McKinsey on Healthcare
What can we learn from the effect of the pandemic on children’s health?
10 Jan 2022
Chapter 1: What impact has the pandemic had on children's health?
Thank you.
I'm Megan Greenfield and I'm a partner in McKinsey's Boston office. Excited to be joined today by Dr. Kevin Churchwell, President and CEO of Boston Children's Hospital. Dr. Churchwell has had an illustrious career. Born in Tennessee, he's a graduate of Massachusetts Institute of Technology and Vanderbilt Medical School.
Dr. Churchwell completed his pediatric residency and a clinical fellowship in pediatric critical care at Boston Children's Hospital. Prior to joining Boston Children's as chief operating officer in 2013, he served as a CEO of two other children's hospitals. He is also an associate professor of pediatric anesthesia at Harvard Medical School. Welcome, Dr. Churchwell.
To kick it off, for those of us in a global audience who are not as familiar with Boston Children's Hospital, tell us a little about it and what drew you there in 2013.
Chapter 2: How did Boston Children's Hospital adapt during the early days of COVID-19?
Well, it's a pleasure to be here, and thank you for the opportunity, Megan. A little bit about Boston Children's Hospital. We just finished celebrating last year our 150th anniversary. And so we're not the oldest children's hospital in the nation, but we're close to it. And we have had a incredible journey in terms of our care for children.
Boston Children's Hospital, by one measure, is looked at as one of the leading children's hospitals in the world. U.S. News and World Report does a piece of ranking every year. And for at least the past 10 years or so, we've been ranked number one. Now, I say that only just to give folks a view of what we try to do at Boston Children's.
And that number one ranking, although it's nice to have, I think just describes in some respects the depth of what we try to do at Boston Children's in terms of what we provide. We work to be the leader in pediatrics, in pediatric research, pediatric clinical care, pediatric education, and our work in the community.
And over the 150 years, we have been intentional around what we have tried to recruit to and wanted to develop from that standpoint. That's our mission here, and that's what we continue to work toward. My relationship to Boston Children's, to be honest with you, Megan, is not an eight-year journey, but more like 30 years.
Chapter 3: What mental health issues are children facing due to the pandemic?
I first arrived at Boston Children's to do my internship and residency back in the 80s. and spent over eight years here in my training. I did when I practiced pediatric critical care and spent two years on staff before I left and returned about eight years ago with the opportunity of being the EVP of Health Affairs and Chief Operating Officer.
Thank you for sharing. When you were named CEO back in March, one of your board members told the Boston Globe that you were level-headed and unflappable, which is incredibly impressive as the pandemic offered a leadership test like no other. Describe for us what it was like at Boston Children's back in those early days of the pandemic.
How has the clinical response to the health crisis evolved from then to today?
That's a great question. The early days of the pandemic were days that were a bit confusing, but we worked to provide clarity, especially early on. Right. So as the nation was confronting the COVID crisis, the pandemic, we saw what was happening in New York. We saw what had happened in Italy.
The state of Massachusetts began to really develop a plan of action to counter what was occurring elsewhere. At Boston Children's, I remember vividly St. Patrick's Day weekend.
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Chapter 4: How can families support children's mental health during challenging times?
That was in March of 2020. where during that weekend, there were significant crowds outside, parades, individuals having a great time. And as I was sitting at my desk, I realized we were going to head to significant problems if we did do something drastically. All the other hospitals also realized it at the same time, that we had to change our practice.
So during those days, I actually called all of our leadership, both physician, nursing, administrative leadership, and let them know that we were going to have to change our practice dramatically, meaning that we were all going to have to go remotely. And what I meant by that was that if you needed to be in the hospital, you could come to the hospital.
If you didn't need to be in the hospital or in your office, you were going to work from home. And I gave everyone a week to get that done. It was incredible how we just all came together to figure out how to make that happen. And it happened in less than a week.
It happened in about three days that we were able to put processes in to have over 8,000 individuals work from home to actually see patients remotely. via telemedicine or other opportunities, and to actually really decide who needed to be at the hospital, who needed care, and who didn't.
And we've been working through that ever since in terms of how we are working together to make things happen, to actually adjust to what this pandemic has continued to show us and ask us to do.
It's truly amazing. I think that's the fastest change in healthcare that we've ever seen.
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Chapter 5: What role does community play in addressing children's health needs?
Thinking about the role of leaders in a crisis, you have been widely recognized as a uniquely empathic CEO. Reflecting on your role at the height of this pandemic, how did you approach supporting your workforce, both those remotely and those on the front lines, to help them navigate what was one of the most challenging times they've ever faced?
Well, I appreciate you saying that, Megan. I will tell you that I continue to work on that empathy part. I think that what I've worked on and continue to work on is how do we become better servant leaders? How do we address and support those that work for us, that work with us?
