Pandemic Lessons Learnt COVID 19

PAPER 8

Paper 3

Introduction

To a large extent, the COVID-19 pandemic could be described as one of the worst pandemics the world has experienced in modern times. In addition to occasioning the death of millions of people, this particular pandemic was especially taxing for healthcare systems across the world. For instance, in the U.S., hospitals had to continue routine medical care roles while at the same time attending to the needs of those diagnosed with COVID-19. What lessons, if any, have we learnt from this complex situation? What steps should we take to ensure that we are better prepared to respond to a future pandemic? These are some of the key issues that will be highlighted in this text.

Discussion

From the onset, it would be prudent to note that so far, close to 6 million deaths have been directly or indirectly associated with COVID-19. In addition to the said fatalities, the disease has largely destabilized entire economic and financial systems – effectively leaving many families destitute. An argument could be presented to the effect that better response measures could have blunted the impact of this particular global pandemic.

To a large extent, an assessment of response measures could be undertaken from the perspective of national public level response and localized (i.e. hospital-level) response. As part of my healthcare organization’s leadership, I will focus on lessons of relevance at the hospital-level. It is important to note that it is from this level that we can work upwards in efforts to ensure that our systems are better prepared to handle a pandemic of a similar magnitude and scale as the Covid-19.

a) Planning for Continuing Patient Care

One of the aspects of hospital operations that was affected by the COVID-19 pandemic happens to be continuing patient care. Lim et al. (2021) indicate that at both the patient and service levels, primary care was adversely affected by the COVID-19 pandemic. It is on this basis that the authors indicate that going forward, there is need for healthcare organizations to formulate and deploy strategies to mitigate the said impact. It therefore follows that hospitals ought to develop a disaster plan containing crucial aspects to be operationalized during a pandemic or in situations when there is an unexpected increase in the demand for services. As Griffith and White (2019) indicate, “forecasts of demand” often underlie facility size ad layout (p. 372). According to Wei, Long, and Katz (2021), a disaster plan of this kind could, amongst other things, capture aspects such as: “what areas of the hospital to expand to and in what order (e.g. recovery room first, ambulatory areas second), how to increase ability to care for incoming patients (e.g. cancel routine surgeries and appointments)”, etc. (p. 1162). A similar point of view is advanced by Griffith and White (2019) who indicate that there is need for healthcare organizations to come up with disaster and emergency response plans that address issues relating to increased utilization. This is especially instrumental in efforts to ensure that there are no significant disruptions in continuing patient care during periods of sudden increase in demand for services, i.e. in case of a pandemic such as COVID-19.

Next, the COVID-19 pandemic also underlined the relevance of telemedicine in the realm of healthcare. In basic terms, telemedicine could be defined as the utilization of telecommunication as well as information technology to enable or facilitate remote contact between patients and healthcare providers. Hospitals can deploy telemedicine solutions to rein in disruptions and promote/enhance care continuity by reducing the need for physical visits – and hence additional strain on medical resources during periods of increased utilization. Indeed, as Muli at al. (2021) point out, telemedicine could be perceived as one way of leveraging technology to ensure continuity of care during a pandemic. In their study seeking to establish to what extent technological interventions such as telemedicine could be used to promote continuity of services, especially in relation to patient follow-up, the authors make a finding to the effect that “there is a dire need to integrate technological interventions in the provision of health care services to ensure continuity” (Muli et al. 2021, p. 41).

b) Supply and Scheduling

Griffith and White (2019) point out that healthcare organizations often seek to ensure that they do not maintain excess supplies in efforts to rein in costs. Further, according to Wei, Long, and Katz (2021), owing to the fact that manufacturing consolidation results in cost reduction, most healthcare organizations often have an incentive to source for supplies from a limited list of vendors. The downsides of these approaches were exposed during the COVID-19 pandemic. This is more so the case with regard to most healthcare organizations being hit by depletion of supplies when the pandemic hit. According to Wei, Long, and Katz (2021), most healthcare institutions were short of crucial equipment such as ventilators and medications. It is important to note that the solution to this issue does not lie with the maintenance of excess supplies. Indeed, this is a luxury that most small and medium healthcare organizations cannot afford. Instead, healthcare organizations can seek to eliminate paper-heavy medical procurement processes in favor of more efficient digital processes. This would have the effect of ensuring swift and efficient processes in as far as medical equipment and medication procurement is concerned. This is more so the case when it comes to requisition, solicitation, awarding, and order management processes.

