The Great Healthcare Reset: A Pandemic Prognosis

Healthcare delivery in the United States was upended in a matter of days in March of 2020. COVID-19 caused shortages of personal protective and other equipment, bed utilization issues, contagion concerns, and staffing dilemmas. Although promising research is being conducted and fortunate patients are being discharged, the healthcare delivery climate is highly unstable. A “new normal” does not seem to be in the foreseeable future. As Jeffrey Weiss, DO, the President of TeamHealth Anesthesia described it, “we are constantly resetting” (personal communication, May 2020). How should healthcare leaders approach a system that cannot pause long enough for them to formulate a stable plan? The necessary approach includes accepting that the industry must undergo a reset.

Evidence of this evolving need for a reset in healthcare was indicated within our interviews; over the two-week span of phone calls, the concerns and trends were already shifting. The nature of the virus is inherently linked to this constant recalibration, so it is difficult to pinpoint exact areas of focus. However, at this early stage, we see four major themes: fear of the unknown; the need to balance financial concerns with patient and staff safety; the urgency in adapting to a digital healthcare model; and, lastly and most hopefully, the opportunities born from rapidly adjusting to a new healthcare system.

Methodology

Cassatly Leadership Coaching conducted individual phone interviews with 27 healthcare leaders across a wide range of healthcare delivery systems. Some of these organizations include TeamHealth, Hospital for Special Surgery, Englewood Hospital and Medical Center, Cleveland Clinic, Hospital Sisters Health System, Springfield Clinic, ID Care, and Boca Raton Regional Hospital. The questions were as follows:

1. What are the ways that COVID-19 is currently affecting your institution?

2. How will COVID-19 reset healthcare at your institution for the next 12 months?

3. How will COVID-19 reset healthcare at your institution for the next two years?

4. How will you lead your organization through the changes that you anticipate during the reset?

5. What leadership skills will be the most valuable?

Results and Trends: The Prognosis

Fear of the Unknown

The lack of knowledge about SARS-CoV-2 (commonly called COVID-19) causes a great deal of uncertainty, because medical professionals are accustomed to concrete data and predictability, particularly in treatment regimens and outcomes. With COVID-19, the treatment, outcomes, and volume of patients seem uncontrollable—a feeling that was heightened by lack of detection and knowledge of virus transmission. Two months of this new and chaotic environment has led to an understandable fear of the unknown. When speaking with the healthcare leaders we interviewed, we heard many concerns regarding undefined treatment options and how to prioritize patients. The lack of direction has left many asking, “where do we go from here?” But beyond caring for COVID-19 patients, they also worry about bringing the illness out of the hospital home to loved ones and bringing the illness into the hospital to colleagues and patients.

Financial Concerns versus Patient and Staff Safety

Fear of the unknown also is linked inextricably to financial concerns. Financially planning for an unknown future seems, at first, contradictory. In the interviews, we heard many organizations struggling with the notion of balancing financial concerns with patient and staff safety. Trying to turn a profit can lead to an adverse impact on patient and staff safety and the subsequent quality of care. As Jonell Hembrough, BSN, the Surgical Services Practice Manager at Hospital Sisters Health System Medical Group (HSHS), noted “we need to keep the doors open while balancing spaced-out waiting rooms, less elective care, etc.” (personal communication, May 2020). In fact, more than 30% of the interviews included a mention of the negative impacts of fewer elective procedures, which represent a significant portion of practice and hospital profits. Americans are, understandably, reluctant to visit providers, and James M. Bock, MD, the Chief Medical Officer at HSHS Medical Group, noted that this has led to the “clearer understanding that elective procedures actually fund healthcare in America” (personal communication, May 2020). The question then becomes: how do we regain these profits or fill the gap?

Digital Healthcare

Finally, we noticed an increasing reliance on digital healthcare. Because of infectious disease spread, many healthcare delivery organizations have had to provide noncritical care through virtual visits. Organizations that had telehealth programs before the pandemic rapidly accelerated use of the programs. Organizations that did not already have such programs developed telehealth programs de novo in a matter of days! Nationwide, outpatient ambulatory visits have decreased 60% and telehealth visits have increased 30%.(1) For most, this change came out of necessity. Melinda Clark, CEO of HSHS Medical Group, reported that “we realized that we can move a lot faster than we thought we could, and we rolled out virtual visits within 48 hours” (personal communication, May 2020). Clark speaks to an overarching theme that emerged: COVID-19 is helping many realize their resilience, adaptability, and organizational room for growth.

Opportunities

Fear of the unknown and the experiences endured by many frontline clinicians have offered an opportunity for organizations to support their employees. Organizations in epicenter areas are sure that the experience has caused PTSD for some. Many of the interviewees already had instituted wellness programs specific to clinicians treating patients with COVID-19. This challenge has offered a chance for the healthcare community to be stronger together, with support from organizational resources. Healthcare coaching, trauma counseling, and robust employee assistance programs are more important than ever as they support healthcare practitioners and expand their coping skillsets.

Financial uncertainty has resulted in positive hospital collaboration and consolidation. Many of those we interviewed expressed feelings of an overwhelming sense of community within the industry; they are all in this together. It will be interesting to see how marketplace consolidation continues to progress, but it is positive that organizations are sharing resources during a time of crisis. Bryan Kelly, MD, MBA, the Surgeon-in-Chief at the Hospital for Special Services, stated it perfectly: “we have identified a common enemy (COVID-19), and it is now collaboration and teamwork with a singular goal” (personal communication, May 2020).