And this pandemic is a great example of that, in that we sent everyone home, over 8,000 individuals, but also asked the question, what did they need? to help them continue to work from home? And it turns out there were a lot of answers to that question.
Issues that we had not thought about before, childcare, parental care, the support that's needed when your kids aren't in school and you still have to work. How do you deal with that? How do they stay effective, efficient in that regard? What do they need in terms of that support?
And so we work to put those programs in place, those opportunities in place with a continued listening cycle of what else is needed. What's needed to make your basement an office from ergonomics to the Wi-Fi system, because we still had to continue to take care of patients and we still needed everyone to work as efficiently and as effectively as possible.
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Chapter 6: How can healthcare institutions improve racial equity?
And so it's a continuing process. The anxiety around the pandemic. Am I going to have a job? When am I going to go back to work? You know, how do we communicate to them? How do we let them know that we are with them all the way? And so we made some important decisions that we had the opportunity in our environment at Boston Children's Hospital make.
We decided and made the decision that no one would be furloughed. that everyone would continue to be paid as we moved forward. And we found out that was a very important decision in terms of how everyone who worked at Boston Children's felt about working there, the anxiety that they were encompassing and how we could help them work through that.
It continues to be a work in progress because the issues continue to change. But our goal is to keep in front of us how can we be the best servant leaders we can possibly be because that is the impact that will truly make a difference in what we're trying to achieve as a hospital, as an institution.
I love that, framing as a servant leader. I'd love to turn to a topic that has been front and center in the pandemic, which is mental and behavioral health. In addition to seeing the patients that are being impacted directly by COVID-19, the pandemic has taken a staggering toll on mental and behavioral health.
Chapter 7: What innovations in healthcare have emerged from the pandemic?
We're seeing it impact adults and would love to get your thoughts. What has the mental and behavioral health issues that you're seeing facing children, both near-term and also longer-term ramifications?
So Megan, that's a really important question. I will tell you that for the most part, we have not seen a large number of children who are COVID positive presenting to the hospital with their infection. It remains a small number in the Northeast, certainly in the South, as you know, the numbers have increased dramatically over the last three months. And we are very much looking out for that.
But what we have seen and what I've described as our pandemic during this time, during this 20 months, is the pandemic of children, pediatric patients, adolescents, young adults with behavioral and mental health issues that are presenting to our emergency department, to our inpatient psychiatric units in just exploding numbers. I'll just give you a couple of examples and some numbers.
Prior to the COVID pandemic, the number of children that we were seeing per day, we thought that number was extremely high. That number was in the 20s. During the pandemic and currently, those numbers are now in the 50s to 70. And I get asked, well, how are you managing that? My usual answer is, well, hour by hour.
That's our challenge to how do we create a system of care for our children with behavioral and mental health issues that we currently don't have. Why is this problem exploding?
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Chapter 8: How can leaders maintain a positive outlook during crises?
The issues around social isolation, the issues around not going to school, the issues around social media, issues that we were seeing pre-pandemic have certainly exploded during this pandemic. And we've got to get a handle on those.
We've got to create more of a continuum of care that encompasses the family, the primary care pediatrician, the school system, the hospital, the state in terms of providing and supporting programs and care for our children who are presenting because we cannot lose this generation. And this is our opportunity to really make a difference.
That's really tough numbers to digest. So I'd love to get your thoughts to the many people who are listening here, whether the families, teachers and others that are supporting these children. Any advice to them as they navigate and try to support these vulnerable children during this time?
Well, we have found that It is very important for the development of a continuation of care for our children, where it's not just the family's responsibility or the primary care pediatrician's responsibility, but it is all of our responsibilities to work in concert, to provide support, whether it's the family unit.
their primary care pediatrician, the school system, the hospital, the healthcare entity, and the state support. And I am finding and believe that the solution is really based upon how we coordinate and work together and create that continuum for our kids. For our families, I want you to know that you are not alone. You're not isolated in these issues and that we are here for you to reach out to.
It is a stressful time, but please know we are doing the best we possibly can to create that access to be available for the care of our children. I think that as we continue to learn more, continue to develop more opportunities, more programs, that we will be more and more available. Technology is going to be very important from this standpoint.
How we utilize technology for that outreach, whether it's telehealth or just a phone call, is something that we've got to really continue to explore and develop in support of the care of our kids with behavioral and mental health issues.
Thank you for that advice, Dr. Churchwell. I want to turn as well, because not only have we had the pandemic of COVID-19, but also a nationwide reckoning with issues of racial equity and recognition that employers need to play a central role in helping level the playing field and create opportunities for a diverse workforce.
I'm sure these questions and the role of institutions making racial progress have been front and center. From your father's role as one of the first Black journalists hired by a white-owned Southern newspaper, and now you and your brothers both being executives at leading health care institutions.
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