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Selwyn Vickers, MD, FACS (Host):  Good afternoon. President Watts, thank you for joining me for the episode of the Checkup. I'm excited to have you here today. I've looked forward to this because there's a lot to cover and we've gone through a lot through this unprecedented year. So, I'm excited that we can have a chance maybe to cover some of the things you've gone through as a leader of our university. And we're looking forward to having you here. So, there are a couple of things specifically I want to talk about. If you can remember back about a year ago, maybe late March and we were having calls once or twice a week. And we knew that there was potentially an epidemic. We knew about the Coronavirus, you particularly, as a physician as well. What was your sort of belief of what we might be facing? Before we got into the massive infections, what allowed you to prepare for something greater than what you potentially could envision?

Ray Watts (Guest): Well, I read all of the information I could about COVID, both scientifically and otherwise. And it became clear to me that we were going to face a tsunami with this virus, a true epidemic and turned out to be a true pandemic. So, we began to prepare. And as you remember, Director Collins was visiting with us that week. And that was his last trip and that was our last gathering. And the next couple of days it became clear. So, we said we're going to have to protect our people. And we said, we're going to have to keep as many people from coming to work on Monday. This was over the weekend, as possible. So, we pivoted to remote work over 24 to 48 hours.

We began then a daily meeting of our leadership, 10:00 AM every morning, seven days a week for many, many weeks. And we did that so that we were all on the same page. We would share our various intel and talk about all the ways we could protect our family, really our UAB family, and certainly our families in our community. So, we put our heads together. We looked at the safety measures and we implemented within 24 to 48 hours.

Host: Yeah, I do remember that and it was daily and it was an important piece as I saw the evolution of that, we really had a chance to understand the nature of the pandemic and its impact, but probably more importantly, we had a chance to really mobilize our resources, which I don't know that we would've done that, had we not been coordinated. Let me ask you about that decision to do that. 2020 was unique in a lot of ways, but it was a still politically polarized year. How did you come to that sense of true North, when there was much around us saying don't overreact, don't blow this up out of proportion? This is not much different than a bad flu.

Ray Watts (Guest): I studied the science and it was very clear this was very different and that it was taking over populations daily. So, we consulted with our ID experts and with our public health experts and with our medical experts and you and I put our heads together. So, we got our entire leadership on the same page. And importantly, every day we had those calls, our chief of ID Jeannine Rosseau started us off and it put us in perspective, but we had all of the health system, the school of medicine, school of public health, the entire university mobilize to use our talent and knowledge to protect our university, but protect our families, our community, our state, and certainly beyond.

Host: I agree. It was painful, but necessary and it was exciting to see us step up in a difficult situation. That year had several things that were wrapped up in what made it a challenge. And you've highlighted how you focused on science to position us, to deal with the crisis.

You know, people often say and again, focusing on the health care delivery and crisis point of view, that difficult times more so than they develop character, they reveal character. What do you think the crisis revealed about the UAB community of its character?

Ray Watts (Guest): I think it revealed in action, the values that we live every day. And that is to use our minds and to work together for the greater good of humanity and our community consists of our own families. And you know, many of us didn't see our families for months and months. So, we made those sacrifices so that we could protect as much as possible against this virus.

And we realized quickly that safety measures particularly, face mask, hygiene, social distancing, were the only way we could fight it until we had some medicines or a vaccine. And so, we were a zero tolerance. If you didn't do those things on this campus, you went home. And if you didn't want to do them long, then you weren't going to be employed here anymore or come to school here anymore. And everybody realized that we were doing it to protect them. And to protect our families, our community, protect our state. So, we had to become the leadership that people could know they could rely on.

Host: It was hard because the tools we had were pretty crude. Right? They weren't sophisticated. There was no pill or drug that you could take, certainly no vaccine and made even harder when these requests and these tools were framed in the context of my personal rights, made it difficult. What did you learn about the people at UAB?

Ray Watts (Guest): I learned that our resilience is second to none. And I realized that everybody was so unselfish with when called to duty, they came to duty and they did more than they needed. And everybody worked selflessly together to make sure we had the best evidence driven decision making process possible. And we went to work quickly on studying COVID. We were fortunate. I spoke to a group of executives that first week in Birmingham to give them an update. And I told them that we've got to mobilize research now. And we raised over one and a half to $2 million. And we put that with our resources and funded over 20 outstanding projects that were put together over a week or two or three, and they yielded great results.

