NOTE: This blog is an edited version of a podcast with Tim Chapman. Listen to the full conversation here.
Having spent over 35 years in the healthcare industry in a variety of roles, with the last 7 of those years working with health systems and healthcare IT companies as an advisor, consultant, and board member, it’s most certainly an understatement to say that I’ve never seen a time like this before in healthcare.
In speaking with several healthcare executives and board members across the country recently, I’ve heard many common concerns and questions about what health systems are facing during this COVID-19 recovery period. In my view, these are the biggest risk areas and some ideas to address each:
Patient and Staff Safety
This is the biggest issue by far. Patients and their families have always had a fear of hospitals, so this is not a new issue; it’s just substantially more acute. But now the staff also fears being in the hospital, which is unusual. It will take time to restore confidence in the safety of hospitals. The key will be ensuring access to COVID testing, adhering to safeguards including CMS and state guidelines, and educating staff on all recovery activities.
Executives should also double down on comprehensive housekeeping, infection prevention, and hand hygiene. Make a big deal out of this. Visual management is hugely important. Hang signs about the steps the health system is taking to improve safety and turn employees into safety and infection prevention advocates. Patients and their families should hear and believe that one of the safest places they can be during this pandemic is in a hospital.
Financials and Liquidity
I am hearing from most hospitals that it will likely take until Q1 of 2021 before their volumes are back to pre-COVID levels. Hospitals have significant fixed costs and when elective surgeries were cancelled, those fixed costs became a massive drain on cash. Many austerity measures have already been taken by most hospitals. As a result, there will be a significant premium on restarting operations using fact-based and thorough planning that will help to preserve or enhance cash balances.
Take staffing as an example. Historically, understaffing units posed safety risks for health systems, possibly compromising patient care. Today however, that risk has flipped: now the consequences of overstaffing are greater because of the unnecessary use of funds at a time when cash balances are already under pressure. Health systems should use artificial intelligence to become fact-based in making staffing decisions. They should strive to staff units accurately to meet predicted demand, not staff to capacity. The key will be using AI to predict demand.
Healthcare executives are in the process of determining their best COVID recovery strategy, knowing that they will more than likely be calling audibles along the way. Calling audibles is not a sign of weakness. Right now, health system leaders are focused on a beacon on the hill – restarting their hospitals safely and preserving their financial foundation. The beacon is the same for all, but the pathway to get there may be a bit more circuitous and fluid than normal.
Throughout the restart process, leadership will need to absorb new information daily and respond quickly. It will be important that leadership communicates these changes openly, including their rationale. Explain to everyone that new data has emerged that have led to changes to the restart plans.
Accessibility and Visibility
Walking around the hospital is always a good use of managements’ time, but now it’s even more important. Leaders need to be seen in all parts of the hospital. Walking the halls, in waiting rooms, in the cafeteria, etc. If employees see the executives outside of their offices and in common areas, it will send a signal to the broader organization that it’s safe to be in the hospital. And don’t just be seen. Stop and talk to people. Hear their concerns, ask them for updates, be open to ideas they might have on dealing with the recovery period. A daily communication blast with news and updates is also a great idea.
This is going to be a hot topic for consultants. I remember Enterprise Risk Management was a hot topic 10-15 years ago, but if health systems haven’t actually experienced a disaster such as a hurricane, tornado, flood, etc., they probably haven’t kept their disaster recovery or haven’t conducted drills.
The biggest takeaway from this pandemic will likely be the abject lack of preparedness at the hospital level, the state level, and the federal level. Training staff for disaster response will also be another lesson. But it’s ironic because every year, health systems prepare for flu season. They know instinctively to order and store extra supplies, reserve capacity, ensure PTO policies are appropriate for the period, and the like. But with the potential of a second wave of COVID on the horizon, the imperative will be for hospitals to prepare for both COVID and the flu season simultaneously. It’s analogous to what health systems in the Southeast are doing right now in planning for hurricane season during the pandemic.
Financial management and preparedness will be another lesson learned. What other actions could health system leaders have taken to ensure adequate cash on hand?
Finally, the limited visibility of all aspects of operations was also a major shortcoming for most hospitals. Historically hospitals have used past experiences as guides for making resource allocation and purchasing decisions. But during COVID, there were no past experiences or predicates. The key lesson learned here will be access to and use of predictive AI capabilities to predict census and overall demand. With these predictions in hand, leaders will be far more prepared to make more informed staffing decisions, better purchasing decisions for critical supplies and equipment, and more effective capacity decisions.
Biggest Potential Risk in Recovery
The biggest risk by far is complacency. I don’t think this will happen, especially given all of the press related to a second wave of COVID. But the biggest risk is if leaders fail to build reserves of critical supplies, prepare staff for the possibility of a second wave, ensure adequate capacity is available, or take any additional steps to bolster their balance sheets (e.g., lines of credit).
Back to the beacon on the hill analogy – that beacon doesn’t change. But with immense uncertainty related to a potential second wave of COVID, the pathway to get there will more than likely change frequently as new information and data emerge.