A Note To Hospital and Health System Leaders

Note to readers: This is the introduction that will kick off a 4-part blog series on strategic planning for hospitals and health systems.

You have been through a lot. We have battled the first pandemic in a decade. For many of you, this will have been the first pandemic you have led an organization through. Unfortunately, for some of you, this may very well not be the last pandemic of your career.

This has been a very challenging time. For some of you, you have had physicians and members of your organization infected by this virus; some of you may have even lost colleagues to this pandemic. You have suffered tremendous financial losses. You have likely faced the difficult decision whether to lay off or furlough employees. You have put your disaster and pandemic plans in place, staffed up incident command centers, struggled with your supply chains, had to learn about a novel pathogen and how best to address it, and often improvised or innovated along the way. You have probably also struggled to keep up with all the media requests for updates and interviews and the demands from state and federal agencies for data reporting.

Many of you, exhausted, sleep-deprived and without a day off in months, including weekends, are now facing your first lull, having navigated through the first wave of this pandemic. After getting some much-needed rest, you may be able to move from crisis management and thinking about the next day or week, to thinking more strategically, to the important question of now what? How do you recover financially? Is it time to bring back employees who were laid off or furloughed? How will we restart our other services? What about construction projects or new services we were planning before this hit us?

These are all important questions, however, I hope you are also taking this time when you can clear your mind a bit to think about what lessons did you and your team learn from this? What do we need to do to be prepared for a possible second wave – a wave that based on previous influenza pandemics could be even bigger and deadlier? What changes should we make to our disaster and pandemic plans to learn from this experience and prepare our organization and its future leaders to respond even better to the next pandemic or other more localized or regionalized threat?

But, I would suggest that this is also the time to begin a review of your strategic plan and very likely substantial revisions or even a completely new strategic plan. Whether we acknowledge it or not, the world has always been changing. It was last year before any of us knew about this novel coronavirus. In many ways, this pandemic will accelerate the change, especially in health care. If you don’t anticipate these changes, coronavirus will be the least of your long-term concerns.

First things first. What would I specifically recommend?

1. Take this time to thank your physicians and employees. If you have lost members of the team, be sure to memorialize them. If physicians or staff have been infected and recovered, acknowledge them and thank them for their service and sacrifice. But, thank everyone, and be especially cognizant that while nurses and doctors have understandably received the highest profile in the media and online, we have many unsung heroes. Many of our non-clinical staff have saved lives. Can you imagine how many more people would have been infected without the diligent cleaning and disinfecting by the environmental services staff? Can you imagine the number of additional infections and potentially deaths if your supply chain staff had not been resourceful and pursued non-traditional sources of PPE and hand sanitizer? And, your non-clinical staff may have been most fearful about coming to work, yet critical to the operations. During this time, we still had to register patients. We still had to provide the staff and patients with meals. We still needed our hospital operators to handle calls from distraught family members who could not visit their loved ones. And, there are many clinical staff who may or may not have been at the bedside, but were still critical to our success in managing these patients – pharmacists, respiratory therapists (arguably the most dangerous job), imaging and laboratory professionals, the palliative care team, medical assistants, nursing assistants, clinical educators (can you imagine with the rapidly evolving and changing guidance if we did not have these professionals updating and educating our nurses and other clinicians?), unit secretaries (back when I did this job I was called a ward clerk), physical therapy, IT, medical records, and the list goes on and on. With the financial hardships we all are facing, we also need to express appreciation to all of our revenue cycle experts – billers, coders, and all those who had to keep up with all the new rules and regulations for financial assistance from the government. My point is that doctors and nurses deserve our tremendous debt of gratitude, but so does everyone else on our team. Be sure they all get recognized. They were there when we needed them.
2. Acknowledge the support of the public and external stakeholders – EMS, donors, volunteers, all the companies who donated PPE to us, the public that made home-made masks, and everyone else who contributed to our success in managing through this. These are heroes too. Sadly, at my former health system, we lost a dedicated volunteer to this disease.
3. Begin your messaging to the public that you are taking extraordinary steps to ensure their safety when they need your services and that the risk of staying home with a stroke or a heart attack is much greater than the extremely remote possibility of contracting COVID by coming to the ER or other sites of care.
4. As I mentioned above, conduct a formal debriefing with all the leaders involved in managing this first wave. What went well and what didn’t? What were unanticipated issues that we didn’t address in our prior disaster and pandemic plans? What did we learn? What would we do differently? This is the time, while it is still fresh in everyone’s minds to update your plans and prepare for a potential second wave.
5. Reevaluate your supply chains. Perhaps I shouldn’t have been surprised, but my biggest surprise was how relatively little there was in the national strategic stockpile. I had always thought that if there was a major event, we could rely on the federal government to get us the supplies we needed. Turns out that is not the case. In fact, the lack of federal preparation meant that physician groups, hospitals, health systems, states, and the federal government were all competing for limited supplies by bidding against each other and other countries. Obviously, if we cannot agree to national preparation and a national coordinated response, then we have to plan differently to ensure that we have the supplies we need for the next wave or next crisis.
6. We also need to reevaluate our policies. For example, do our policies discourage people from staying home when they are sick by requiring a doctor’s visit and note or using unpaid time off?
7. It is likely that all of us realized that our information systems were not well designed to track and report syndromic, epidemiologic and supply data for internal and external purposes. Leaders should review with their teams what changes are necessary to automate this data collection for the future, in collaboration with the state. In addition, health systems have likely seen the value of internal modeling and predictive analytics given the limitations of other models that were available to us. This may be the time to strengthen our commitment and investments in data analytics.
8. Finally, as I mentioned, I believe this is an important time to revisit the environmental and economic landscape of health care and our communities, the assumptions we used in prior plans, the cost pressures that will be on health care providers and our customers, the lessons we have learned through this pandemic relative to our clinical model and what the new normal is likely to be. Because of the importance of this topic, I have created a blog series to help leaders and their boards think about the implications of where we were, where we are now, and what is likely coming to begin a reassessment of the current strategic plan, or perhaps new strategic planning from a fresh point of view.