Wood, RN, contributor
COVID-19 has altered healthcare in profound ways, and some best practices learned during the pandemic will endure long after it ends
The COVID-19 pandemic forced the U.S.
healthcare system to undertake a multitude of innovations, such as the rapid
acceleration of telemedicine and cross training and flexibility in nurse
staffing. Those advances will prove helpful as the industry adapts to a new
we move forward into the future, we have more challenges, because COVID is no
longer a crisis; it’s a chronic disease,” said Mary Ann Fuchs, DNP, RN,
NEA-BC, FAAN, president of the American Organization for Nursing Leadership (AONL)
and chief nurse executive and vice president of patient care and system at the Duke
University Health System in Raleigh, North Carolina. “How will we continue to
change the delivery care models and how do we help our staff build resilience?”
Dealing with clinician
has long affected physicians and nurses, but stressors associated with the
pandemic, such as the volume of critically ill and dying patients, have created
new challenges. Ryan Furr-Johnson and Sarah Hostetter, both with the
Advisory Board, recommend organizations develop a “comprehensive burnout
strategy to support physician recovery.” That plan should be forward thinking
and not reliant on how things were done before the pandemic, but rather by building
on new innovations to improve clinician mental health and wellness.
although often cited as a burnout contributor, could also help address the
problem. For instance, artificial intelligence (AI) may enable keyboard-free
electronic medical record documentation, as well as integrate information about
social determinants of health into the patient’s record. These time-saving
steps will reduce clinicians’ stress levels and improve outcomes and workflows.
The residual effects of the pandemic will cause
ongoing challenges for healthcare operations executives. Revenues, which
declined due to the cancellation of elective procedures and other factors, are
not expected to bounce all the way back to pre-COVID levels. David Wildebrandt,
a member of Berkeley Research Group’s healthcare performance improvement
practice, told Healthleaders that revenue growth “will be 5% to 8% less when all the
dust settles.” He suggested that
leaders will shift their focus to fixed costs in order to meet growth targets
with less revenue available.
operational consequences of COVID-19 are:
- Increased provider consolidation
- The need to address cost leakages, including vulnerabilities in
revenue cycle, management of outside vendors, and payer compliance
- Continued expansion of
numbers of patients arriving in the emergency department forced hospitals to
creatively surge their available beds and nursing staff to care for the influx
of people. Many hospitals relied on travel nurses to meet increased patient
needs. AMN Healthcare reported record demand in its nurse and allied staffing
businesses during the fourth quarter of 2020 amid rising hospitalizations and a
shortage of workers.
need for continued education of nurses to ensure system agility has
intensified. The American Association of Critical-Care Nurses created
educational programs to help nurses safely float to intensive care settings.
The Association also developed a micro credential.
COVID-19 persists and as more surgeries and procedures are scheduled, the need
for qualitied staff continues. Mr.
that staffing challenges will persist and become a “new normal” as hospitals
provide care for patients with coronavirus and other conditions.
of a staffing contingency plan is a key component of a successful talent
strategy. A set, go-to plan will help solve growing demand in times of
uncertainty or when permanent staff is overwhelmed.
COVID-19 pandemic has adversely affected many hospitals and health systems’
balance sheets, potentially creating financial trouble for years ahead. The
pandemic required unexpected and outsized costs related to staffing and
purchasing personal protective equipment, to cite just two examples.
In February 2021, the American Hospital Association
released an analysis which found hospital and health system revenues could be
down as much as $122 billion in 2021, in addition to an estimated loss of at
least $323 billion in 2020.
March 21, 2021, National Hospital Flash
indicates hospital and health system margins are suffering from declining
inpatient, emergency department and outpatient volumes, while at the same time
dealing with high pandemic-related costs. Year over year, February 2021 operating
margins were down 30.8 percent.
has led some hospitals and providers to partner with larger, more financially
secure organizations with more scale to better manage the financial challenges.
Others are trying to increase their liquidity in an attempt to stave off
agility to adjust to the changing healthcare environment will serve hospitals
and health systems well. Recommendations include prioritizing or delaying
certain capital expenses, making a rolling forecast for 2021, using a daily
dashboard for volumes and utilization, and reducing waste.
hospitals, healthcare systems and businesses have developed and practiced
disaster response plans for expected mass casualty events, the COVID-19
pandemic has lasted longer than a hurricane or wildfires. Building
relationships with public health officials will remain important and a resource
to turn to for assistance in accessing needed resources, such as vaccines and
personal protective equipment. Incident command systems enhance rapid communication
COVID-19 pandemic resulted in disruptions of supply chains and demonstrated how
vulnerable hospitals were with just-in-time delivery. Personal protective
equipment was hard to obtain and costly. Contributing factors included an
over-reliance on offshore production, a shortage of manufacturers, and
bottlenecks with trucking and at ports. Panic buying and hoarding led to
shortages for organizations that needed those supplies.
systems will need to evaluate their strategies to prevent disruptions of
delivery of essential products moving forward. That may include building in
redundancy, purchasing from U.S. companies, and diversifying suppliers. Technology
can help. Artificial intelligence can aid in monitoring supplies, and mapping
can provide greater visibility of the supply network. Organizations can work
more collaboratively. In addition, greater transparency as to what is in the
Strategic National Stockpile will help governments and others with planning.
Telemedicine has existed for years, but
the COVID-19 pandemic gave it a tremendous boost. Both providers and patients
enjoy its convenience and time-saving ability. Telemedicine can help boost
revenue while keeping in touch with patients.
The Centers of Medicare & Medicaid
Services has provided reimbursement, adding to practices and health systems’
revenues at a time when patients remain fearful of in-person care. Third-party
reimbursements will play a big factor in how quickly telemedicine continues to
tools have helped hospitals track understaffed shifts and nurse shortages,
where staff members were assigned, including those working remotely, and staff who
test positive for COVID-19. Susan Salka, CEO of AMN, said that the company
“created and acquired new technology-enabled solutions that supported our
clients' ability to provide services in different settings, including virtual
environments and temporary facilities. We greatly improved our ability to
direct our resources where they are needed most.”
Electronic health record vendors have
prepared their systems to track COVID-19 vaccine administration for now and
into the future. The systems remind patients to return for a second dose. This
automated feature will prove helpful if patients require annual COVID-19
vaccinations or boosters for new variants.
Use of artificial intelligence (AI) is
gaining in popularity and increasing productivity. HealthcareITNews reported that Regional Cancer Care Associates in New Jersey
uses AI to identify patients considered at high risk for COVID-19, so that team
members could reach out to them. Organizations also have employed AI to create
a contact-free check-in process, and to assist physicians and other providers
diagnose COVID-19 by using magnetic resonance imaging.
The future of healthcare delivery
The COVID-19 pandemic has spurred
changes in healthcare organizations. Technology has helped, but ultimately,
healthcare is a people-centric industry. Across the board, people have risen to
the challenges and adapted to a new environment.
challenging as dealing with the COVID-19 pandemic surge has been, 86 percent of
respondents to the Joslin/AONL survey said they now feel better prepared for
the future. “Organizations changed how they deliver care, how
they interact with teams and patients,” said Ms. Fuchs. “These are things we
can continue to build upon.”
more insights on how to “Plan and Persevere” for the future, please visit our website
learn more about AMN Healthcare and how we can help your organization plan for
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