The leader of the Columbus region's largest health system has trained his entire life for crisis command—as a military pilot, ER physician and health care executive. Now, his skills are being put to the ultimate test as the coronavirus crisis continues.

Situational awareness.

Early in his Air Force career, Stephen Markovich learned these two words were the key to success—and survival. “Situational awareness is being aware of what’s going on around you at all times, where you are in a three-dimensional space,” says Markovich, who flew the A-7D Corsair and F-16 Fighting Falcon on three Middle East deployments. “I’ve been shot at from the ground with missiles, in the air with missiles, from the ground with guns and mortars—and I’ve never been hit, knock on wood. I’m even prouder of the fact that everyone under my command made it home.”

And now, Markovich, 61, a family and emergency physician and the president and CEO of OhioHealth, faces perhaps the biggest challenge of his accomplished careers in the military and in medicine: Leading the region’s largest hospital network though an unprecedented pandemic in which lives are at stake and every day includes a new crisis. The situation is dire, and it requires awareness and leadership to create, coordinate and carry out OhioHealth’s emergency plan. Gov. Mike DeWine once estimated there could be as many as 10,000 new COVID-19 cases a day in Ohio by May, a situation that could overwhelm the region’s hospitals.

Markovich compares the coronavirus crisis to the terrorist attacks on Sept. 11, 2001. “It’s very similar in that this is a disaster of national proportions and could devastate lives and the national economy,” he says. “But it’s happening in much more of a slow motion with a lot more unknowns.”

With his knowledge of situational awareness and a military-style command structure in place at OhioHealth, Markovich has led his team of 12 hospitals and 200 ambulatory sites, hospices and home health sites through the equivalent of flying combat missions in a war zone.

“We have a complete Incident Command Center in place,” Markovich says. “The hub is here [at the OhioHealth David P. Blom Administrative Center in Columbus], with Incident Command Center spokes on all our campuses. It’s all about creating the right team and structures and role clarity, and empowering our people to make decisions. It’s how you protect your people, protect and communicate with your patients and manage your supply chain.”

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First flight

Growing up in Detroit, Markovich had two dreams: The Air Force and medicine. The first goal came from his father, Lee, who had served in the Air Force and took his son to local air shows; the second from his mother, Joline, a nurse. There was one problem: “To be a pilot in the Air Force, you have to go to college and be an officer, and you had to join before you’re 26 if you wanted to fly,” Markovich says. This meant medical school would have to wait. And wait, and wait, while Markovich flew fighter jets.

“People who have never flown [a fighter jet] don’t really understand what it’s all about,” he says. “Once you’ve flown upside down at 700 miles an hour, you never want to stop doing it.”

While a military career was tempting and rewarding, especially the upside down at 700 mph part, Markovich was determined to become a doctor. “A lot of folks said, yeah kid, you’re dreaming, but I figured out how to do it,” he says. The figuring involved a switch from active duty to the Ohio Air National Guard, and the start of medical school at Ohio State University at the ripe, old age of 29. Between his second and third years of medical school in 1991, Markovich was deployed to the Middle East as part of the Gulf War and flew combat missions in the no-fly zone over Iraq.

“The military is so focused on safety and teamwork and leadership,” Markovich says. “People tap you on the shoulder at various points in your career, in the military and in medicine, and say ‘here’s an opportunity.’ ”

The opportunities came quickly. And Markovich dove in. He logged more than 2,000 hours as a fighter pilot, led the development of the military medical-response task force for medical disasters in the state, rose to the rank of major general and served as commander of the Ohio Air National Guard. 

“On the morning of 9/11, I was seeing patients,” Markovich says. “My nurse came in and said, ‘Marko, look at the TV,’ and I saw the second plane hit the tower. My pager went off. It was the guard in Springfield and they said, when can you get here? I said, I’m on my way—and that day we were flying missions over the United States as part of the no-fly zone.” Markovich and his Ohio Air National Guard unit were deployed to the Middle East twice.

In his “other” career in medicine, Markovich practiced family medicine and was an emergency-room physician. He served as president of Riverside Methodist Hospital, was OhioHealth’s senior vice president for acute care operations and was named the president and CEO of the region’s largest health system in July 2019, replacing the retiring David Blom, who led OhioHealth for 17 years and remains a key business leader in the community.

“It became clear to us that Steve was the right guy for the job,” Blom says. “He has the right values. He’s grounded, and humble and smart, and people like to follow him because of these characteristics.” Soon after Markovich settled fully into his new role, which followed a year-long transition period, Blom began receiving emails from former OhioHealth colleagues. “They thanked me for the transition period and supporting Steve for the role,” he says. “The number of emails has accelerated in the midst of this crisis.”

