Health Care Leadership Amid Covid-19: Dr. Elsa Escalera

Dr. Elsa Escalera, MD

In 1981, when I enrolled as a freshman at Hamilton College, there were particular class of ‘85 peers who stood out. Fellow native New Yorker Elsa Escalera was special: a graduate of the prestigious Bronx High School of Science, I remember her as laser-focused and driven. She was on a mission and had no time for mess. As it turned out, that mission was to become a Medical Doctor, an aspiration close to her heart since she was a young girl growing up in the South Bronx.

Not only did she become a medical doctor in five years, graduating from the Albert Einstein College of Medicine, she since earned additional degrees—a Master’s in Public Health from Columbia and an MBA from Baruch. A married mom of two accomplished daughters, Elsa’s work includes medical practice at Bronx Lebanon Hospital, where she treated HIV+ patients, and service, with ascending levels of leadership responsibility, at several federally qualified health centers. Most recently she was the Chief Medical Officer (CMO) for the Jewish Guild for the Blind (now the Lighthouse Guild International) and currently serves as Medical Director of the Westchester Institute for Human Development.

We conducted this interview by phone and email.

Happy Mother’s Day, Elsa!

From first responders to correction officers to train conductors and bus drivers, so many of us are stepping into new and challenging leadership roles, taking turns at leading and then really listening when others lead. It's time for leadership and humility, as we put our egos to the side. Like jazz musicians working together to create beauty, we are all working together today.

—Dr. Elsa Escalera, MD

Interview: Dr. Elsa Escalera, MD

Greg: Thanks for sharing your experience and knowledge, Elsa, and for being an avid reader of our blog.

Dr. Escalera: You’re welcome, Greg. I find the integration of jazz and leadership fascinating.

How has COVID-19 impacted you personally and professionally?

Dr. Escalera: COVID-19 has been one of the most impactful experiences in my lifetime. On a personal level, it has helped me focus on what is really most important in my life—family and the other close relationships in my life. Professionally, I think it has made me more sensitive than ever to the importance of developing and following careful infection control processes. 

I am also very concerned about the physical and mental health of our health care providers on the front lines of this crisis. They are under tremendous pressure, not only to provide quality care, but also to be an information life-line between patients and their loved ones. Then, when they finish their shifts, they must worry about whether they are inadvertently exposing their loved ones to the virus. These health care providers are doing heroic work and deserve our support.

I count you among those heroes. In our work, we use the musical practice of syncopation as a way of describing readiness for the unexpected. Obviously, Covid-19 was unexpected by most. We also equate the jazz practice of swinging with resilience, and improvisation with thinking wisely on your feet.

How have you had to be resilient and improvise as a medical professional in the current pandemic environment?

I love this question. Not only was Covid-19 unexpected by most, but we still know so little about it. So we must be ready to improvise, to constantly take in new information and apply it very quickly. For example, in my current position, I led an incredible team to develop and implement a telehealth program over a 2-week window. Before Covid-19, I never thought that this would be a critical part of my job.

We are all the same to the coronavirus, so we should try to be the same to each other.

—Dr. Elsa Escalera

Improvising a Telehealth System

Please say more about the team and how you all improvised in that 2-week window.

The CEO tasked me with developing a telehealth program on my first day at my new job. I literally went door-to-door to get to know my colleagues as people while simultaneously asking them about telehealth. 

I needed people who understood our business processes, the workflow of various specialists, our IT infrastructure and capabilities, the intricacies of patient scheduling for our special needs clients, and compliance, among other things. One doctor, it turned out, was already using a technical platform on an individual level that could also be used for the organization—the time he spent introducing me to the platform was invaluable. 

I learned how our clients and the staff who supervised them could be taught, on the computer, how to use the platform—and to show up for their appointments already comfortable with the technology. Our IT team had to obtain new hardware—including cameras, computers and speakers—capable of merging with our existing hardware. Operationally, our schedulers may have had the hardest job of all: not only scheduling and training the patients and their staff, but having the patient's EMR [Electronic Medical Record] ready for the physicians, with each appointment scheduled with logon instructions for each appointment given to each health care provider and client. I needed strong people at all of these intersections. Fortunately, they were already there. 

