As this article went to press, there were still many unknowns. Predictions of potential new waves of the COVID-19 virus into 2021 seemed likely to come true, compounded by interaction with the normal flu season. Here is a generalized industry assessment of the emerging reality and what our altered health system might look like in light of COVID-19.
Changing Patient Expectations
Though some have predicted this crisis will crush the hospital industry in the short term, few would argue that it will not change the field drastically in the future. “The reported demise of hospitals is on hold for the time being. CoVID-19 has taught us that hospitals are essential to respond to important environmental jolts,” says Leonard Friedman, PhD, FACHE, professor, Department of Health Policy and Management, and director, Executive Master of Health Services Administration, George Washington University.
Patient experience and satisfaction, however, may not have the emphasis they previously did prior to the pandemic. Patients and families will still expect a certain level of personalized care. However, visits with nurses may satisfy that need and become more prevalent in our future, according to Steve Nadeau, former executive vice president, Gwinnett Medical Center, Lawrenceville, Ga.
Changing Approaches to Preparedness
The COVID-19 situation will have lasting effects on hospitals’ and health systems’ disaster planning and preparedness strategies. “The infrastructure and processes that we created over the years, primarily to respond to natural disasters that have a more defined start and finish, need to be modified for pandemic situations,” says Phillip D. Robinson, FACHE, president, Lankenau Medical Center, Wynnewood, Pa.
In 2009, when planning for the possible swine flu outbreak, employers urged staff who felt sick to stay home, entire schools were shut down and universities made plans to teach via online platforms. As frame breaking as that was at the time, “it would have been incomprehensible if local hospitals were to employ the same strategy,” Friedman says. During the swine flu outbreak, the question was asked: What do hospitals need to do to prepare for the next pandemic?
Foreseeing the future, Friedman proposed using alternative treatment sites for routine or nonpandemic-related care, freeing hospitals to treat the most critically ill patients only. He also suggested allowing nurses and paraprofessionals control over certain treatment areas.
We have now, during the current pandemic, experienced some of these changes. According to Fredrick “Skip” Burkle Jr., MD, senior fellow and scientist, Harvard Humanitarian Initiative, the healthcare field has learned two strategies from the 1918–1920 Spanish flu pandemic—social distancing and vaccines; however, Burkle cautions, “Social distancing will only work if it is done completely.”
Rise of Technology, Failure of the Medical Supply Chain
In an April 21, 2020, article in the Prehospital and Disaster Medicine journal addressing failures in the medical supply chain, Greg Burel, prior director of the Strategic National Stockpile for Assistant Secretary for Preparedness and Response, wrote: “There are limitations on all products … The medical supply chain is very fragile … There is never more than about 30 days of projected need for the entire market available … There is no safety stock … Coming out of this on the other side, we’re going to have to really rethink the entire healthcare supply chain.”
Throughout the COVID-19 crisis, of all the healthcare-related technologies, the EHR has made the tracking of patient demographics, trends and outcomes amazingly sophisticated, and “there is a gold mine of information available both to manage through the situation and in analyzing and learning from it after the fact,” says Robinson. “Also, adding process engineers in the command centers, and with our key work teams, added a new level of sophistication for modeling surge plans, tracking utilization and clinical data, and allowing us to manage and adjust our plans, almost real time. This will continue in the future.”
Protection of Workers’ Mental and Physical Health
The mental and physical toll of this pandemic on the front-line workforce seems to be much greater, and may be much longer lasting, than as seen with even some of the major disasters of the past because it is nationwide and global in scope. A whole generation of healthcare workers will be permanently impacted by this experience, especially if it lingers over a year or two. Others may decide to leave the field as a result, Robinson suggests.
In addition, there most likely will be a continued demand for personal protective equipment in the workplace.
The global lack of PPE during this pandemic and misunderstanding about the importance of this issue is critical. Some institutions have been using PPE in ways inconsistent with standards of care, and patient treatment and provider protection is suffering as a result, according to Burkle. Whether it be in hospitals, or in the prehospital setting, there will be increased emphasis on thorough disinfection and airborne protection and use of PPE as a standard of care for all.
Rise of Telemedicine and Telehealth
The rapid growth in telemedicine begs the questions: How does this get paid for, and how do we deal with the interstate practice of medicine? George Washington University’s Friedman believes these two questions will come into focus in the coming months.
Telemedicine will continue to expand and may become the norm for physician offices, especially for follow-up visits, suggests Nadeau. However, provider-initiated refusals (under medical direction and in conjunction with telemedicine) will see greater acceptance in prehospital care, according to Fifer.
Crisis Leadership
Healthcare administrators have reported that the lack of coordination at all levels caused delays and confusion during the early COVID-19 outbreak. James Phillips, MD, of the George Washington University School of Medicine and Health Sciences, states that at the highest levels, responding to this crisis cannot be about politics—it’s about crisis leadership. The ability to communicate the issues at hand is critical.
“EQ is more important than IQ. Emotional intelligence is going to be one of the most important attributes for highly effective health
sector leaders,” says Friedman. Strong leadership, trusted communication based in science and coordination among all levels of government, public health and the entire healthcare continuum are—and will be—imperative.
Positive Futures?
The emergence of public health driving the medical response of our nation has arrived. The response of individual healthcare workers and the public has been positive. The Federal Emergency Management Agency has been granted authority to respond to pandemic events, which is new, and is also seen as a positive.
Global public health is also showing its value. And, in our future, wearable technology, combined with big data and analytics, will allow patients and clinicians to
better manage chronic conditions, suggests Friedman. Adds Woodworth, “COVID-19, while tragic, may help us change ways we set standards and force needed changes in the way healthcare businesses are run.”
K. Joanne McGlown, PhD, RN, FACHE, is assistant professor, Disaster Management, Homeland Security, Eastern Kentucky University, and CEO, McGlown-Self Consulting LLC, both in Richmond, Ky., and co-author of Anticipate, Respond, Recover: Healthcare Leadership and Catastrophic Events (Health Administration Press, 2011) (kjmcglown@earthlink.net).