By the time you read this, the hope is that the worst is over and the healing process is underway. Now is the time to take the long view, assess what happened and what needs to be done differently to ensure the safety of our communities in this new era, when another coronavirus may indeed be the new normal.
Leading During the Crisis
The most pressing questions we received from members was about what to do in the middle of the crisis. We were hard-pressed to find much meaningful or helpful information to give. At that point, crisis management plans were already being implemented, and the front lines were preparing for the worst. CEOs and their senior executives were looking at information and data from the Centers for Disease Control and Prevention and the Department of Health and Human Services to estimate how many patients they might be seeing and roughly when. They were tasking management with finding supply chains to support what they needed. Some of these efforts were successful and some were not.
The biggest question we received was what should board members be doing right now? Board members ache to do something to help. They are a group of go-getters who want to jump in, elbow-deep when they see so many urgently facing the most critical challenge of their careers. The main answer, unfortunately, is not much. While this is not a satisfying answer, the most important thing for boards to do is open up liquidity and funds if needed, and then support the CEO and his or her senior executives as they lead and manage operations.
This experience serves as an important reminder that the board’s job is threefold: plan strategically so that your organization has what it needs to prepare for the next crisis; ensure that management has the resources, capabilities and training it needs to implement the plan; and educate the community, while providing hope and support to the community and workforce. Then, when the plan is underway, the board needs to refrain from hindering the action by trying to take a role that is not appropriate.
Preserve Critical Board Functions
One of the most important things for boards to remember is that they need to continue to function during and immediately after the crisis. Once the crisis is underway and management is implementing the response plan, other than remaining available for communication, support and to address important questions, the board needs to move on with its main business and continue to address the existing strategic concerns of the organization. This is a critical reason why boards need to have virtual meeting capabilities and guidelines in place for virtual quorum and voting mechanisms that follow applicable state laws.
Long-Term Financial Impacts
During a crisis, healthcare organizations must have enough liquidity or flexibility to free up liquidity quickly in order to remove a potential barrier to a swift response. In preparing for a future crisis, any capital project being considered must be placed in this context: Will this project put our organization in a threatened position in the event of a crisis? How can we pursue this project while also protecting our organization and our community if a crisis occurs during this tighter/higher-risk period? Increasing philanthropy and fundraising efforts, along with searching for alternate revenue streams will be ever more critical.
Cross-Sector Partnerships
This experience revealed a need for stronger partnerships and co-planning between healthcare organizations and public health agencies, local governments and supply chain vendors. Hospitals and health systems can be leaders in this space, to create a combined, cross-sector planning effort and task force with cross-representation from each agency and organization involved. All parties must understand what their role is and know what to do when (and before/leading up to) the next crisis comes. Each group can support each other during the crisis to further actions more swiftly, when they know in advance who is supposed to do what.
Telehealth
This crisis fueled the need for robust telehealth capabilities, both to expand access to care for those who needed it, and, most importantly, to be able to provide care without placing physicians and nurses in harm’s way whenever possible. Organizations that already had telehealth capabilities in place were better positioned to handle this crisis than those that weren’t. Many believe now that telehealth (and reimbursement for it) is here to stay. Healthcare leaders need to ensure now that their organization can provide telehealth to meet the demands of its patients. Part of this planning and strategy should include what other ways telehealth should be used and why, and advocating for proper reimbursement going forward for all proper uses of e-health.
Mental Health
This experience has been deeply traumatic for all affected. The mental healthcare deficit in this country was substantial before this crisis, which highlights more starkly our need to move farther and faster to expand our mental health capabilities.
In addition, academic institutions owe it to their communities to encourage, push and heavily recruit medical students interested in mental health and expand programs to fit the demand. Healthcare leaders can emphasize this year’s impacts on mental health to payers and the government to work harder for fairer, affordable coverage for mental health needs.
Deeper Partnerships With Physician, Nurse Leaders
Physician and nurse leaders must be engaged in root-cause analysis to identify gaps and necessary changes in the crisis management plan. Potential issues to discuss include the following:
Cross-training specialists and other physicians who are not already trained to treat infectious diseases. Surgeons and other physicians and caregivers without existing training should go through a training process that is updated and revisited periodically. The plan should include other types of treatments that different pandemic diseases could require. That way, these physicians can be called upon immediately when they are needed during the crisis.
Supply chain strengthening and planning for alternate sources when typical chains break down. Engage physicians in the supply planning as part of the crisis management plan. What supplies will be needed in larger numbers than usual? How and where can they be obtained if typical chains are overwhelmed or break down? During this pandemic, construction masks were sold to healthcare organizations, and car manufacturers began to make ventilators using alternative parts, made possible by the government loosening its requirements on how healthcare ventilators are made.
Reserve planning to reinstate retired physicians and nurses. Have policies and guidelines in place so that retired physicians and nurses from the community can come back in to help when current staff becomes ill themselves or overwhelmed. This may require an emergency credentialing policy. This experience also brings up the larger question of workforce shortages in general. How will this affect your organization’s plan for future hiring and the way it normally analyzes predicted shortages?
Outpatient growth strategy and planning for rapid increase in inpatient bed capacity during a crisis. As more care is moving (as it should) to outpatient care settings, the potential to reduce inpatient bed capacity too much in the event of a pandemic or similar crisis becomes very real. Engage physician and nurse leaders in determining the right way to continue growth in outpatient settings, while developing innovative ways to partner with the community (e.g., hotels, civic centers, other large spaces) to build temporary inpatient beds and quarantine units swiftly and efficiently. The ideal scenario is to enable “pop-up” hospitals during a crisis and avoid, as much as possible, keeping inpatient beds that will be unused during normal circumstances, only so that there is capacity for the next pandemic.
As healthcare leaders, we must search deeply to find ways to maintain a sense of community during times like these. For our workers and leaders, we must find ways to maintain the right level of intensity and concern after the pandemic is over, so that we do not forget these lessons and let history repeat itself again.
Kathryn C. Peisert is managing editor for The Governance Institute and an ACHE Member (kpeisert@governanceinstitute.com).