My challenge was to figure out who needed a proverbial seat at the table. Once identified, I needed to listen to and empower the team, organize their various knowledge bases, and coordinate their activities.

The telehealth program has been a rousing success, just in time. With it, we have provided medical care to many clients who have tested positive for Covid while they remained in the privacy of their rooms.  We monitor their health, including their oxygen levels, and their mental health through our Behavioral Health Group.   They have done an amazing job.

Shared Leadership: A Collaborative Necessity

. . . every person is both empowered and expected to lead within their sphere of expertise, and then to pass the proverbial baton to other team members.

—Elsa Escalera, MD

Shared leadership is another principle in jazz. How do you practice leadership with other leaders?

Generally speaking: all of us can be leaders, regardless of our titles at our organizations.  Where possible, I believe in collaboration—this is true whether I am the highest-ranking person on the team or the lowest.  A true collaboration, where people with different experiences, talents and perspectives come together, is my favorite way to work. While I’m not a musician, that sounds a lot like what I imagine shared leadership in jazz might be.

Yet specifically, if my first project was telehealth, my current project, under the overall leadership of the CEO, is preparing the organization for return-to-work (RTW).  It is an enormous challenge. I think of it as a big puzzle that no one sees in its entirety. To succeed, I need the right people to help me, and I must take responsibility for using their talents optimally.

My team includes compliance, facilities staff and the head nurse. From a patient perspective, it starts with a medical assessment that includes Covid screening questions. An initial telehealth visit is one option. If appropriate, an in-person visit may follow.   

This means that the patient and the person accompanying them must have appropriate PPE [personal protective equipment]. The patient then physically enters the facility, which requires intervention of staff with further appropriate questioning and taking temperatures, and then get them to the right office while maintaining social distancing throughout. We have to determine how many people can safely be in the facility at any one time. 

Other protocols must be developed for employees. On our RTW team, every person is both empowered and expected to lead within their sphere of expertise, and then to pass the proverbial baton to other team members. Together, we can get the job done.

Hope for Tomorrow

When we get to the other side of the pandemic, social restrictions, and lockdowns, what is your hope for a better tomorrow, generally, and for the population of people your organization serves, specifically?

While this may be naïve, I hope we come to realize that as we are all the same to the coronavirus, so we should try to be the same to each other. I hope we continue to work to break down the social and economic barriers that divide us. My organization focuses on providing health care services to the developmentally disabled—a mission I find consistent with this hope.

How do you think this crisis will change the shape of leadership going forward?

We can't do it alone. That was true before and it is true today, perhaps more important than ever. From first responders to correction officers to train conductors and bus drivers, so many of us are stepping into new and challenging leadership roles, taking turns at leading and then really listening when others lead. It's time for leadership and humility, as we put our egos to the side. Like jazz musicians working together to create beauty, we are all working together today. Community means recognizing that we accomplish great things—together.

That’s eloquently stated, Elsa. Our professors at Hamilton would be proud! What leadership book would you give a mentee?

Our Iceberg is Melting by John Kotter.

Who has been a great influence on you as a leader?

No single person has taught me leadership, it’s been a collective effort. I've learned from different people in my life.   

My mom was my first leader—she maintained a safe, stable and cohesive family under extremely difficult circumstances. She led, with very few words, through hard work and example as a line worker in a cosmetics factory. I learned from her that leadership comes more from what you do, and how you do it, than from what you say. 

I worked with Dr. Yvette Walker for over 20 years in various capacities. Yvette taught me both the strength of education and the value of maintaining relationships over time.  Yvette remains my "lifeline" when I need guidance.   

I've also learned from my colleagues and friends going all the way back to high school, where some of my classmates were incredibly talented. I've remained close to some Hamilton and medical school classmates who have taken on leadership roles in their organizations. I have learned much from them. Much of what we do to develop our own "leadership personality" is to observe what works for those around us and see what we can take from them. But, going back to my mom, I believe we must remain authentically true to who we are.