to getting back to the role of your hospital. If you think about the history of healthcare in the United States and how it evolved, a big part of it was community-centric and most hospitals are community hospitals. And they were formed by municipalities coming together, putting money in to build a hospital to take care of people in the community. So it really is getting back to the roots. I remember one of my first roles in healthcare, I was a board member in a community hospital in the city that I grew up in, actually where I was born. And it was a hospital that was built in early sixties by seven communities coming together. One donated the land, everybody threw in some money and before you know it, you had a hospital. And today, that's part of a big healthcare system in Cleveland. It's doing amazing stuff, but that's what we're about in healthcare. So taking care of our neighbors, caring for the sick, but also providing information to the community on how to stay healthy, which is just, when you think about it, that's noble.

Stewart Gandolf, MBA:
We've talked about in some of the other relevant webinars and podcasts I've been doing surrounding this topic. If you haven't, first of all, it's for the good, to get the word out, but also that's the primary reason. We're in this for healthcare. We're in this to serve our community. But from a business standpoint too, it's to take the leadership because if there's a void in the marketplace to be a positive force, we're not doing it for that, but that's a good thing too. We want to be more than just that big building that people fear or may have had ... Everybody has their own relationship with the community hospital. They've typically been part of the community for years, but to be that kind of thought leader, I think is important. And all the things we've talked about in the past like, and I'm going to dive into the advisory service in a moment here, but the social media, the emails, and talking to patients, the safety videos, showing them how you care, showing them how the heroes, the everyday stories, showing them how they're going to be safe are all important.

Stewart Gandolf, MBA:
So from there, I'd love to segue to more about the advisor service. Tell me about how do you deliver it and what is it? How much does it cost, if anything? How do they deliver it? What the purpose is, all that. I'm fascinated.

Dr. Jim Merlino:
Thanks for asking. We are too in terms of how quickly it's really grown into something. And first of all, it's free so that makes it easy for people to consider it.

Stewart Gandolf, MBA:
You did it!

Dr. Jim Merlino:
Exactly.

Stewart Gandolf, MBA:
All of our listeners need to write this down, they can just write this down. Free is good. So yeah.

Dr. Jim Merlino:
Free is good. Well sometimes free is not good. You always wonder what the intent is or if there is something behind the curtain, but no, this is free. And it hasn't cost us much because we really just take in what we do every day for our caregivers and repackaged it so it's a little easier for people who are not in medicine to understand. So we have a website that on that website, we have multiple industry playbooks that we've assembled that break down in simple terms how to think about keeping people safe. So there's one for restaurants, for instance, manufacturing, office environment. They're on the website. They're all free. They're all downloadable. They're all easy to read. They all have a basic template that talks about the basics of COVID and safety, and then that portion that deals with the specific environment. They're not that long.

Dr. Jim Merlino:
We built a playbook around how to better communicate with people, your employees, customers during this time, how to communicate with empathy because certainly, healthcare workers aren't the only ones that are being stressed. Everybody's being stressed on something so we thought that would be important. We do weekly webinars with our experts. So infectious disease, epidemiology, testing, HR to provide insight, to help employers, organizations keep their employees mentally fit and exercising their minds and healthy at home. We have a long-running list of frequently asked questions that are posted as new information becomes available. Again, translated into simple terms, what do you do if somebody in your office tests positive for COVID? What do you do if somebody has symptoms? What do you do if somebody has a family member? What do you do if somebody gets exposed? Again, it's just breaking down on all the things that people worry about. And all of that's on the website, which I'll share with you. It's clevelandclinic.org/covid19atwork. Once again, clevelandclinic.org/covid19atwork.

Dr. Jim Merlino:
And what's interesting about the material and the reaction to it, as I said earlier, is that it's been a service because people just want to know what is going on, what the information they need to be concerned about really is. Cutting through the media, the conflicting news reports, the things they read and then translating it into what to do. And that's been very rewarding because I think that's the clarity that we've been able to bring in. And frankly, Stewart, as you would suspect, in some cases we just don't know and we say it, but everything is guided by CDC guidance, what the scientific evidence is demonstrating. And then if there's no gold standard to go to, it's the best clinical judgment based on a pool of experts. I'll give you one example that's very public, which is our relationship with United Airlines.

Dr. Jim Merlino:
So Cleveland Clinic's had a long relationship with United and it's been our corporate partner. And during the worst part of the pandemic, the darkest days of the pandemic when New York City was being clobbered, we sent a team of physicians and nurses to help out, and United was kind enough to fly them there and fly them back. And we got into a discussion about what they needed because they were asking, "We're trying to figure out how to keep people safe while flying, how to keep our people safe. Would you be able to provide some input to us?" And then we said, "Absolutely. We're here. Let's talk about it."