In addition, financial concerns are accelerating optimization projects that have been sitting on the back burner. Brad Logan, MBA, the Executive Vice President at Team Health Anesthesia, told us that “as our clients experience the decrease in volume and subsequent financial impacts and concerns, they realize improved efficiency in the operating room is required. This makes them more willing to institute new efficiencies that we have been proposing, such as block scheduling” (personal communication, May 2020). Beyond projects already in the pipeline, the healthcare industry has seen providers partnering with their clients and insurance companies to take on risk. In a perverse way, financial fears resulting from COVID-19 within the healthcare delivery industry have led to the opportunity to accelerate much-needed change and have kickstarted organizations into becoming leaner and more efficient.

As noted earlier in this article, although there has been an acceleration of telehealth due to fear of the virus, there also has been a new landscape emerging in digital healthcare delivery. The need for greater efficiency in healthcare delivery coupled with the lower costs of virtual visits will propel not only greater use of telehealth, but also the use of telehealth in other areas in addition to virtual visits, such as remote patient monitoring, AI-driven triage, and diagnostic testing. Additionally, now that the CMS is allowing for telehealth reimbursement, there is an increasing incentive to meet the need for virtual visits. The people we interviewed not only are observing a larger acceptance of telehealth—they also are noticing that patients are more embracing and trusting of virtual visits. This has not historically been seen in either rural or metropolitan areas. These opportunities point to an exciting and leaner future for efficiency in healthcare (Figure 1).

Figure 1. Challenges turning into opportunities.

Adaptive Leadership: The Reset

The need for adaptive leadership was a clear thread through our interviews. Many leaders reported on positive leadership experiences and offer advice that fits within the adaptive leadership model (Figure 2). The following advice was gathered from telephone conversations in May of 2020:

• Leaders must be “boots on the ground” listening to employees’ fears. — Cristy Matias, MBA, Vice President of Operations, TeamHealth Anesthesia.

• Don’t ask employees to do things you wouldn’t do yourself. — Jonathan Slonin, MD, Regional Medical Director, TeamHealth Anesthesia.

• Get out of your comfort zone. — Ronald G. Nahass, MD, MHCM, President, IDCare.

• Lead by doing the least desirable tasks; take the bad shifts. — Evan Goldstein, MD, FACEP, Managing Partner, EMED LLP.

• When you are thinking about who will be your next leader, look for those who leaned in during this time. — Han Jo Kim, MD, Fellowship Director, Hospital for Special Surgery.

Figure 2. The characteristics of an adaptive leader.

These statements exemplify how leaders view their responsibilities and approaches during times of crises. The term adaptive leadership describes a leadership approach based on constant recalibration, or resetting. It is much like sailing on a windy day: the endpoint is always the same, but depending on the changes in sailing conditions, the waypoints frequently change. Leaders must constantly adjust to the new waypoints, while maintaining the vision to lead their teams to the endpoint. In the case of COVID-19, the endpoint is safety of both patients and staff and a high quality of healthcare delivery in an efficient and cost-effective manner.

There are five main characteristics of an adaptive leader. It is crucial to note that, because the leader is constantly resetting, the characteristics flow in no particular order. Each new waypoint calls for an adjustment to all five characteristics:

1. Communicate a clear vision: Be well-defined about the endpoint in the short term and the long term.

2. Establish priorities: As waypoints are reached and passed, what priorities will be constant?

3. Lead by example: Exemplify the type of sailing or sailor you want in your employees.

4. Encourage creative problem-solving: Identify your nonnegotiables and, from there, think outside of the box.

5. Rely on active collaboration: Gather the opinions of all stakeholders, and avoid being married to your own opinion.

Although these guidelines may seem basic, it can be difficult to include each one through a crisis. We heard many stories that exemplify how important the adaptive leadership model can be. For instance, one organization noticed that adjusting the ventilators in patient rooms used up personal protective equipment (PPE), which was in short supply, and was incredibly time consuming. Every time a ventilator needed to be adjusted, the nurses had to suit up in protective gear, enter the room, change the ventilator settings, and then follow many sanitation precautions when they exited the room. The hospital addressed the issue by drilling holes through the walls so the ventilator could sit in the hallway. The airway tubing ran from the ventilator, through the hole in the wall, to the patient. Thus, when the patient needed the ventilator settings adjusted, healthcare providers could do it from outside the room, so they did not need to use PPE, which also significantly reduced the time it took. The hospital leaders identified the nonnegotiable aspects of patient care, established the priority of protecting the staff, and creatively solved the problem of PPE shortages by placing the ventilator control units outside the patient rooms. This story of the development of resiliency and higher efficiency during COVID-19 is just one of the many that we heard.

Conclusion

COVID-19 is rapidly changing the healthcare delivery landscape, and we do not anticipate this resetting to end soon. By the time of publication, the resetting will have progressed to such an extent that this paper may already be “old news.” However, that speaks to the need for adaptive leadership. As the pandemic and response efforts progress, new themes and approaches will emerge. One thing will remain constant throughout this crisis: it will continue to be important for organizations to offer support for leaders and those they lead through coaching, counseling, and employee assistance programs.

Reference

1. Mehrotra A, Chernew M, Linetsky D, Hatch H, Cutler D. What impact has COVID-19 had on outpatient visits? The Commonwealth Fund. April 23, 2020. www.commonwealthfund.org/publications/2020/apr/impact-covid-19-outpatient-visits . Accessed May 15, 2020.