You know, I was so proud of our pathology and laboratory medicine team. Everybody was trying to get test kits. Well, we weren't getting test kits, so we talked to them about it. And even without us suggesting it, they figured out how to test it with their very precise mechanisms very quickly. So, we depended on us then, and that was the best test anywhere in the country. So, that kind of resilience and that kind of rising to the occasion. And I think you're right, you know, we know we're a top-notch institution. We know we have top-notch talent and we know that we work together, you know. Innovation and collaboration are the hallmarks of UAB. And we use those and we came together as a team and we let no problem go unsolved.

Host: Yeah, I think you’re right. We know and hopefully the world broadly knows that's who we are as well through the actions of many of our leaders. Long in this time with dealing with the hospital's shortage of equipment and taking care of COVID patients, we saw them move to a point where that we stopped elective care. We stopped surgeries and we did that because we were worried about running out of personal protective equipment for our physicians, our nurses, and our caregivers and staff and workers, while we were still taking care of patients who were being diagnosed with COVID-19. But we also learned how dependent we were financially on that model. And so soon after some hard decisions in the summer had to be made about finances. Tell me your thought processes. When we had to make decisions regarding in some parts of our institutions, reducing salaries and effecting the financial status that was occurring in the midst of this crisis.

Ray Watts (Guest): Well, it was in March and April, we essentially shut the hospital down except for COVID. And except for emergency patients and it really projected to be a tremendous revenue reducer. And even in the University we pivoted from in-class teaching, to hybrid and remote learning over a week. And we invested millions of dollars in the equipment to do that. But as we looked at our overall revenue streams, we realized this was going to have a big financial hit. And so we did what we had to do. We tightened our belts. We had no travel, we worked remotely. We, in some places lowered our salaries and we froze our retirement benefits investments. We did what we had to do to stop the loss of revenue, or to match the loss of revenue that COVID put in front of us.

But we pulled through that together and we worked over those coming weeks and months and learned how to take care of COVID patients, learned how to test widely. And then we knew that our patients with heart disease and cancer and other serious diseases had to have their care. And so we gradually mobilized back our inpatient hospital. And we brought those patients back gradually. We'd learned how to take care. PPE was a big concern in those early weeks and couple of months, just a lack of preparation, the lack of supply, but even there, the resilience was shown. Lar Kowolsky our VP for Equipment and Facilities went to work.

People donated it to us. Our research labs donated everything they could in form of face masks. So, everybody worked together to rise to the occasion. And it's remarkable now, when you look back on that, how deep was that serious valley and how challenging it was. But again, coming together, making decisions based on evidence for the greater good and sacrificing where we had to helped, us get through it. And you know, our frontline healthcare workers just worked themselves tired to the bone, never complained, always willing to do more if necessary and the resilience of our UAB team and family, it's remarkable.

Host: No, I agree. You know, when you look at across the Southeast, and I think this is not without some influence that we have, Alabama does stand out, particularly with our governor's mask order, we sort of were an outlier compared to the States around us. And I would like to think that some of that was not only due to wise people around her, but the influence of UAB in the healthcare arena in our state.

When you look at that crisis, and we've just talked about the financial part as well as the healthcare that obviously wasn't the only crisis we saw. We saw as you might expect, not only here, but across the country, this crisis related to disparities, that in this scenario, I remember giving a town hall on Facebook with almost a hundred thousand people really allowing the black community to know that yes, you could get COVID-19. There was a belief that you couldn't get it. How do you think UAB has been, or is positioned to take care of these disparities both in the COVID crisis, but going forward?

Ray Watts (Guest): Well we have always been an institution that's very supportive of our community. And community investment and activity is required because we're the largest employer, the largest economic impact. And we know that we are a global force, but global citizenship starts right here at home. So, we have continually reached into our neighbors in the city.

We've made places for our young people there to come to UAB and get a world-class education. And we've supported our communities, our minority health research center and Dr. Fawad and her team won a challenge, which we put together two years ago. We said as part of our strategic plan, we need to use the breadth of our people and brainpower and resources to do something really important for the people that we serve.

So, we went through a process and said, let's look at some of our major societal challenges and how can we use the breadth and depth of 23,000 employees, 22,000 students, a lot of smart people who are committed to work together, do something important. Seventy some odd applications. We went through a process of about a year of peer review and our grand challenge became improving the health of the people of Alabama, both inner city, rural, everyone.

And so, we put this grand challenge, Health Smart 2030 for Alabama to reduce the burden of the most serious cardiovascular, diabetes, obesity diseases for our state. And so, we set a goal over 10 years to lower our disparities. You know, we're like 48th in diabetes and 48th in heart disease. We said we're going to work hard. Get inside of our communities, work with our people, our neighbors, our citizens, and help them learn how to be healthier. And help them get access to healthcare and get access to knowledge about how to be healthier. So, that it has served us extremely well. And it's interesting because we were in the midst of that first year, starting up, cranking up. UAB agreed to invest a million dollars a year of our precious resources in this initiative because it was so important.