Dr. Jim Merlino:
And so, and again, sharing with permission and we started going through the material and they were very sophisticated. As you would expect, it's a big company, the airlines. When it comes to safety, they all talk to each other. They think about this all the time. They're very sophisticated and they had a lot of great material and we provided input based on what we saw as the science around what they were doing. They adapted some things that we suggested that they didn't think about. They changed some things that they probably didn't need to do. But that, I think, has probably made flying safer.

Dr. Jim Merlino:
And what's interesting about flying right now is so certainly airline travel has significantly decreased, but planes never stopped flying and they didn't put in the safety precautions. And yet, we don't yet think we have a confirmed case of, there may be one we don't know of, but we haven't traced the case of COVID through airline transmissions. It's probably coming as community spread increases and flying increases. But I think right now, we feel comfortable that we haven't seen it. But the interesting thing is that, relative to United, is they were the first airline to mandate masks, and that was one piece of advice that we had given them, and they were very, very aggressive about it. They said, "Okay. If you tell us that that's important, we will do it and we will enforce it." And as you know now, all the airlines are doing it.

Dr. Jim Merlino:
So I think that's a good partnership because the last thing I would say, and then I'll shut up, is that it's not just what the businesses or the hospitals need to be doing to keep us safe. This is a social contract. We have to be doing things to keep ourselves safe. If we go onto an airplane, we should need to wear a mask. We shouldn't refuse to do that. We shouldn't protest like, "We don't have to do that." No, you need to do that. That's your responsibility. When you go to an environment where you're working, like a hospital, where we know we can keep you safe. When you go home, you have to think about how to continue to keep you safe.

Dr. Jim Merlino:
I have a colleague, Dr. Steve Gordon, he's our chair of infectious disease. He's internationally renowned. He says, "Listen, COVID gets in healthcare, for healthcare workers, COVID gets into the back door, which is they come to work, they have all the precautions, they're safe. They go home, they do something they shouldn't have done. They drop their guard, they get infected." That's the backdoor and that's the thing we have to close by being very mindful. We all have a role. COVID doesn't discriminate and everybody in the world right now, everyone, and think about that. Everyone in the world is susceptible to it. So we all have a responsibility in this. We're all in it together.

Stewart Gandolf, MBA:
It's fascinating when I think about that and it's interesting too, because the idea of airplanes, and I didn't know that. I didn't know there are no documented cases for airlines having COVID. So there's so much fear out there, misinformation and what I really like about the idea that you guys are doing this is beyond it's helping me us all safer, but curating it, helping people understand what's real, what's not, how do you do that? Is there any secret to that? Because that's very ... Just that one little anecdote I think is really important.

Dr. Jim Merlino:
We have a big team and we talk about things, and so I'll give you an example. During the heart of the pandemic, one of the biggest concerns ... Well, during the start of the pandemic. We're in the heart of the pandemic. There was a big concern about PPE, personal protective equipment. One of the top concerns was we're going to run out. The tsunami is coming, we're going to run out and what are we going to do? But yet you can't ration it because you can't cut corners. You can't say to people, "You don't need it there," or, "Don't use it this way." It just wasn't an option. So we had a team of people, of about 10 people, probably a little more, that really were meeting every day to talk about how do you manage PPE? What's the best way to do it? How do you account for supply chain issues? How do you model out how much you have, and what's your run rate on PPE?

Dr. Jim Merlino:
But it's a statement of how experts come together to really tackle the smallest of problems that are really huge problems. That's been our approach for everything, is we've had teams of professionals that are really experts in this space that have worked on these issues.

Dr. Jim Merlino:
Is my dog barking?

Stewart Gandolf, MBA:
That’s part of COVID. It’s perfectly OK to have dogs barking!

Dr. Jim Merlino:
Einstein my labradoodle.

Stewart Gandolf, MBA:
Oh my gosh. When we go offline, I’ll put my camera so you can see my dog. I have a labradoodle too. He’s enormous.

Dr. Jim Merlino:
Oh, I have a miniature. Oh yeah! We got to do it!

Stewart Gandolf, MBA:
Going back to the curation and United in that, again, thought leadership, I fly on a different airline. I have about three million miles. As you know, I travel a lot as you do too. And at the beginning of the pandemic, there was news reports about them being very spotty with requiring masks. So they lost me for a long time because I'm not getting on a plane if this has become a political statement with the person sitting next to me. I want to be safe and that whole idea of we're all responsible, I think is really important. And it's great that you guys are doing that. I think also, I want to ask about this. You mentioned restaurants and I don't know if you guys do bars, but even offices. So this is very real to me today.

Stewart Gandolf, MBA:
So literally last night, I mentioned we went virtual earlier and I've just been very conservative about this. And people who know me know I'm not doing this from a fear standpoint, I'm doing it from a public health standpoint. So we shut down early, not because I was paranoid about getting COVID, but more you don't know who you're impacting. And I have a bunch of a team and it turned out actually we could have had a near miss with COVID had we stayed open very much longer, which I won't go into.

