Opinion | Don’t Waste the COVID Crisis

“Never let a good crisis go to waste.” — Winston Churchill

Many of the initiatives adopted by hospitals, regulatory agencies, executives, and care providers in the face of the COVID-19 pandemic upset the status quo of standard rules, regulations, and approaches to care. The benefits of many of these changes can extend far beyond the crisis. With states around the country giving up on their pandemic responses, here are a few management “lessons learned” that hospitals and healthcare systems should keep top of mind.

Meet Regularly As a Leadership Team

Hospitals are large complex organizations that can operate within large silos. In response to the pandemic, hospitals convened “COVID Command Centers.” The executive leadership team and department heads spent most of their days together identifying challenges and creating innovative solutions. Roles were clearly delineated, frequently with reflective vests emboldened with name and title. Problems were identified, priorities were set, teams were organized, and timelines were declared. Similarly, state and county agencies, as well as hospital systems, met regularly online to coordinate resources on a regional scale in an unprecedented fashion.

We as healthcare leaders should continue to meet regularly as a team, addressing problems quickly, prioritizing efforts, and holding each other accountable.

Take Decisive Action to Provide Patients Access to Care

Emergency department and hospital overcrowding have been career-long challenges with few sustainable, effective solutions.

During the pandemic, CMS and state health departments waived many of the regulations that create tremendous barriers to utilizing non-traditional patient care space. Suddenly, tents were erected and hospital space not traditionally used for patient care was made available.

The power of the personal communication device in the provision of medical care was never more apparent than during the peak of the pandemic. We saw this in the way hospital staff used cell phones to communicate with emergency department patients in the hospital parking lot; in the families who stayed connected to loved ones in the ICU via iPad; and in the rapid expansion of telehealth.

We should continue to create non-traditional means to connect our patients most efficiently with providers.

Make Hospital Throughput a Priority

The issue of hospital overcrowding is not only about space, but process. The emphasis to move patients immediately to their appropriate location to prevent COVID spread illustrated that when there is a will, there is a way.

Patients were screened for COVID, and in many cases immediately accepted by the admitting hospitalist, with evaluations still in progress.

Lack of Skilled Nursing Facility beds is a significant obstacle to the discharge of medically stable patients from a tertiary care facility. During the pandemic, alternative care facilities were erected to care for stable COVID-positive nursing home patients who had minor medical needs but who were unable to return to their home facility. These alternative care sites decompressed the tertiary care hospital.

EMS agencies created protocols for paramedics to treat and release patients with minor medical complaints, and designated alternate transport destinations that were appropriate to a patient’s condition.

The urgency seen during the pandemic to “get the right patient to the right location” must be sustained far beyond the pandemic.

Implement Innovative Workforce Strategies

The preparation for COVID surges and the realities of staffing in the face of provider illness led to innovation in staffing patterns not seen prior to the pandemic. For example, an increased number of shorter shifts with increased on-call back up were instituted at our facilities.

State medical boards recognized medical licensure from other states so that providers could be immediately utilized where the need was greatest.

Existing barriers preventing the flexible and efficient use of our care providers must be removed.

Prioritize Provider Safety and Wellness

The issue of provider safety will forever be associated with the consequences of the pandemic response. The image of “healthcare heroes,” entering hospitals without appropriate Personal Protective Equipment (PPE) while communities applauded from their windows, will always be tied to this pandemic. Appropriate reserves of PPE, equipment, and medications must be a top priority.

Professional burnout among healthcare providers was already at an all-time high prior to the pandemic. In response, progressive healthcare organizations responded with interventions such as frequent rounding by leaders, the provision of formal mental health resources, increased online roundtables to share feelings and provide support, and the flexing from exhausted providers. Expanding use of these initiatives is essential, especially as we face a growing shortage of doctors.

Advocate for Social Justice

Finally, the COVID-19 pandemic shined a light on many of the social ills we have failed to address as a nation. When looked at through the lens of the pandemic, the need to address these issues — from homelessness to poor mental health to social inequality to poverty to the unequal justice system — takes on a new urgency. We are only as healthy as our most vulnerable and we, as healthcare providers, have a unique role in instituting social change.

The response to the COVID-19 pandemic has highlighted the importance of these critical healthcare management principles. The U.S. may be moving back toward a more “normal” day-to-day in society broadly, but we should never go back to the old way healthcare systems were run. Don’t let this crisis go to waste.

Gary Tamkin, MD, is the vice president of provider development for US Acute Care Solutions, which provides emergency department, hospitalist, and intensivist services nationwide. He is a volunteer associate clinical professor of emergency medicine at UCSF, a past president of the California Chapter of The American College of Emergency Physicians, and currently serves as the statewide medical director of the California Highway Patrol.