Lessons learned more than six months into the U.S. response to COVID-19

More than half a year into the COVID-19 pandemic, healthcare experts have some ideas on how the industry can do better, looking at such areas as supply chain, staffing and disparities of care. The following strategies and tactics could ease the challenge of an expected second wave of COVID-19 infections as the flu season takes hold.

The days of providers and manufacturers withholding vital information from each other about products will be a thing of the past. The COVID-19 pandemic revealed problems with that practice in the early months of the pandemic, according to supply chain consultants.

Shortages of N95 respirators, gowns and other personal protective equipment made headlines nationally during the onset of the pandemic because suppliers were unable to meet the sudden heightened demand for those materials.

That experience will likely cause a shift in how providers contract with manufacturers, according to consultants. Providers are going to expect manufacturers to offer information about where they store supplies and how much they have on hand at any given time, which has traditionally been cloaked in secrecy.

At the same time, suppliers are expecting a more transparent relationship with providers, understanding in advance what their supply chain needs are likely to be so they can plan.

Some manufacturers may be hesitant to offer this kind of data, said Chaun Powell, group vice president of strategic supplier engagement at Premier, but the ones that are willing to do so are going to be most attractive to providers. “It’s going to become an expectation rather than a nice-to-have, and those suppliers and distributors that are willing to participate are going to be seen as favorable partners,” he said.

The issue has only grown more important after ECRI found that 70% of N95 masks imported from China don’t meet U.S. standards.

Before COVID-19, most health systems’ supply chain strategy focused mainly on costs. Providers partnered with one supplier and had minimal inventory levels to keep costs low. Now providers have a heightened appreciation for a supply chain built on predicting future needs as well as current ones, said Steve Downey, group senior vice president of supply chain operations at Vizient.

“Now is supply chain’s time in the spotlight,” he said.

Before the pandemic, NYC Health + Hospitals staffed units based on average daily admissions for each department to run safely, with no extra hands in case of sudden surges. It’s a common approach across the industry to keep costs down.

So when the health system went from no hospitalized COVID-19 patients on March 1 to 3,700 patients by April 1, it was nearly impossible to keep up with the sudden demand from a staffing perspective, said Dr. Mitchell Katz, CEO of the public health system. “If I’m always running exactly the number of doctors or nurses (we typically need), and I suddenly have an influx of newly sick patients with a disease no one has seen before, how could I possibly staff up for that?” he said.

It was a critical lesson for Katz and he hopes for the industry too. He said it’s unrealistic to simply inflate staffing numbers, because that’ll only hike costs. Rather, a solution could be regional centers that house tele-ICUs with physicians and nurses who are able to connect via video to hospitals that need the extra help. He said it could be an effort run by the federal government but housed at large medical centers.

“The pandemic teaches us we can’t run on exactly the amount of staff we need,” he said.

Mental health professionals and healthcare executives worry that those on the front lines of the COVID-19 pandemic are burned out and traumatized from their experience, and it may lead to some leaving the profession.

In response, many systems have adopted programs to help keep up morale, such as offering free meals and groceries as well as providing free behavioral health services to help employees cope.

Northern Arizona Healthcare is prioritizing offering those kinds of benefits long term, even after the pandemic. “This is a marathon, not a sprint, and we are far from over those ramifications and they have impacted employees,” CEO Florence Spyrow said.

The health system is looking into permanently offering free physician therapy and behavioral health services.

Leadership is also looking at establishing a fund for employees on an ongoing basis for those struggling financially because perhaps a spouse lost their job. For their part, Northern Arizona hasn’t laid off or furloughed any staff.

“We need to have a more robust system for our employees and a way to support them through their lives whether we are in a pandemic situation or not,” Spyrow said.

More robust staffing of infection prevention programs also needs to be prioritized going forward, said Karen Hoffmann, immediate past president of the Association for Professionals in Infection Control and Epidemiology.

The expertise of infection preventionists has proved vital during the pandemic for hospitals, nursing homes and home health centers, but their programs have traditionally been under-resourced and -staffed because they aren’t revenue generators for systems, she said.

“Really having adequate staffing is one of the things facilities are going to have to take a new look at—not only in acute care but long-term care, home health, and dialysis as well. Patients are affected across the whole continuum of care,” Hoffmann said.

COVID-19 has especially affected minority populations, with the Black population accounting for nearly 33% of hospitalized cases and Latinos for 23% so far. Native Americans have also been hard hit.

The data has been a wakeup call in the industry. “One of the things we are working on now is being a lot more outwardly focused. … What do they (the community) need from us as a healthcare system that maybe we aren’t providing?” Northern Arizona Healthcare CEO Florence Spyrow said.

The two-hospital system is the nearest Level 1 trauma center to the Navajo Nation reservation in northern Arizona and beginning in mid-March that community was hit hard by COVID-19 cases. So far, the Navajo Nation overall has had more than 10,000 cases and 540 deaths. Their population is about 300,000 nationally.

Northern Arizona responded, flying helicopters into the reservation with supplies or to transfer patients to its Flagstaff Medical Center. Cases have since leveled out and Spyrow said her system is committed to expanding its relationship with the community to address health disparities.

The system has partnered with the reservation in the past on building an oncology program to be part of the federal Indian Health Service. Spyrow said now the system is interested in developing alliances with community groups on the reservation to understand their needs. Further, it’s exploring working with legislators on how to expand internet access so the community can participate in remote patient monitoring services.

“Healthcare systems should be leaders in identifying and building coalitions in their communities to be able to address those disparities,” Spyrow said.

Real-time data on COVID-19 admissions in emergency departments, information on positive coronavirus tests across the system, data regarding available supplies and predictive analytics proved essential for Seattle-based UW Medicine as it faced an early surge of COVID-19 cases.

Although the academic health system, as the region’s Level 1 trauma center, is accustomed to command center systems, it had little experience using real-time dashboards during a crisis of this magnitude

“We recognized really early on this need for central decisionmaking based on good information that is assembled on dashboards and using the data to make projections about where the pandemic might be going,” said Dr. Paul Ramsey, the system’s CEO.

Real-time dashboards have been used in healthcare for some years now, but Ramsey said the pandemic solidified their use going forward. “The need to do this so rapidly with COVID was a bit of a stress test, but it allows us to create better systems” beyond the pandemic, he said.

For NYC Health + Hospitals, COVID-19 has driven the investment in remote monitoring technology for patient rooms. Katz said staffers were put at risk and PPE was used more than necessary because nurses and other clinicians had to enter a COVID patient’s room every time they needed to check on them or if the patient called them.

Now the health system is exploring putting cameras and speakers in inpatient rooms. The cameras would be helpful for nurses since they won’t have to walk down long hallways to patient rooms only to find they don’t have on hand what the patient needs, Katz said.

NYC Health + Hospitals is also considering putting a tablet in every room; iPads were donated to the health system and used so patients could see family and friends because visitors weren’t allowed.

“Maybe people would like to see their relatives not at visiting times but at other times during the day, or maybe going forward, people would like to see relatives who don’t live in the area. We never really thought about it that way,” Katz said.

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