Earlier this month, the Centers for Medicare & Medicaid Services provided recommendations on reopening facilities to provide non-emergent, non-COVID-19 healthcare, including elective procedures. Before providers bring elective procedures back in full swing, though, some are using this unprecedented period to assess and fine-tune practices from the pandemic they want to bring with them.
In fact, some healthcare organizations emerging on the flatter end of the curve have assembled mini redesign teams to create and implement the most effective staffing and throughput models for the time when elective procedures resume. Their thinking: there will never be a time like this again when stakeholders can calibrate operations and smoothly introduce new models of staffing or care delivery.
Crisis often lays the best foundation for organizational change.
COVID-19 has forced providers to experiment with different labor, clinical and operational models. One positive takeaway: there are new and innovative opportunities to incorporate virtual care into care delivery models.
For example, while staffing models within nursing have remained fairly constant for years, COVID-19 encouraged swift adoption of virtual technology for nurses to triage and care for patients. Going forward, the opportunities explode for ways virtual care and remote staffing could be leveraged. Functions that may lend themselves to virtual care include patient and family education, admission assessments, care planning, increased touchpoints for patients in isolation and patient and workforce safety. This will allow for more efficient, effective use of staff and could enable the retention or delayed retirement of expert nurses.
These virtual strategies provide tangible benefits in an evolving environment. With some nursing agencies observing a surge in requests of more than 1,000 percent in March, telehealth can benefit the caregivers and patients by reducing exposure of transmission as well as demand for personal protective equipment (PPE), as required for bedside care. For example, in April Northwell Health noted its use of tele-ICU technology to increase its ICU capacity by nearly 150 percent. As an added bonus, as the pandemic calms, virtual care models will help retain a critical and aging population of advanced care nursing, which will help address the nursing shortage that is expected to reach 1.1 million by 2022.
Predictive modeling will be key in forecasting demand and capacity, so that providers can create a realistic timeline for return strategies.
As providers begin to map out the reinstatement of elective procedures – and thereby, the duration of the COVID-induced intermission – they should draw on strong predictive analytics that leverage data to define volumes and predict priority supply needs. Modeling various potential scenarios is critical for providers to efficiently and effectively manage already strained organizational resources.
Predictive analytics are essential to model what the coming weeks may contain, including anticipated surge timing, patient volume and supply usage. Predictive modeling sheds light on how long a provider’s ramp-up period may be to bringing elective procedures fully back. And not to be forgotten, this technology should also predict flare-ups of future cases, so providers can keep an eye on any potential COVID-19 resurgence.
In the shift toward the post-pandemic reality, there are unifying practices healthcare organizations will want to carry forward.
The key, providers say, is to maintain the information-sharing that allowed for staff unification and stronger decision-making and evaluation of outcomes during the pandemic. They can do this in several ways, including:
Uniting to work on hospital capacity. Premier members shared that one of the most effective tactics during the pandemic was a daily capacity management huddle, in which caregivers from across the hospital discuss patient volumes, beds and staffing. During these huddles, multidisciplinary teams collaborated on processes the teams could employ to meet the daily demands. Participants included nursing leadership, physician leadership, patient transport, administration and environmental services.
Deploying visual management tools. During daily huddles, visual management tools that collated all the pertinent information into a snapshot were a gamechanger for staff to quickly ascertain availability of resources and beds during COVID-19. Teams came together to gain visibility into projected patient flow, conduct resource planning and plan around if/then scenarios if a patient surge was predicted for the day.
Updating and integrating surge plans. As elective procedures are reinstated, a visual management tool and capacity management meetings will continue to play a vital role in determining safe areas for care. Therefore, ongoing communication around surge status should not go away. Integrating this practice with a visual management tool and providing communication to the frontline will reinforce continued unity and alignment in daily operations.
Maintaining safe patient flow. Staff created deliberate patient flow plans during COVID-19 to ensure appropriate distancing that protected the safety of patients and workers. As providers balance one foot in the COVID-19 world and another in the familiar space of elective surgeries, a priority will be checklists and planned patient flow models that ensure patients and healthcare teams are protected from the virus.
Referrals and follow-up care will also come into play early. Providers will need to assess whether the whole care continuum, including rehabilitation facilities and home health, is activated and has capacity and resources to care for post-operative patients. The American Hospital Association partnered with several organizations to release a roadmap to guide resuming elective surgeries while managing the daily crisis at hand.
Taking care of the workforce. A studypublished in the Journal of the American Medicine Association in March examined the mental health outcomes of more than 1,250 healthcare workers attending to COVID-19 patients in China and found that nearly half experienced symptoms of depression or anxiety, a third struggled with insomnia and more than two-thirds experienced psychological distress.
Healthcare workers who have been on the front lines need self-care to avoid developing or exacerbating mental health problems related to the pandemic. To the extent possible, providers’ staffing plans should encourage rotations so that workers have time off, as well as access to self-help forums or counseling as needed. Providers may extend behavioral health services to their own workers, offer more on-site counselor or chaplain conversations, and extend leave time policies for the workforce to recuperate physically and mentally.
Through the pandemic, providers learned they are more resilient than ever, and when aligned, their teammates are stronger. Communication is still key. And flexible, responsive and decisive leadership is critical.
Pent-up demand is going to necessitate effective staffing and operational strategies that optimize patient outcomes, virtual care and efficiency to help grow and stabilize margins. While this pandemic has been a disruption to the usual methods, it’s also presented a rare opportunity for hospitals and health systems to test and adopt new and inclusive strategies.
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