by Heather Forst, MS-HSM
Performance Improvement Program Director
07/06/20

For a few hospitals, the initial COVID-19 response may be behind them. For most however, they face the daunting task of balancing their normal operations with being prepared for sudden surges of COVID-19, which are currently rising in many markets. The most successful health care organizations will be those who are able to respond with the agility needed in this unprecedented situation. 

The federal government and the Centers for Medicare and Medicaid Services have published guidelines to help prioritize deferred patient services while balancing local public health needs and the availability of hospital space, equipment, supplies and staff. 

In this blog post, I’ll share some emerging practices Vizient member hospitals are using for reactivating operations and adopting agility. The goal is to help provide perspective and understanding on ways you can create flexibility while adapting to a new normal, stabilizing financial and operational impacts, and preparing for long-term success.   

  1. Collaborate with your local department of health. It’s important to connect with your local department of health and build coalitions across the public and private sectors to respond to capacity and supply constraints. These relationships can help remove regulatory barriers to establish alternative sites of care and repurpose existing sites to expand capacity to appropriately transfer patients within and beyond hospital walls. Ensure an adequate supply of health care workers by deploying cross-state licensure and activating reserve professionals.
  1. Be agile and adjust workflows and protocols. Many hospitals have invested in real-time analytics to measure decision-making. Others are making physical changes, such as screening and triaging patients using alternative sites of care and partitioning the emergency department (ED) into cool and hot zones. Also, consider maintaining augmented levels of hospital capacity, such as creating the ability to isolate and cohort patients in any setting across the care continuum.

Lean on new growth models as you adapt to the new normal. Artificial intelligence and predictive analytics solutions are emerging to identify, test, trace and steer patients to appropriate care settings as are tools to manage a flex and virtual workforce. New virtual health solutions beyond triage, direct patient care and remote monitoring solutions continue to come to market that can support new workflows and care models.

  1. Establish protocols to resume deferred patient care. Develop a governing council to establish prioritization measures to resume deferred patient treatments and services. Your council should be comprised of medical staff, nursing, operations, administration, finance and accounting, legal and compliance, and information technology stakeholders.

Your hospital’s response for resuming operations should be based on COVID-19 trends at your hospital and in your region. Specific metrics to watch within your organization include the number of COVID presentations to your ED, admissions, ICU census, the number of beds with COVID-19 patients, ventilator and PPE use, and the number of employee infections. Local and state metrics to track include the number of hospitalizations, infection rate, number of deaths, and percentage of antibody tests, diagnostic tests and tracing data.

  1. Optimize and stabilize your business. In today’s new normal, it’s important to outline workflow changes and adjust protocols and policies to optimize and stabilize your organization. These changes may include prioritizing or developing a tier schedule based on back-logged cases, and regulatory and legal recommendations. You should also implement measures for rapid COVID testing for patients and staff upon entrance, maintaining social distancing, and infection control and prevention. Consider reserving a percentage of bed capacity to respond to future surges and ensure at least a 90-day supply of PPE is on hand. Finally, develop a discipline-specific workforce plan to redeploy and cross-train staff at top of license.
  1. Communicate with your workforce and the public. Building trust amid COVID-19 concerns takes time and consistency. Develop a communication and patient outreach plan to set expectations around elevated infection prevention and control measures for the long term. It’s critical to articulate safety measures and available supportive services to instill consumer confidence. Amid widespread unemployment, health care organizations must recognize that many patients are facing significant financial challenges due to lost health care coverage. Ensure your patient access and scheduling staff have communication scripts with appropriate language to share with patients about their responsibilities. Work with your legal stakeholders to understand evolving reimbursement and financial relief legislation provided by state and federal regulators.
  1. Stabilize operations and financial performance. Develop strategies with executive leadership and governance team to prioritize services that are economically favorable while also balancing  operational impacts from COVID-19 related to capacity, testing and workforce shortages. Look for margin or partnership opportunities beyond traditional service channels in virtual and digital health. Use scenario planning with trackable metrics across markets to measure daily operational changes, e.g. rise in COVID-19 hospitalizations, increase in PPE burn rate, decline in supply usage  as local situations evolve.   
  1. Improve supply chain reliability. Create a supply chain disaster response plan that aligns with state supply requirements in anticipation of critical supplies necessary for operations and to help ensure visibility into supply disruption. Develop an assessment system with supply threshold requirements and triggers to inform inventory levels, e.g. ramp-up rates by procedural area, fill-rate times, vendor PPE requirements, clearance protocols. Scale solutions by collaborating with regional providers and establishing alternative sourcing agreements. Implement clinical-based protocols for conservation strategies and create just-in-time training for health care workers in areas such as PPE selection and donning and doffing.   

Ready your organization for long-term success

Now is the time to align your business plans to regulatory constraints, public health policy, economic impacts and payer response. As we shift our focus from initial response to preparing for surges in cases, identify shifts and care delivery model changes across your care settings and articulate the organization’s long-term vision for virtual health as it relates to access, clinical, operational, quality, and financial implications.

To learn how Vizient can support your organization in reactivating operations and preparing for a resurgence, visit our COVID-19 Resources page.

About the author. A program director on the Vizient PI Collaboratives team, Heather Forst develops, manages, facilitates and leads a complex set of collaborative programs to member hospitals, physician groups and clinics. She also delivers leading strategies, cutting-edge research, comparative data and actionable insights to help member organizations provide high-value health care. Forst has more than a decade of experience working with organizations to achieve strategic and performance improvement goals by delivering market, clinical and operational assessments to inform opportunities across the care continuum. She has worked in advisory and consulting care services, hospitals systems as well as VA hospitals.  

Special thanks to these Vizient teams for their valuable contributions to this post: Advisory Solutions, Patient Safety Programs, Nursing Programs and Media Productions.