Running a Marathon at a Sprinter's Pace

From disruption to innovation, Emergency Medicine Chair Richard Zane leads the way

By Katie Kerwin McCrimmon

(April 2021) The moment when Richard Zane, MD, received a new COVID-19 vaccine became one of the most memorable of his career and an experience that all of his professional accomplishments have prepared him to fully appreciate.

“This is the event of our generation. It will be in every history book, every scientific book. The creation of this vaccine will be taught in every medical school class. We are seeing a light at the end of a tunnel,” said Zane, who is an expert on emergency medicine, emergency preparedness, mass casualty care, and health care innovation.

Zane became one of the first medical providers on the Anschutz Medical Campus to receive his vaccine as soon as the first shipments become available.

He is a professor and chair of the Department of Emergency Medicine at University of Colorado School of Medicine, executive director of emergency services for UCHealth, and UCHealth’s Chief Innovation Officer.

When Zane’s turn arrived, he gladly held out his arm as medical assistant Shavona Gunn plunged a needle into the muscle on his upper right arm. The two gave a thumbs up together and Zane said it didn’t hurt a bit. He’s confident that COVID-19 vaccines are safe. And he’s marveling at the moment because it marks both the end of this devastating pandemic and the dawn of a remarkable new era in science.

Rising to challenges all year long

The COVID-19 pandemic has caused suffering all year. Like many, Zane has felt the reverberations personally. His mother is Italian and speaks several languages. She met Zane’s father when she worked as his translator in Switzerland in 1964. They married and Zane was born there and lived until age 7 in Switzerland and northern Italy, where he still has relatives.

Aside from China, Italy was one the first places to suffer most from COVID-19. One of Zane’s Italian aunts already had respiratory problems before the new virus devastated Italy. She became sick in the spring in her hometown of Pavia, where she was a retired university math professor. Since hospital beds were scarce throughout northern Italy, she had to be transferred from hospital to hospital and ultimately died on Easter Sunday, April 12. It’s impossible to know if she died from COVID-19 or the collateral damage that the pandemic unleashed.

While Zane is an expert at helping people during medical emergencies, he was powerless to help his “Zia Carla,” who died at age 76.

“There was nothing we could do,” he said.

Zane also lost his father this year. His dad received a cancer diagnosis in the summer.  Zane and his sister brought their parents, Bob and Gilda, from their Florida home to Colorado, where Zane helped his dad get top-notch medical care at the University of Colorado Cancer Center. But the family soon learned that Bob already had stage 4 cancer. There was little anyone could do. With the support of hospice workers, the family cocooned together in Colorado before saying their final goodbyes to Bob Zane in September. He was 81.

“There was this big overall crisis of the pandemic, and in our family, we had this crisis,” said Zane’s sister, Daniela Kaisth.

She said her brother stepped up both for his work family and for their family.

“He faced it with courage and also reached out for help. He took care of some things. I took care of others. He realized how important it was to take care of our father. We were a team.”

Riding to the rescue

He was driving his family from Massachusetts to Colorado for his new job as head of the Emergency Department at University of Colorado Hospital on the day in July 2012 when a gunman attacked theater goers in Aurora, a short distance from Zane’s new hospital. First responders and Zane’s team handled the emergency overnight, and Zane later wrote a playbook on mass casualties and lessons learned from the Aurora shootings that assisted his former colleagues when they dealt with the Boston Marathon bombings less than a year later in April 2013.

Kaisth said her big brother always seems primed for emergencies. Instead of donning a superhero’s cape, he’s poised with a stethoscope, a sense of calm and a plenty of medical knowledge. One time, he also happened to have a life-saving lollipop.
Zane was visiting Kaisth around the holidays and the two were at a mall near her home in New Jersey. They divided up to run errands and planned to meet back at the car.

Zane was late, and when he showed up, he calmly explained the holdup.

“I was walking through the mall and a guy was in diabetic shock. I found a little lollipop in my pocket and put it in the guy’s mouth. I had to wait for the ambulance,” he explained.

Zane was nonplussed. Kaisth was stunned.

“That’s crazy,” she said. "He was just so calm."

It’s actually typical of her brother, who is two years older and has always been her protector and champion.

“He immediately sprang into action, probably saved that guy’s life, then found me and drove home,” she said. “He never thinks what he does is a big deal. He’s a strong person who also has this very caring side.”

Kaisth is used to working with powerful leaders. She’s president of Gratias Partners and helps non-profits and high-impact donors invest in philanthropic projects around the globe.

“She’s the smart one,” Zane says of his sister.

Kaisth, in turn, says Zane is a rare techy wonk who also has a big heart.

