Editor’s Note: The following article is part of an ongoing series offering our strategic advice and expertise on what hospitals, healthcare workers, providers, and caregivers should do immediately in response to the rapidly evolving novel coronavirus (COVID-19) pandemic. What follows are strategies and tactics that we hope will help hospitals and health systems prepare for and contend with the coronavirus pandemic.
Information regarding the new coronavirus, which causes the disease commonly referred to as COVID-19, surfaced in early December of 2019 in Wuhan, China. The Centers for Disease Control and Prevention (CDC) reported the first coronavirus case in the United States in late January. As of Tuesday morning, the number of cases in the US has grown to 747 and will continue to grow. Lack of access to test kits and faulty test kits undermined provider efforts to detect the virus in the US over the last six weeks.
In addition to COVID-19, most hospitals and health systems are still managing the staffing and capacity demands of a vigorous flu season with 34 million Americans having contracted the 2019-2020 flu, accounting for approximately 20,000 deaths.
“What can I be doing right now to help my organization navigate the coronavirus?” It’s an urgent question many are grappling with in live-time.
Many C-suite executives and boards are questioning how they themselves best serve their organizations during COVID-19. Worries about what COVID-19 means to the economic outlook for 2020 are sudden and heavy.
Clinicians are built to manage clinical crises such as the one presented by COVID-19 which is a movie we have seen before. If we learned anything from EBOLA, SARS, Swine Flu, and other public health emergencies, it’s that there’s a better way. While the Incident Command Center model is necessary, it’s insufficient. The role of the Incident Command Center to manage short-term issues is immediately present at the point(s) of care and in communicating responses. But this approach will be inadequate for COVID-19, as we do not have either the intensive care unit (ICU) or staffing capacity to manage an ongoing pandemic on a daily or weekly basis.
Hospital and health system executives must go upstream NOW to best serve their organizations through the COVID-19 pandemic.
It is the role of clinicians and provider organizations to put their heads down and focus on patients as demand peaks.
However, it is essential that management keep a look ahead – to how the next seven days out, 14 days out, four weeks out, and more – will play out for the system. How do we optimize each day for the community? For our providers? For the system?
Immediate “Smart Capacity” Tactics
The Incident Command Center needs to be supplemented by a System Capacity Planning Center with a team fully focused on anticipating and managing future patient flow, just like air-traffic control manages aircraft flow. This team should develop a vision for how the delivery system and its environment will have to shift over the next two to four weeks and beyond to accommodate the needs of an ill population, while maintaining the organization’s viability. Central questions taken on by this group include:
- What services can be suspended over the next two to four weeks to free up capacity and reduce the exposure of well people?
- What services, procedures, and surgeries must we pull forward over the next fourteen days? And, how will this impact staffing?
- Are there still elective surgeries and procedures that should be pulled forward over the next fourteen days?
- How will we appropriately curtail this volume as a surge in ill patients occurs?
Planning for “Smart Capacity” Management
It is critical these tactical plans impacting site and caregiver capacity be connected to those being drawn up by the Incident Command Center. This will ensure a coordinated use of all clinical bandwidth. Key questions to ask now include:
- How can we realign freed up resources across sites and services to better prepare for potential surges?
- Where and how can support be lent to the ICU and emergency department (ED) over the next 30 days? How can we build back-up plans if/when caregivers have to come off the line?
- How much pent up capacity can be released as non-essential services are re-prioritized or rescheduled system-wide?
- What technologies or services can we employ to communicate with our patients (for example, visits that have been rescheduled)?
- Which patient groups (such as the elderly, those with Chronic Obstructive Pulmonary Disease, Asthma, or any combination) should have elective visits canceled and be provided extra medications? Can certain sites be designated for the evaluation and management of respiratory infections (especially COVID-19) only?
Knowing Which Levers to Pull
Capacity mapping backed by predictive analytics can yield an impact analysis that will enable a better understanding of which levers should be pulled to accomplish the above goals and their associated trade-offs.
For example, bed capacity is dependent upon staffing capacity. Will the system have enough trained staff to care for the surge, particularly given the already heavy demand from the 2019-2020 flu season? What about triage, ED, imaging, telemetry, ventilators, ICU beds, pharmacy, care management, sterile processing, and bio-med? Understanding and predicting staffing demand to meet patient demand and make informed, real-time decisions will be necessary over coming weeks.
Outlining the Coming Months is Now a Top Priority
A rapid assessment of the next 30 to 60 days will inform hot spots that must be managed. Staffing agencies (including physician agencies) indicate they do not have the capacity to meet the demands they receive. Therefore, hospitals and health systems must develop internal flexible staffing plans.
Closing services and consolidating workforce based on competency by population will be necessary, and must be carefully managed (for example, through planning changes, engaging and training staff, integrating into operations, and the like).
The days of focusing narrowly on what comes through our doors and managing only what is right in front of us are gone. We must deploy smarter strategies and allow the better systems we have today to give us the major “power up” we need. We will not have the staff or the capacity to meet the demands of a major COVID-19 pandemic unless we reconceive an approach that indexes high on prioritization, critical levers, and trade-offs.