Stewart Gandolf, MBA:
What kind of response have you gotten? Because I know from our standpoint, that's going to be fantastically helpful to have an authority because again, we're not experts at this. Yeah, I market healthcare, doesn't mean I'm a doctor. It doesn't mean I don't have any expertise in COVID. I read a lot, but I don't feel comfortable with my employees safety and their relatives' safety by making these decisions. So by guiding, having a sense of trusted authority to go to makes me feel a whole lot better. I don't know if you have anything to add to that, and certainly what kind of reaction have you gotten from doing this?

Dr. Jim Merlino:
A good reaction. I think one of the biggest concerns of patients is coming back to healthcare for elective procedures or not urgent procedures is will they be safe? And the answer is yes, they will be. And I think that that's the same thing that employees want to know coming back to work or staying working. Will they be safe? And the answer is, yes, you will. However, and it's a but, and that is you have to follow the rules. You have to be thoughtful. When your employer executes on a mask policy, you should follow the rules and wear the mask. When you have the ability to sanitize your hands, you should sanitize your hands.

Dr. Jim Merlino:
Look, the way we talk about these protections, these layers of protection, is that there's something called the Swiss cheese model. In safety science for the military, for the airlines or healthcare, we assume that events are trying to hurt people and we enact barriers, and each barrier is like a piece of Swiss cheese. It blocks some things, but it has holes and it lets some things through. But the more pieces of Swiss cheese, the more barriers you line up, the better protective screen you can build to prevent those things from hurting people. And so when we think about precautions that employers put together; masking, social distancing, hand-washing, disinfecting commonly touched surfaces, education about how to keep yourself safe at home. None of those are perfect. Some are better than others, but collectively, they create a pretty strong barrier.

Dr. Jim Merlino:
And again, going back to healthcare experience, we know that we can keep people safe if they follow the rules and they have to be mindful about it. Again, I think the message is that if we do the right thing and we execute on what we know works, we can keep people safe and that should be the message. But again, part of that message needs to be that you have a responsibility as well. So when you leave the workplace, you want to be concerned about what you're doing, who you're interacting with, how you're behaving, because you want to keep yourself safe at home as equally as much as you want to keep yourself safe at work.

Stewart Gandolf, MBA:
My wife went through a procedure right when things started to open up again and I told her, "Hey, this is a window. It's probably going to bad again pretty quickly. Jump on now." So she got her elective procedure done whenever that was. And so she went through it and it was amazing. They really had thought it through the whole, from the start to finish, how they greeted her in the parking lot, how they did all the way through. And then my wife said, "But the one thing is one nurse looked down and said, "This mask is just stupid. We don't really need this." And so that one, and fortunately, she kept her mask on, but obviously, didn't have total buy in at an individual level. And that's really what this requires, is a bunch of individuals doing stuff right, and even it's ... Maybe I'll just argue, okay, you don't believe it, but just suspend disbelief for me. Would you please? Because at the end of the day, that's what we need.

Stewart Gandolf, MBA:
And I think the other point that you bring up is the importance of responsibility because, okay, great. This is so insightful to me, the idea of, okay, we have all this PPE. Who thought that your most dangerous experiences are not at the hospital, it's when you go home? If you're not being careful? Is that what you're saying essentially, that the most dangerous part of your day if you were treating COVID patients, is if you're going home and being irresponsible?

Dr. Jim Merlino:
Well, I think that the biggest opening for risk is that. I wouldn't say it's the most dangerous. If you're an ICU physician or a nurse taking care of COVID positive patients, that's dangerous work. But I think if you're following the precautions and you're using them, you can keep yourself safe. So you have to be very mindful about that. It's no different than any other environment where the risk of getting hurt is real if you're not following safety precautions.

Dr. Jim Merlino:
But the need to be paying attention to safety doesn't stop when you leave. And you don't need to wear an N95 mask and gown at home, but you do need to be thinking about potential exposure opportunities, who you're communicating with, making sure you're avoiding large groups, quarantining yourself if you're exposed to somebody. So that continuum of safety really stretches everywhere, not just where you're working, regardless of what you do for a living.

Stewart Gandolf, MBA:
As we come into the home stretch here, I'd love to get any final comments you have, but I guess maybe starting with that would be to give you a place to start is what is the advice you would give to the pastor of a church or the owner of a bar, or an office? All of us say to you with exasperation, "Dr. Merlino, I'm a pastor. I don't know anything about this stuff." What would you tell them? Obviously go to your side, but what's maybe the philosophy or?