Zane’s dedication to his staff shows in the Emergency Department. He takes at least one shift a week working alongside students and new doctors, even though he has plenty of managerial work to keep him busy. He’s juggling the equivalent of four jobs: Chief innovation officer for UCHealth’s 12 hospitals, Chair of Emergency Medicine for the University of Colorado School of Medicine,

emergency medicine doctor and one of the leaders for UCHealth’s pandemic response team. While some administrators don’t work directly with patients, Zane believes it’s critical to keep seeing patients and to mentor younger providers.

‘Running toward the explosion’

When the pandemic hit, the ER instantly became one of the most vulnerable places. Zane worked to keep patients and staff members safe, coordinating closely with UCHealth’s infectious disease experts, like Michelle Barron, MD, professor of medicine, and others to make sure everyone had the right protective gear.

It then became obvious that the lack of reliable, plentiful COVID-19 tests was a huge problem. Without adequate testing, how could medical providers accurately diagnose patients and begin to slow the spread of COVID-19? Zane and his team immediately started working with researchers and lab experts at University of Colorado to test the accuracy and reliability of commercial COVID-19 tests, while also manufacturing their own. He and others ultimately set up a system that supplies thousands of COVID-19 tests a day, an indispensable tool for timely diagnoses.

During the spring shutdown, it also became clear that patients needed to see their doctors safely from home. UCHealth already had a Virtual Urgent Care, but demand for the service grew overnight. Patients appreciated the convenience and the 24/7 access to Colorado medical experts. At the same time, Zane, with UCHealth’s Chief Information Officer Steve Hess, and many others scaled up a full-fledged Virtual Health center, extending online visits from urgent care to primary care and specialty care almost overnight — in all making virtual visits possible in about 600 clinics.

“We’ve been running a marathon on a sprinter’s pace,” Hess said. “All of this was unknown. It’s so impressive to me that people like Rich and others in the ER had no clue what this disease was. Yet, they were putting their own lives at risk.

“It’s like that commercial for the Army that shows some people running away and others running toward an explosion. That’s how I see Rich. He’s the guy, leading the charge, running toward the explosion, running toward the pandemic. He jumped in to help with labs, testing, the ER, and now vaccines.

“Some people shrink in the spotlight,” Hess said. “Rich embraces it. He is commanding. This was his moment. He keeps people safe.”

Another colleague, Richard Schulick, MD, MBA, has known Zane since the two trained together at Johns Hopkins University. Back when they met, Shulick was a surgical resident and Zane was one of his interns.

Both are high-powered leaders today, but Schulick still likes to rib Zane.

“He’s a bigshot, but I always tell him that he’s still my intern,” said Schulick, who is a renowned cancer surgeon and chair of surgery at the CU School of Medicine and director of the University of Colorado Cancer Center.

“We’d get up at 3:30 a.m. and do rounds. We had a lot of complex patients. We really bonded through that experience,” Schulick said.

He now sees the pandemic as the perfect challenge for Zane.

“He’s data-driven. He’s organized. He’s pragmatic and he gets the job done. He’s even a little bit modest,” Schulick said with a laugh.

“He was on the frontlines from the beginning. Before anyone gets admitted to the hospital, they go through his department. He had to deal with COVID-19 immediately, and he did a great job,” Schulick said. “The key is balance: getting things done while staying safe and taking care of people. Our primary mission is to take care of people and he always takes care of patients and his staff.”

A desire to shake it up

While Zane has excelled at medicine, he might just as easily have become a lawyer, a college professor, or a professional motocross rider.

Back in high school in Pennsylvania, where the family moved after returning from Europe, Zane loved wrestling and playing on the football team. His dad worked in the fashion industry, and when Zane announced toward the end of high school that he planned to skip college to ride motorcycles, his dad wisely got his son a job in a warehouse.

Zane lasted three days before deciding that college was indeed for him. He played offensive tackle for the Johns Hopkins football team and after graduating, taught elementary school and coached football for a year before simultaneously applying to medical school, law school, and graduate school.

His soon-to-be-wife, Siobhan Murphy-Zane, MD, had plans to go to medical school. Zane wanted to impress her, so he opted for medical school too. The two met at age 22, have been married for 26 years and have three children. Murphy-Zane now is a pediatric orthopedic surgeon at Children’s Hospital Colorado and an assistant professor of orthopedics at CU School of Medicine.

During medical school, Zane originally planned to go into primary care or become an obstetrician. Then, he found his calling in emergency medicine.

“It really clicked. It felt like skimming the cream from every other specialty. There’s this intensity. There’s something new all the time. It’s very intense,” Zane said.

After medical school at Temple University, he completed his residency and fellowship at Johns Hopkins and went on to practice at Brigham and Women’s Hospital and to serve as a faculty member at Harvard Medical School. Zane started working on emergency preparedness and mass casualty care long before arriving in Colorado, and during an expansion at University of Colorado Hospital, when he had the chance to create a new Emergency Department from the ground up, Zane insisted on a “no waiting” system.

“His vision was, ‘I want to keep the waiting room empty. We need to make sure we’re getting patients back into exam rooms within 15 minutes,’” said Hess, a frequent co-conspirator with Zane in plans to disrupt and improve stubbornly complex health systems.

