Children’s health during the COVID-19 pandemic: What have we learned?

Since the pandemic began, there has been an increase in the number of children and young adults with behavioral- and mental-health issues. How can these issues be tackled holistically?

Viewed as one of the world’s leading children’s hospitals, Boston Children’s Hospital is constantly striving to maintain its position as a leader in pediatrics, pediatric research, pediatric clinical care, pediatric education, and community work. Dr. Kevin Churchwell, the hospital’s president and CEO, suggests that one way to confront the current crisis in children’s health is to recognize that we—whether it’s the family unit, the primary-care pediatrician, the school system, the hospital, the healthcare entity, or the state—must all work together to provide support.

In this episode of the McKinsey on Healthcare podcast, McKinsey partner Megan Greenfield speaks with Dr. Churchwell about the current health crisis, as well as pandemic leadership. The wide-ranging discussion touches on topics from the effect of the pandemic on children to putting equity and inclusivity at the top of every meeting agenda. An edited transcript of their conversation follows.

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Children’s health during the COVID-19 pandemic: What have we learned?

McKinsey: Describe for us what it was like at Boston Children’s Hospital in the early days of the pandemic. How has the clinical response to the health crisis evolved?

Kevin Churchwell: During those early days, I called physician, nursing, and administrative leadership and let them know that we were going to have to change our practice dramatically. This meant we had to work remotely. Only essential workers could come to the hospital. If you didn’t need to be in the hospital or in your office, you had to work from home. I gave everyone a week to get that done. It was incredible how we all came together to figure out how to make that happen. In about three days, over 8,000 individuals were working from home. They were seeing patients remotely via telemedicine [visits] or other opportunities. So we had to act quickly to decide who needed to be at the hospital or who needed care and who didn’t. Since then, we’ve been working through that in terms of how we are working together to adjust to what this pandemic has continued to show us and ask us to do.

McKinsey: Reflecting on your role at the height of this pandemic, how did you support your workforce both remotely and on the frontline to navigate one of the most challenging times they’ve faced?

Kevin Churchwell: I think that what I’ve worked on, and will continue to work on, is how do we become better servant leaders? How do we address and support those who work for us and work with us? The work we’ve done during this pandemic is a great example of that. Not only did we send over 8,000 individuals to work from home, but we also asked what they needed to help them continue to work from home. It turned out there were multiple, diverse answers to that question, and there were issues we had never thought about before: childcare, parental care, the support that’s needed when your children aren’t in school but you still have to work. How do you deal with that? How do people stay effective and efficient? What do they need in terms of support?

So we worked to put those programs in place with a continued listening cycle based on what else was needed. For example, how do you make your basement into an office—from ergonomics to the Wi-Fi system? We still had to take care of patients, and we needed everyone to work as efficiently and effectively as possible.

We also addressed the anxiety around the pandemic. People worrying about their jobs or having to return to their work site. We let them know that we were with them all the way. We made the decision that no one would be furloughed—everyone would continue to be paid as we moved forward. Later, we found out that that had been a very important decision in terms of how everyone who worked at Boston Children’s felt about working there and how it helped them to deal with their anxiety.

However, it continues to be a work in progress because the issues continue to change and our goal is to keep asking the question, “How can we be the best servant leaders we can possibly be?”

McKinsey: What are the mental- and behavioral-health issues that you see children facing in both the near and long term?

Kevin Churchwell: What we have seen during this pandemic is a sharp rise in children and young adults with behavioral- and mental-health issues. Prior to the COVID-19 pandemic, we thought that the number of children we were seeing per day with these issues was already extremely high—that number was in the 20s. During the pandemic, and currently, those numbers are in the 50s to 70s. Our deep challenge is, “How do we create a system of care for children with behavioral- and mental- health issues that currently doesn’t exist?”

We need to think about why this problem is escalating—the issues are around social isolation, not going to school, social media, et cetera. Problems that we were already seeing prepandemic have increased rapidly during this time, and we’ve got to get a handle on those. We must create more of a continuum of care that encompasses the family, the primary-care pediatrician, the school system, the hospital, and the state when it comes to providing and supporting programs and care for our children who are presenting [mental-health issues]. We cannot lose this generation.