And so we were in the midst of that first year, getting it implemented and COVID hit us. Well, we didn't stop working. Our team didn't stop work. They pivoted to get testing into our neighborhoods and develop mobile testing and went out and educated our citizens about safety factors. And so, that was a real positive initial impact and Mayor Woodfin and other leaders they knew that they could depend on us. And we had the most progressive face masking orders and other safety measures of any city. And it was because of the influence of UAB. And they knew that we were here to take care of all of our people.

Host: Yeah. I think that's something that we all can be proud of, the business of dealing with disparities and the social determinants of health really needed to have begun before COVID. And for those who didn't begin it, then it was hard to make up the ground. And so I think in many ways, whether it comes to our teaching people about the need for testing and safety measures, taking care of everybody coming through our hospital door or the vaccination levels that we give, that's part of our DNA to be able to affect those lives, who simply need opportunities as much as anything else. And so, I think we all could be proud of what we were doing before COVID and how that prepared for us to do well in the midst of COVID to those populations. So, in this period of sort of moving through this, there's a lot of stress. Tell me how you handled your own personal stress. And maybe I should ask, how did Nancy handle the stress since you didn't leave home a lot that you couldn't come in, in the midst of that.

Ray Watts (Guest): I have a fully functional office at home and you know, I handled my stress like I've handled my stress throughout my career and life. And that is, I made time for prayer and meditation. I studied the Bible and other great leadership books and tools, and I made time to exercise and tried to keep myself as fit as possible. And I made time to walk outside and observe nature at least five or 10 minutes a day. But all those things together, and you know, the comradery of our leadership team is so supportive of one another. And we all looked out for each other and tried to make sure we were watching for signs of stress in one another. And that we helped intervene.

Host: Well, I agree with those. Those are powerful things. I think in as Francis Collins said as a person of faith, was important to have that as a foundation during this time as well. Now, if those weren't enough crisis for us to face Dr. Watts, we had the death of George Floyd and opening up long-standing wounds in our country, obviously significant in the history of Birmingham. How do you think UAB is positioned and has positioned itself with that third crisis or fourth crisis in the midst of 2020 to lead both Birmingham, our state and the nation of dealing with this issue of racial injustice?

Ray Watts (Guest): Well, we have dealt with it by living our values, among which are dignity, respect, and we use those values to help guide all of our actions. We are one of the most diverse universities in the country. Among our undergraduates, we have 40 some odd percent who are underrepresented minorities, 21% are first in their family to go to college. And we are reaching out to those young people in our inner city and in our rural counties to give them a world-class education because they're our future. And so we know how important diversity is and you and I have had the privilege of working and living and traveling around the world in our careers.

And we know that deep down everybody's more alike than they are different. And these seemingly either physical or religious or ethnic differences have kept people from reaching their full potential. So, we lived out those, we spoke out against it. We started a series of conversations about all of these issues, racism, discrimination, violence, including police violence. And we gave everyone a civil discourse opportunity to be able to share their concerns. And we learned a lot from each other. I learned a lot through those discussions and we tried to make sure that we had as progressive a program as possible trying to help our employees, our students understand that we are together and we're more one than anything else.

And so I think that we live that each day. We had, but I think we realized we needed to be more intentional, even though we were living those values out every day and these civil discourse lectures and discussions and meetings with our students and our employees and our faculty and letting them share what was on their mind. And it was amazing, sometimes. I think we didn't realize that there was this subliminal racism that people didn't either talk about or recognize. And so that's a key. And so, we've been more intentional than ever about recruiting diverse leaders and diverse faculty because our students and our community need that.

Host: Great exposition on that. The other thing, President Watts that occurred, maybe not in 2020, but I'd like to hear your thoughts about it and what drove it, is that UAB unexpectedly was named America's Best Employer. And I think we're all proud of that. You arguably have to be one of the most proud because it recognizes the broader institution and the leadership of yourself and those around you. What makes you proud of that? And then what factors do you think made us distinguishable to receive such an award?