The rules of leadership

Over the years, in the military and in hospital administration, Markovich observed the leaders around him and took notes on how they brought out the best in the men and women they led. “It’s all about people,” he says. “It doesn’t matter if it’s combat or if it’s surgery, leadership is all about how to get people to work cohesively and collaboratively and achieve more together than they could on their own. You do it by inspiring and challenging and teaching. You have to build trust, and people have to know you’ll go to the mat for them and you’re invested in their development and their lives. I have had some experiences that forced the development of these skills.”

Soon after he took over at OhioHealth, all of Markovich’s leadership skills would be put to the ultimate test.

Pandemic closes in

Health officials started hearing about a new flu-type virus in December, Markovich says of what would soon be called the novel coronavirus, which spread from China to continents and countries around the world, and eventually to Ohio, causing people to become ill with the COVID-19 disease. 

OhioHealth’s Incident Command Center created teams of senior leaders responsible for 10 critical areas: supplies, inpatient, emergency department, surgery, access/security, redeployment of personnel, ambulatory, employer services, home care and communication. At the daily meetings, which Markovich attends via video to stay safe, each team leader gives an update on their area, and Markovich asks: “What barriers are you facing, what do you need from senior leadership?”

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Markovich declined to share the number of OhioHealth patients and hospital employees diagnosed with COVID-19, saying this was being handled by Gov. DeWine and Dr. Amy Acton, director of the Ohio Department of Health. “We have had several positive results [for COVID-19] and we submit all that information every day to the state,” he says.

There were 13,275 diagnosed COVID-19 cases in Ohio on April 22, with 557 deaths, numbers that were rising daily. There were 2,779 patients in Ohio hospitals, with 838 in intensive care units. “Not everyone who is diagnosed is being admitted to the hospital, about 25 percent are,” Markovich says. “And, of that 25 percent, about 20 percent are in the ICU and not everyone in the ICU needs to be on a ventilator. Right now, we have an adequate supply of ventilators and we continue to look for more; partnering with surgery centers, [obtaining]machines used for anesthesia; I think we’re in good shape now.”

Testing patients to determine if they have COVID-19 is another important issue, and one that took a significant amount of time in January and all the way into March. “Early on, it took about seven days to get the results, then about five days,” Markovich says. “If someone was sick and dehydrated and not able to take care of themselves, they were admitted and treated as if they have COVID-19 until we got the test results back and knew. Now, it’s down to hours, less than two hours with our in-house testing kits.”

Personal protective equipment (PPE) for staff also has been something to track closely in the battle against COVID-19 as hospitals in New York and around the country began reporting shortages in mid-March. “At the moment, we have enough personal protection gear,” Markovich said in early April. “I get a report every morning and we talk about it in terms of days of inventory we have on hand for masks, gloves and scrubs. Periodically we’re concerned, and we’re working hard with our supply chain. Our community has been amazing and people and commercial businesses are coming to us and saying they have N95 masks, where can they drop them off.”

There also have been reported shortages of ventilators, but in early April Markovich felt OhioHealth’s supply was adequate. “And, we’ll continue to look for alternatives and additional ventilators from our partners and surgery centers and anesthesia operations that use them. And, if we run out, we can ventilate a person by hand with a [ventilator] bag.”

OhioHealth hospitals passed out 500 iPads to patients with the coronavirus or a respiratory illness that could be the coronavirus to reduce the number of times nurses have to enter their rooms. The iPads allow patients and medical staff to communicate remotely and eliminate unnecessary trips into the room that would require the use of PPE, reducing the number of protective gear items used and discarded. OhioHealth hospitals are using IV poles with extra-long cords so nurses can check and refill IV bags from outside a patient’s room, again reducing the use of PPE. The hospital system has incorporated video conference calls and telehealth visits between physicians and patients, and it eliminated elective surgeries for a time. The goal at OhioHealth, and at hospitals across the country, has been to free up as much medical staff and beds as possible for the growing number of COVID-19 patients in preparation for a surge, which was for a time expected in late April.

OhioHealth also brought in additional medical personnel.

“We’ve created a process to add to our medical staff,” Markovich says. “New graduates from medical school and residents and physicians in the community who are not affiliated with our hospitals or are retired that have a relationship with us. And new nurses, even before they’ve taken the nursing exam.”

Before a fighter pilot takes off, he or she goes through a long series of checklists. “We have these checklists because the human mind can become confused, especially in times of stress,” Markovich says, adding he believes checklists are important in operating rooms and meeting rooms. “I’ve brought these checklist techniques to my teams here. I think the health care field can learn from the military and the nuclear power industry and the transportation industry. How to do things in a complex and high-risk environment where you can’t fail.”