Kluger et al. (2020) also indicate that there may be need to hospitals to invest in real-time data solutions in as far as supply-chain decisions are concerned. According to the authors, some healthcare organizations rely on supply-chain staff intuition and knowledge when making crucial supply-chain decisions. This is suboptimal in case of an unfamiliar event such as an unexpected pandemic. In the words of the authors, during such periods, “visibility into real-time data empowers hospitals to proactively manage critical supplies by adjusting consumption, shifting to secondary suppliers, and working with manufacturers to locate more supplies” (Kluger et al., 2020, p. 116).

c) Staffing

It is important to note that as Wei, Long, and Katz (2021) point out, the COVID-19 pandemic was, to a large extent, a reminder that most healthcare institutions are ill-equipped to handle unanticipated large scale events. This, according to the authors, is more so the case given that such institutions often run complex systems designed to promote effective resource utilization, i.e. by ensuring that patient census is matched to available staff as well as beds. This essentially means that such institutions often find it difficult to expand capacity in case of a significant unanticipated event such as a large scale disease outbreak or multicasualty natural disaster or accident. This is more so the case with regard to the identification and allocation of space to handle increased number of patients and ensuring that the institution is adequately staffed. According to Keeley et al. (2020), most hospitals faced the uphill task of ensuring that they were adequately staffed in certain areas, i.e. with regard to intensivist physicians, respiratory therapists, ICU nurses, etc. The very same assertion is advanced by Wei, Long, and Katz (2021) who indicate that for most hospitals, “discharging stable patients immediately provided a pool for staffing inpatient beds, but many diverted staff were unfamiliar with the areas where they were needed” (1162). According to the authors, one of the strategies that was found to be effective on this front was the development of training materials to ensure that diverted staff were familiarized with certain skillsets such as ICU operations and the utilization of ventilators. Wei, Long, and Katz (2021) also observe that there may be need for hospitals to establish working relations well in advance with certain partners such as regional hospitals. According to the authors, such regional centers could be instrumental if there arises need to provide guidance to generalists on certain aspects of care or practice, i.e. ICU care. The said guidance could be provided by way of video monitoring.

Secondly, as Kluger et al. (2020) indicate, there may be need for healthcare institutions to develop policies meant to facilitate or aid the achievement of adequate staffing levels during pandemics. A good example of a policy adaptation on this front, according to the authors, relates to the putting in place mechanisms to ensure that if and when necessary, professionals not on the medical staff list of facilities are provided with emergency credentials in an efficient and seamless manner.

It should also be noted that according to Kluger et al. (2020), poor staff scheduling approaches could have contributed towards a higher rate of transmission of the COVID-19 virus from patients to healthcare workers and from healthcare workers to their peers or colleagues. It therefore follows that the relevance of having in place an optimal scheduling mechanism cannot be overstated. This is especially the case with regard to ensuring that the patient pool to which healthcare workers are exposed to is limited in scenarios involving highly infectious viruses. There are several scheduling designs that have been presented by Kluger et al. (2020) in this case. In their study, which sought to explore how the scheduling of healthcare workers impacts the preservation of the entire workforce during a pandemic, the authors made three crucial observations:

(1) Having all HCWs work at least 3 consecutive days reduces the chance of team failure, (2) longer nursing shifts (12 versus 8 hours) decreases the rate of HCW infection, and (3) avoiding staggering of rotations of attendings, house staff, and nurses reduces the number of infected HCWs. (p. 119)

d) Response Efforts: Partnering with Municipal and State Leadership

Yet another lesson that we could learn from the COVID-19 pandemic relates to the need as well as relevance of public-private partnerships. This is more so the case when it comes to pandemic assessment and surveillance. To begin with, it should be noted that incase of epidemics and pandemics, one of the key capabilities of public health public health systems – backed by the relevant agencies – happens to be tracing and testing. It would, however, be prudent to note that as Wei, Long, and Katz (2021) indicate, this capability was overstretched during the present pandemic. More specifically, in the words of the authors, “the scale and speed of the outbreak rapidly outpaced the resources of health departments...” (Wei, Long, and Katz, 2021, p. 1162). Better partnership mechanisms between municipal/state leadership and healthcare organizations could have been instrumental in as far as surveillance and assessment capabilities expansion are concerned.