Even in Crisis, Don’t Underestimate the Value of Your Strategy
Emergency preparedness plans on which provider systems routinely drill with public health partners are being activated. Current impact of COVID-19 varies widely across markets. Yet frontline staff nationwide are preparing for a demand surge. Work is underway to adequately safeguard the workforce. And potential supply chain disruption is being closely monitored by our parent company, Vizient Inc, which is also providing its members with frequent updates and a weekly webinar series.
It is easy to succumb to a form of business fog in the midst of a public health crisis. This outbreak is not only a clinical challenge, however. It will pressure test countless strategic initiatives deployed by our members across the country.
For strategy teams, there is time to take stock of the foundation already laid and to ensure it is now fully leveraged. Numerous examples come to mind:
We’ve worked with many of you to consider how various external developments could influence your strategic plans. Learning to pivot a plan when trigger moments are reached is a core part of those exercises. Such prowess makes you invaluable for attempts to anticipate the impact on your market, community and organization. Capacity planning in intensive care units and emergency departments will be crucial, given the potential for demand for high-acuity care to outstrip existing beds. Sg2 is developing a model to bring further clarity to the utilization and financial workforce implications for different ways this emergency plays out, both short-term and long-term.
Systems of CARE and Service Distribution
The past decade’s shift from the acute care hospital as systems’ center of gravity leaves us better positioned today to confront an outbreak of this magnitude. The 2009 H1N1 scare caused an 18% spike in ED visits, driven in part by the worried well. Drive-thru screening and treatment, dubbed “McTriage” and now commonly integrated into disaster exercises, emerged as one answer that will help today. Yet decompressing our EDs and building alternate access channels has been a strategic focus for many. Increasingly strong Systems of CARE diversify sites to handle low-acuity volumes while protecting capacity in high-acuity settings. The rise of hospital-at-home models, chronic care clinics and strong partnerships for post-acute care (PAC) create avenues to protect the most vulnerable individuals—the elderly and those with comorbidities. As we’ve seen in Washington state, PAC sites should be an epicenter of vigilance.
Efforts simultaneously must be made to ensure service continuity to meet the health needs of the community beyond those infected. That requires thoughtful balance of your full suite of assets (eg, urgent care centers, ambulatory surgery centers) and effective service distribution across your organizational footprint. Plans for how to centralize services and repurpose underused space make strategists key to creatively maximizing capacity and preserving as many elective cases as possible.
At the same time, many of you have championed alternate front doors for patient care. Sophisticated call centers seamlessly direct consumers to optimal sites. Previous investment for virtual visits and remote monitoring can now support screening and consultations with symptomatic and self-quarantined patients. Intermountain Healthcare and Spectrum Health are among those offering free visits for COVID-19 via their virtual health platforms. Payers are easing restrictions to spur telehealth use.
Partnerships with outside vendors also come into play, like Bright.md’s screening approach. It ultimately will shed light on the adequacy of options powered by artificial intelligence. And don’t forget the ways you’ve improved your organization’s “back door.” Monitoring technologies that help your teams safely accelerate patient discharges will be crucial to helping hospitals clear beds for those most in need.
Components of your digital platform launched for patient acquisition and retention can now be pivoted into a powerful communication engine. Deliver on your brand promise to become a trusted source of facts on the virus while dispelling rampant misinformation. Organizations already versed in geotargeting of web ads and intuitive content management to customize views of your system’s website are ready to tailor outreach to specific patient segments. Popular patient portals, one payoff from sizable investment in electronic health records, give us a crucial engagement tool to support patients, their families and our clinicians.
Heightened focus on consumers’ convenience and cost concerns also prepares you for this moment. Moves away from the classic waiting room, like Dell Medical School at the University of Texas-Austin’s approach, combats not only transmission risk but the related angst. Work already underway to address surprise billing and affordability concerns gives you a head start in forging financial assurances to help ensure symptomatic individuals do not delay testing due to potential pocketbook pain. Momentum is mounting among insurers and regulators to waive copays.
Significant effort has gone into enhancing aging infrastructure and guarding against premature obsolescence in new builds. Premanufactured modules to accelerate additions and universal patient rooms to maximize flexibility now will help combat COVID-19–sparked capacity constraints. For example, clear trends toward rising patient acuity already have driven moves to plan all inpatient beds as monitored beds, enabling ubiquitous eICU-level monitoring. Flexible space also more readily allows space conversions for patient isolation. Rush University Medical Center in Chicago is among those that can convert ED pods to supplement its negative air pressure rooms.
Another central focus of current facility design is improving workflow patterns and supporting team-based care. That will be crucial given the tremendous strain on our already overtaxed workforce. Centralized staffing centers and cross-training offer a key advantage, given that infection of one team member can impact the staffing plan for an entire unit. Organizations like Texas Health Resources are better prepared to nimbly deploy clinicians across the system.
Protecting staff and addressing stress are no less important. With burnout a problem well before the outset of this epidemic, clinician resilience programs have emerged at organizations like Novant Health. Enhanced channels for internal communications, often devised for those programs, can now be turbocharged to support staff and educate them on ways to reduce infection risk.
Until the current emergency abates, strategy teams even more than usual will need a disciplined process for planning prioritization and deselection. Once we come out the other side, business and existential questions will emerge.
- What is your brand promise during such consequential events for your community?
- Is your board capable of speaking publicly about your organization’s role in times of uncertainty?
- How well are you connected to community stakeholders to tackle not only viral outbreaks but conditions of every scope?
- Will this epidemic’s impact on the most vulnerable members of your communities influence how you address social determinants of health?
- What vulnerabilities in high-acuity services surfaced and how will you address that moving forward?
- Does your facility planning approach adequately account for future crises?
With the planning horizon itself somewhat volatile, consider how best to spend your time and where you fit in support of ongoing clinical and operational work. Expect to hear from Sg2 throughout the year with help for adjusting your planning process and updating your demand forecasts.
We invite Sg2 members to access the following information. Stay tuned for more COVID-19 resources and updates from Sg2 in the coming days and weeks.
- Sg2 COVID-19 Surge Demand Calculator (publicly available)
- Sg2 Is Here For You: A Letter from Sg2 President Aaron Gerber
- Use Virtual Health to Combat the Coronavirus
- Virtual Health Resource Kit
- Facility Planning Resource Kit
- Vizient COVID-19 Webinar Series (publicly available)
Tags: communication, coronavirus, COVID-19, facility planning, outbreak, public health crisis, scenario planning, service distribution, System of CARE