McKinsey: What advice do you have for people who are supporting these children, whether they are families, teachers, or doctors?

We must create more of a continuum of care when it comes to providing and supporting programs and care for our children who are presenting [mental-health issues]. We cannot lose this generation.

Kevin Churchwell: We have found that the development of a continuation of care for our children is vitally important. It’s not just the family’s responsibility or the primary-care pediatrician’s responsibility, but it is all of our responsibilities to work together to provide support. I believe the solution is based upon how we coordinate and collaborate to create that continuum. We want families to feel supported. Technology is going to be very important from this standpoint, such as how we utilize technology for outreach, whether it’s telehealth or just a phone call. This is something we’ve got to explore and develop to support those families and children.

McKinsey: Not only are we facing the COVID-19 pandemic, but we’re also experiencing a nationwide reckoning with the issue of racial equity. What are the key challenges large healthcare systems face when it comes to racial equity?

Kevin Churchwell: I don’t consider [racial-equity issues] challenges—I consider them to be opportunities. I believe that we have been presented with the opportunity to truly move this ball forward. This is extremely important to me personally, and I think it’s also vital to healthcare. How can we fully bring the topic of equity into our discussions? Not simply as a topic we talk about at the end of our conversations, but a topic that is integrated into how we plan, recruit, and develop.

In our organization, we are working to incorporate work around equity, diversity, and inclusivity [EDI], by thinking holistically about every aspect of the work we do. The problem is that EDI usually sits at the end of any meeting’s agenda. We get through the agenda and then if there’s time, we talk about EDI. Our goal is to make sure that our discussion about EDI is either number one or number two on the agenda. This allows the time to properly address issues. It gives EDI the importance it needs for us to be able to move the ball forward.

We will fail if, a year from now, we’re not talking about EDI in the same way we’re doing right now. That something else, the next perceived “issue,” takes the space, and we stop focusing on this important conversation. Our goal has to be that it stays at the top of people’s minds and agendas. Ultimately, solving these issues will translate to better care for everyone.

McKinsey: How can we reduce healthcare disparities in communities?

Kevin Churchwell: One of the key issues that we have to confront is early childhood education and early childhood support. If we can provide good support for the growth and development of children at that early age, then we can solve a lot of these issues. We currently direct our support in that way by providing grants and opportunities to groups or programs working in our community who deal with that issue in particular. We’re not ignoring other issues, but we’re focused on getting to the root of the problem and providing solutions.

McKinsey: What do you think have been the greatest healthcare unlocks that have stemmed from the COVID-19 pandemic?

Kevin Churchwell: I think how we in healthcare have responded to this pandemic has been extraordinary, and I’m very proud of the commitment all caregivers and hospitals have shown. A huge lesson has been around how to utilize technology. We now know that telemedicine is not the future, it’s the present. Through [telemedicine] we’ve provided more access and grasped the opportunity to reach out and touch more families, even more patients, who need our help.

Another unlock has been innovation. Here, we’ve put our listening ears on and stopped saying no. That’s the mindset that we have moved toward as we’ve moved forward.

Lastly, we’ve learned that communication is key. Prior to the pandemic, we thought we were doing a great job of communicating, but we found out very quickly that how we were communicating prepandemic wasn’t going to work anymore. Our communication during COVID-19 has been much more concise, frequent, transparent, and interactive. With the tough issues that we’ve had to address, good communication was essential, and I think one of the key opportunities that we have moving forward is to continue to utilize this lesson.

McKinsey: As a leader in these challenging times, how have you managed to stay grounded and optimistic?

Kevin Churchwell: It hasn’t been that hard, because I appreciate and enjoy the work I do. I believe the work that I’m part of is probably one of the most important pieces of work that we can all be part of, and that’s supporting the next generation of life, of human existence, by supporting our children.

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