By Dorothy Brooks
While healthcare leaders continue to battle a global pandemic, many also are plotting how they will use the lessons of this emergency to make their health systems better. Several shared their ideas during the Institute for Healthcare Improvement’s annual forum in December.
Already, there is much more focus on the importance of caregiver well-being and how to sustain clinicians through extended emergencies, observed Amy Compton-Phillips, MD, executive vice president and chief clinical officer for Providence St. Joseph Health. “We have had mass shootings and we have had wildfires ... so we have had a lot of experience in dealing with calamity, but we haven’t had experience in dealing with a calamity that goes on for a year and half,” she said. “We are figuring out how we sustain the people who are sustaining the patients and sustaining our communities so that we can continue to be resilient into the future.”
Frontline clinicians are exhausted. Still, after passing through two COVID-19 waves (so far), Compton-Phillips sees resilience. “I think that attitude is really what has been sustaining [clinical staff] through this current wave ... they know that because they have done it before, they can do it again,” she said.
There also is renewed appreciation for the value of peer support, noted James Mountford, BM, BCh, MPH, director of National Improvement Strategy for the National Health Service in the United Kingdom. “When you look at some of the literature from military situations ... having escalating support is important. Probably the thing that makes the biggest difference to the most number of people is a little bit of time to just talk to peers on the principle that a problem shared is a problem halved,” he explained.
The speed with which clinicians can innovate and improve has been eye-opening for both leaders and staff, according to Compton-Phillips. “The inpatient mortality rate [for COVID-19 patients] has gone from 25% down to the single digits, which is amazing. That is rapid improvement. It is a testament to the fact that when we focus on [an issue], admit that we don’t know something, and put in the tools to measure and improve, it makes a huge difference,” she noted. “I do think that now that we have done this, and we have done it in a broad way, we can actually leverage those skills in moving forward.”
To fully reap the rewards of innovation, Michael Dowling, president and CEO of Northwell Health, stated there needs to be changes regarding regulations and compliance. “Innovation blossoms during a crisis, and it is no different this time,” he said. “We have been able to do things during COVID that we dream of doing in non-COVID times.”
For instance, when regulations were eased in New York when COVID-19 cases peaked there last spring, easing regulations enabled Northwell to respond quickly. “I remember sitting in meetings where [we] had to, overnight, create a couple hundred beds,” Dowling recalled. “[We] just let people go do and figure it out, break the rules.”
People pushed the envelope and did not worry too much about who was going to be upset. Dowling stressed this attitude must continue. “I am afraid when this is all over, government especially will go back and put all of the constraints back on again,” he lamented.
Too often, government bureaucracy has been disassociated with what is happening on the frontlines, according to Dowling. “We need good people to go into government that have real-life experience on the ground,” he said. “We should be encouraging young people to go in and help reform that side of [healthcare] as well.”
Considering the acceleration of technology like telemedicine and remote work, leaders will have to reimagine how they deliver care. “It is going to be forced upon us rather than us initiating it because the world has changed as a result of COVID,” Dowling said. “It will never go back to the same way.”