This post is the second in a series of three looking at Covid-19's effect on healthcare. Part one discussed how to improve patient access and loyalty. Here, we talk about how healthcare executives can better support clinicians. Part three will examine changes in consumer behavior as a result of the pandemic.
The series content was taken from a webinar hosted by Modern Healthcare, Covid's Call to Action: Resetting for Success in 2021, which featured two SCP Health executives, Lisa Fry, Chief Growth Officer, and Joseph Rose, MD, Senior Vice President, Group Medical Officer.
If you look back to the outset of the pandemic, late March 2020, and asked physicians what they were most concerned about, you might have heard answers like:
- Protocols for treatment to save lives;
- Staff shortages due to exposure to the virus;
- Sufficient cash flow or liquidity;
- Getting enough PPE, ventilators, and supplies;
- Logistics of providing credible information to the community.
At the time, along with taking care of patients, getting enough PPE and ventilators was a chief worry. Aside from that, what were hospital executives doing to safeguard the clinical staff's welfare? And what can hospitals and health systems do to provide better support in the future?
Covid-19 Pandemic Timeline
If there was ever a true hands-on-deck moment for healthcare organizations, it was March through May of 2020.
At that point, early in the pandemic, there was a great deal of variation in occurrence rates by geography. Some parts of the country—New York City and New Orleans, to name just two—were hot spots dealing with unprecedented demands for ventilators and ICU beds. Other parts of the country had yet to see their first case. Everywhere, we were dealing with the impacts of quarantines, volume decreases, and pauses in elective surgeries.
In those early days, organizational leadership teams had daily rapid-fire decision-making huddles, taking a very specific "divide and conquer" approach to ensure everyone knew their role and stayed in their lane regarding logistics, supply chain, liquidity, and patient care and safety
"I was actually working in the hospital when our hospital had the 'luck' of diagnosing the first patient with COVID in Arkansas. It was really surreal," Dr. Rose said in the webinar. "Within two hours, police were literally at the front doors. All access was barred to the hospital. We actually found out about it from the governor announcing it on the radio."
Within a week of the first occurrence, three providers had contracted the disease, Dr. Rose said. One, a doctor in his thirties, was hospitalized for nearly two weeks in the ICU.
Clinicians were also faced with keeping themselves separated from friends and family members.
"What do you do when you go home to your family?" Dr. Rose asked. "That was huge for us. We all saw the CNN articles on doctors who would go sleep in their garages and wives would carry food to them."
Remarking on the scenes he and many other clinicians experienced, Dr. Rose added, "We saw the explosions of patients. We saw bodies stacking up outside of hospitals. ... We saw a lot of courage. We saw a lot of these providers who, because there was less volume in emergency rooms and less work ... flooded into these zones wanting to help."
As the pandemic timeline ticked on, what started as a sprint turned into a marathon, and hospital executives paid more attention to caring for clinicians as well as patients.
"Unlike the sprints early on in the pandemic, the spikes and surges ... the virus's effects were now widespread and prolonged," Fry said. "So, I think of this as more the marathon part of the journey versus the sprint, and in our health systems, it became a focus on the theme of balance and resiliency. We needed to continue to ... [keep] our internal staff and teams encouraged and supported and trying to maintain support for surge level staffing needs, while balancing the need to keep elected volumes up as well."
Taking Care of Clinical Staff Now and in the Future
A hospital’s primary business is to care for patients, but the way that's done is with people: doctors, nurses, and other clinical staff who use their skills and experience to heal the sick. Yet, the pandemic put those people through a challenging, painful time, and many are still worn out. In fact, a Washington Post-Kaiser Family Foundation poll published in April found three out of every ten healthcare providers say they’ve considered no longer working in healthcare.
So, while moving forward, hospital executives still need to focus on staff salaries and benefits, the hospital's reputation, quality measures, and patient experience, they also need to ask questions like:
"Are our clinicians being taken care of on a personal level? Are they being appreciated?"
"How is communication in the organization? With all the changes, were there times when communication with the clinical staff was not as good as it should have been? How can we do better in the future?"
"How can we reassure staff about job security, given the fact there were cuts and layoffs?"
Executives also need to pay particular attention to clinicians' mental and emotional states, which, for many, are still fragile
"If you weren't in the hospital every day seeing it, you may not realize how big a deal it was," Dr. Rose said. "It was an isolating experience. The physician lounge closed down, we couldn't eat lunch together, and the normal camaraderie was gone. When we went home, our family and friends didn't fully get it."
With that in mind, hospitals should communicate clearly with clinicians where to receive help. When it's safe, they should also open the physicians' lounge, hold community events for staff to gather, and walk the halls and talk with staff to see how they're doing.
"For clinicians, honestly, if you're walking down the hallway at your hospital, you might actually see them smiling," Dr. Rose said.
Casting a Vision to Remember the Past & Celebrate the Future
During the webinar, Dr. Rose shared a vision of what hospitals should do to memorialize and, at the same time, celebrate the work of hospital staff once the effects of the pandemic have worn down.
"Wouldn't it be nice if sometime this summer when we're all immunized... if we just gathered out in the parking lot where we have done so for other events? We've got tables set up, we've got food trucks coming in, and we're all eating together, and a stage may be over in the corner.
"The CEO comes up and reads off the names of the folks we've lost, the providers we've lost ... and we have a moment of silence. We then read off the names of the providers who took care of our patients in our hospitals, got sick, and wound up in the hospital, and we thank them for their sacrifice.
"And then last but not least, we talk about some heroic stories. We talk about the folks who just gave it all, the folks who worked hard to get those protocols in place.
"After we have had that moment of silence, and after we have grieved and after we have celebrated, then we cast that vision because, at that point, it's appropriate to do that.
You're now in a situation where you can say, look at what we just did; look at what we accomplished. This vision in front of us, with healthcare changing as it has … with what we just accomplished, there's no way we're not going to make this happen."
Former Secretary of State Henry Kissinger once said of leadership, "The historic challenge for leaders is to manage the crisis while building the future."
The healthcare industry has gone through a massive crisis, but it's not over entirely, so there is still more to manage. And for hospital executives, taking care of clinicians should remain high on the priority list.