Dr. Jim Merlino:
I think the philosophy is to be cautiously optimistic. Number one, we will get through this. It's not going to be without costs and it's not going to be easy, but we will get through this. And I think it's really important that as my boss, Dr. Tom Mihaljevic says, you have to keep perspective because we will get through this. The second thing I would say is to educate yourself and learn as much as you can. Pay attention to sites that are reputable. Don't make your decisions based on what you're hearing or what you're reading on news outlets. Pay attention to medical sites and use that as your guidance. And stay up to date because the information changes. We've evolved a lot of our thinking on COVID. When the pandemic first started here in the United States, my wife and I were wiping down our groceries. You don't need to do that.

Dr. Jim Merlino:
So pay attention to what's changing and use common sense and be diligent about the procedures. A mask needs to cover your nose and mouth. It can't just cover your mouth. It can't be worn at your neck. It has to be worn the right way. You have to have precautions in place, or I'm sorry, protocols in place to think about what you do if somebody gets COVID in the workplace. Don't wait for it to happen. Plan ahead. So those are the things that I would tell businesses. Those are the things that I tell businesses.

Stewart Gandolf, MBA:
There's been times where I've been in situations here in California, which was at the beginning, was in the leadership position. Now, not so much, where nobody's wearing a mask and it's even me knowing what I know, there's that social pressure to not wear a mask and I wear it anyway. And so I think that's important to recognize there'll be times that are probably challenging and do what the experts telling you. Not just because everybody else is not wearing it does not mean, "Well, they're doing it." It's not safe.

Dr. Jim Merlino:
That's right.

Stewart Gandolf, MBA:
Because that's really what I think happens. They just said, "Well, nobody's doing it. I guess it's okay. It's a sunny day and nobody's sick." And on the other hand, to not freak out and not be paralyzed because we have to go through life. And it sounds like, which is very heartening to hear the optimism in there that there are ways to get through this. And if we're following the basics and I love, again, the Swiss cheese model, because that's where I think ... Maybe my last comment and then if you have anything else you can add up is perfection is the enemy of good. So in this case, if you're thinking it's just overwhelming. If I want to be 100% safe, I'd be lying in the sun, by myself with an N95 mask on, with the wind blowing at 100 miles an hour. It's like, well, so then if you're paralyzed and you're afraid to do anything.

Stewart Gandolf, MBA:
But maybe the odds are, and maybe you can tell me this clinically, all right, if you're having dinner outside, you're six feet away or 10 feet away, it becomes like you overreact and just don't have life and it becomes undoable. Do you have any comments on that? Because it feels like that's where people get into trouble. They either, well, this is just too hard, they do nothing, or they end up with no health issues because they're trying to do absolute perfection, which is maybe not as necessary. Any comment on that?

Dr. Jim Merlino:
Yeah. It's like people who have obsessive-compulsive disorder. People who suffer from that, they have to do specifically sometimes over and over again. That's not what this is about. This is about really just understanding what are the few things that are capable of keeping you safe when they're done together and just being vigilant about it. You can go to a restaurant that's appropriately set up for social distancing and where people are wearing masks. You can sit at the table with your spouse and take your masks off if servers are masked. Those things are safe. I've done it. I've flown. My wife and I flew to Florida the first two weeks of July and we wore our masks. Everybody on the plane had a mask on. We went out to eat but we went out to eat in restaurants that we knew were following the precautions. And we were very, very careful about observing our environment because we weren't going to walk into a situation that would put us at risk.

Dr. Jim Merlino:
But the point is you can do things. You don't have to live in a bubble. You just have to be vigilant. And I would add, one of my closing comments would be the biggest thing we worry about in healthcare with any safety precaution or process is fatigue. People forgetting it, or people getting comfortable with it. We have to be mindful. We have to stay vigilant because that's how we'll keep ourselves safe. So we can't relax our guard, so to speak, as we're continuing to live with this pandemic.

Stewart Gandolf, MBA:
That totally makes sense, and for obviously the vast majority of our audience here is in health care. They live this every day and hopefully, some of those insights will help you communicate with your patients or your constituents and your employees too. We haven't talked about this, and maybe just a second before we close here, your own employees at the hospital, they're still people too and there probably is still some fear there. So any comments to the providers that are listening here or one final comments of how to get the word out to employees or to your patients?

Dr. Jim Merlino:
Well, to the providers, thank you, because I know that everyone in the provider space is working very hard to do the right thing, to keep themselves safe, to take care of patients, and it's hard, so thank you. Again, I think it just comes back to emphasizing safety. We have to keep talking about it. We have to remind people about it. We have to reinforce it. That's the message.

Stewart Gandolf, MBA:
Very good. Jim, as always, it's been fun and fantastic talking to you, insightful. Love your thought leadership, love what you and your team are doing. Thank you.

Dr. Jim Merlino:
My pleasure. Thank you, Stewart. It's always great to talk with you about these issues.