Collaborative care

The COVID-19 pandemic has put a strain on health care systems and hospitals across the nation. The effort in Central Ohio is coordinated by the Central Ohio Hospital Council, which is composed of the CEOs of OhioHealth, Ohio State University Wexner Medical Center, Mount Carmel Health System and Nationwide Children’s Hospital. All four CEOs are relatively new in their positions.

“We are setting up command centers, gathering data and making decisions quickly across multiple institutions,” Jeff Klingler, president and CEO of the Central Ohio Hospital Council, said in late March. “Steve is really good at reaching out to other folks, whether it’s his own folks, the CEOs of the other hospitals, the National Guard, the CEOs of other local companies, city or county officials. He’s on top of it and working with them as soon as possible. I’m not sure if this comes from his military background or from medicine, but I really appreciate his ability to reach out to and work with so many others.”

Klingler and the four hospital network CEOs normally meet quarterly and discuss topics such as the opioid epidemic, infant mortality and chronic diseases. “Now, we’re meeting twice a week, teleconferencing,” Markovich says. “That’s one of the things I’m most proud about—how we help each other out and do what’s best for the community as a whole.”

In late March, the Central Ohio Hospital Council announced plans to convert the Greater Columbus Convention Center into a field hospital, stating that the “planning and coordination continues with regional hospitals, nursing homes and surgery centers as we work to maximize our resources.”

“The initial plan is for 1,000 beds, but I’m told the physical capacity could swell to 1,500 if there’s the need,” Markovich says. 

Another thing Markovich is quite proud of is how the men and women he leads have responded to the most challenging health crisis any of them have ever experienced—and put themselves at risk to help others.

“They’re tireless and so dedicated,” he says. “And my job is to protect them and take care of them and make sure they take care of themselves and their families and stay safe and resilient. In the military, we talk about the importance of having a good wingman. It’s so important. And, and I’d be proud to take any of these people here [at OhioHealth] as my wingman.”

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Q&A

OhioHealth CEO Dr. Stephen Markovich’s approach to dealing with the pandemic: Hope for the best and plan for the worst; put the right people in the right places; and ultimately, find a way to evolve and take the waste out of health care.

How long do you think this COVID-19 pandemic will last?
We just don’t know. It could last nine weeks, it could be 16 weeks or even into the fall. We just don’t know. We hope for the best and plan for the worst. And, if it takes a year to develop a vaccine, we could have another round of this in the next flu season.

Do you think the decision to shut the Arnold Sports Festival to spectators helped slow the spread of COVID-19 here in Ohio?
I think when we look back, in retrospect, it will be significant. We may never know the exact number of cases it prevented, but it sent a message that we are taking this seriously and putting the health of the community in front of the economic impact. It was a very strong message from Governor DeWine and Mayor Ginther and put Ohio out in front.

How will the COVID-19 pandemic change health care?
Before we can evolve, we first have to get through this. And then rebuild our economy in multiple sectors. But, I can say that in health care, so many smaller hospitals were already living on razor-thin margins. We need to find a way to raise the clinical bar and preserve capacity, especially in our more rural regions. We have to figure out how to finance it and make it more cost effective. We have to take the waste out of it.

Will all the teleconferencing between doctors and patients taking place now because of the coronavirus be part of this future?
Yes. Look at how much work we’re doing remotely now. This has forced us to change our behaviors relatively quickly.

A few months ago, not many people had heard of Dr. Amy Acton, the director of the Ohio Department of Health.
I have not yet had the pleasure of meeting her, but I’m so impressed by her skill and passion and her ability to navigate an extremely complicated system. She’s a rock star, and when this thing is over she can write a book or maybe be on Dancing With the Stars.

Has it been hard for you to step away from seeing patients as you assumed higher leadership roles, especially during this crisis?
I made the decision when I was named president of Riverside to step away from seeing patients. Because of my schedule—I didn’t want to be disrespectful to my patients. Philosophically, I’m still taking care of patients. But not one at a time—5,000 at a time. I can influence and set priorities. I try and be a visible leader and put scrubs on and go into our operating rooms and talk to our doctors and nurses and patients. It keeps me grounded. In the past, during something like [the COVID-19 pandemic], I would have been in the trenches leading one of the incident command teams. Now, my role is to put the right people in the right places and work on the overall structure and interface with the community and city and state and the other hospitals and CEOs. I’ve learned a lot about being a CEO and I’ve learned a lot about how strong and amazing our people are.

Steve Wartenberg is a freelance writer.