The idea of an empty waiting room was revolutionary and entirely antithetical to TV shows that portrayed ERs stuffed to the gills with people waiting for hours to get care.

“Think about that: an empty waiting room,” Hess said. “He has vision and he’s strategic and he has a passion for disruption.”

The concept has worked so well that UCHealth has replicated Zane’s designs in all its Emergency Departments. In normal times, health leaders from across the United States, Europe, and Asia regularly visit the University of Colorado Emergency Department to learn how they might reshape their hospitals. And the National Health Service in the United Kingdom, Ireland, and Canada have tapped Zane’s concepts to reshape their highly regarded hospitals.

COVID-19 certainly has stressed emergency departments and hospital managers across the globe, but Zane and fellow leaders keep reassessing and redesigning their systems to adapt to the pandemic. Now Zane, Hess, and other leaders are racing to get thousands of UCHealth employees, community providers, and contractors vaccinated as quickly as possible. Their ambitious goal for the moment: get those who have frequent and direct contact with COVID-19 patients vaccinated before Christmas.

Challenges like these are business as usual for Zane, said Hess.

The two joke about “running the briar patch together” every time they launch a new endeavor or innovation.

“Think about a briar patch. It’s a messy bunch of thick bushes and barbs,” Hess said. “We call health care the briar patch. It’s complex and everywhere you turn, you’re going to get stuck on another barb. You’re going to get some scars. And sometimes, you’re going to get stuck. But, we’ve got each other’s backs. And, when we get to the other side, some really cool things have been created.”

A mass casualty event that lasts for months

Zane studied natural sciences and writing, not industrial engineering, but he likes the idea of methodically shaking things up. That’s a good thing because the challenge of facing the biggest pandemic in a century forced Zane and his colleagues to do just that, day after day, throughout 2020.

“I have only read about what it was like to live through the Spanish flu in 1918, but this experience isn’t comparable to anything we’ve lived through before. There’s no comparison in my lifetime. We’ve made plans for anthrax, smallpox, Ebola, terrorism, riots, and natural disasters. Nothing compares to this,” Zane said.

While we tend to think of mass casualty events as quick bursts of chaos, the pandemic actually has been a mass casualty event spread over many months, Zane said. And to handle that kind of ongoing chaos, staying calm and deliberate is all the more important.

“My approach to everything is to try to be deliberate and very systematic. We embed technology and data in everything when it makes sense, but always unapologetically and deliberately,” Zane said.

“We think differently about challenges and constantly try to identify a better way even if it’s been done a certain way forever.  We develop tools for emergency preparedness. I feel like that approach is what is needed for this moment,” Zane said.

“All disasters are just a supply-and-demand mismatch. It’s all about context,” Zane said.

For example, if there’s a bad car accident in a town with a tiny hospital, medical providers can’t handle the influx of several patients all at once. On the other hand, a big hospital with plenty of resources, can handle the crush.

Responding to COVID-19 has required Zane and many, many others to keep bracing for new waves of very sick people, and each time, to be better prepared so they could help more and more of them survive. In fact, the team of providers accomplished just that. Survival rates for COVID-19 have improved dramatically as providers have learned how to better help patients and new therapies have arrived to help them.

Zane said it’s no surprise that the UCHealth team has done well. Teams were ready and executed their plans.

“We don’t think of disasters as isolated occurrences,” Zane said.

“You’re going to have a consistent approach to crisis management, transparency of decisions, follow standard operating procedures when appropriate, and being deliberate and proactive throughout the crisis,” Zane said.

He gives teams at UCHealth – providers and leaders – high marks for weathering the COVID-19 storm.

“Everyone has done a remarkable job of being deliberate, proactive, paying attention to detail, taking care of people and understanding our guiding principles: that we’re taking care of patients and we will never put our staff and providers in positions where they don’t have the right equipment,” Zane said.

‘Herculean’ effort to produce a vaccine

By next summer, Zane hopes a large percentage of people in the United States will be vaccinated and the country and medical providers can finally declare the pandemic over.

Perhaps then, Zane will have more time to relax and enjoy his hobbies like spending time with his family and riding his motorcycle (always wearing a helmet!).

And when he reflects on 2020, he’ll remember getting his vaccine and thinking about the remarkable efforts that made it possible.
“It’s truly one of the most monumental scientific achievements of our lifetimes. Full stop. Operation Warp Speed has put more resources in front of scientists than ever before. It’s not just dollars, but people: the most brilliant minds working on a problem in a very deliberate, systematic way.

“This vaccine was produced in an amazing, thoroughly deliberate, Herculean, genius way,” Zane said. “It’s actually mind-blowing. It’s just unbelievable. I’m not religious. But you could almost call it a miracle.”

This article was originally published in UCHealth Today in December 2020.