Ray Watts (Guest): Well being named the number one large employer in America by Forbes was both a compliment, but a recognition. And it's a real tribute to our people. That's what it's really all about. And just as we all rose to the occasion to fight COVID, to fight discrimination and other major challenges that face us, we worked together and that didn't happen overnight. As you recall, we spent the last decade working very hard for all of our employees to have every opportunity to be successful. And to make sure that we're providing benefits that are among the best anywhere, and that we provide opportunities for professional development and growth. And that we look at ourselves as a family and it's a big family, 23,000 employees and faculty. But to a person, when we do surveys of what our employees think about the most, they say we're proud to work at UAB.

And why, because UAB is so focused on our mission of education, research, knowledge, discovery, world-class healthcare, community service, and economic impact and development. So, people see it, we live it out every day. We are involved in our communities and we are leaders within our community to make sure that we're giving as much back as we are getting, and we have a great community. And our community, supported us wonderfully, but they know how mission focused we are. And I think that, that Forbes recognition was a culmination of that. One other thing that I think about a lot and we've worked hard on, is every week I hear multiple people tell me what a great experience either they had, or their family member had when they were really sick and desperate in this hospital, in our hospitals and the competence and excellence is there, but the compassion is there as well. So, that has taken a decade of training and learning and getting the best thinkers around this here.

And having all of our employees from housekeeping to the Dean of the School of Medicine, to anyone know that what they do is critically important to our success and a lot of people depend on us. If you're really sick in state of Alabama or beyond, and you come to UAB, we're going to take great care of you. And we're going to do it with compassion and concern for you as a person, as well as your medical problem.

Host: That is a great message and it's certainly a foundation that we've built upon and it's more than a pleasant surprise to have that national recognition. Now, certainly in our dialogues President Watts, we always often talk about growth. Tell me why, why is growth important to you and why is it important for UAB to grow in the city of Birmingham and Alabama?

Ray Watts (Guest): Well, our educational mission is such that we're training the future leaders of Birmingham, of Alabama, of America and the world. And we know how powerful education is in an individual's life, in a family's life, in the community. So, we focused hard on that. Research, every new treatment for every serious disease has come about because of research. Just look at discovering those vaccines. Sequence the DNA, learn what the key proteins were and made these vaccines against them, in record time, never before has it been attacked in that way. Some people I have heard say they're concerned that the vaccine is rushed. It wasn't rushed. It was just that everybody was mobilized because this thing has killed over 500,000 Americans.

And millions of people. So, we had to take that seriously. And research is critical and obviously the more you work on a problem, the more smart people you have working on one, the sooner you're going to find solutions. Same with healthcare, you know, now we reach across the state of Alabama and we have hospital affiliates and we work with them because not everybody can come to Birmingham.

We've got to take this great healthcare out to our people across the state. And you know, our community service tells us we can never do enough. There are always more challenges for us to face, but that's what makes us a great institution. So, growth fuels all of that. And we don't grow just to be growing. We grow to pursue our mission even more vigorously than ever before. And the more smart people we have working together, the sooner we're going to solve some of the challenges that we face. So, we want to make sure that we have the best talent in the world. And we're so fortunate to have such a great institution to work for that attracts the best talent.

Host: You know, now that it looks like we're trying to come out of this and moving forward, what are you looking forward to for UAB? It feels in some ways we've been like a rubber band held back and now we're about ready to be released. What do you see us moving rapidly to do and become?

Ray Watts (Guest): Well, I think first of all, everybody is going to be excited to come back together. You know, we are people who like to work together and like to work in teams. And so, that's important, but you know, what's interesting is, that in 2020, in every part of our mission, we broke records from before. We had the largest enrollment ever. Our research funding was up to $638 million a year. And we took care of more patients and saved more lives than ever. And we served our community more vigorously than ever both here in Birmingham, Jefferson County, the metropolitan area and the state and the work we've been doing has reverberated around the world. Our Health Check app, our Tracing app, the innovations that our faculty put together to help track this disease. So, I'm looking forward to us being more invigorated than ever because we have this thankfulness to be coming out of this pandemic. And we know even under the worst circumstances, how much we can accomplish. So, in the new era of coming back to campus and not being held back by COVID, I think there's no limit to what we can do.

Host: Well, I fully agree. I think I'm excited for us to return. I think like you, if we could do this well with one hand tied behind our back, what might we do if we were free with both hands? And so, that's an exciting thing for all of us and a chance that we can continually build on the value that I think many of our people have seen, both the value that we mean to the city, to our own community, to Alabama and the nation. And I think that's an exciting thing. I think the people we attract to bring here want to impact the world and the nation and having the ability to do that means a great deal. Dr. Watts, thank you very much. This has been informative. I think our community will appreciate what you've shared and we look forward to a new and slightly different 2021.

Ray Watts (Guest): Thank you very much, I appreciate it.