If the coronavirus pandemic has revealed anything about health care in the United States, it’s that keeping people well quite literally takes a village.
Hospitals and other health care settings have been stressed to their breaking points. Pre-pandemic, many organizations were already changing to meet new needs, by retooling their facilities and leveraging new technology to improve the patient experience. Some had also been working closely with government officials, business leaders and community stakeholders to address vital needs outside the hospital’s walls, including transportation access, food insecurity and other social determinants of health.
But such efforts have only intensified in the midst of COVID-19. The pandemic has opened up new ways of thinking, forcing leaders to meet an unprecedented need for expanded care. What among these solutions-by-necessity will help carry health care into the future? That was the topic of a recent webinar in the Healthcare of Tomorrow virtual event series from U.S. News & World Report.
Cartoons on the Coronavirus
One success story has been the effectiveness of efforts to “bring health care to where people are,” said Dr. Rishi Sikka, president of system enterprises at Sutter Health, a system based in Sacramento, California. Tactics have included deploying telemedicine, virtual doctor appointments, mobile health clinics and “street nurses” who venture out to provide care for homeless populations. “Honestly, we’ve done virtual visits for people in their car – not driving, by the way,” he said.
Sutter notched about 1 million virtual visits in 2020, Sikka noted, going from something like 25 video visits a day to 7,000 a day at its height. “We would have never predicted that a year ago,” he said.
But going virtual “doesn’t really work for everyone,” such as seniors or those in underserved communities, and COVID has exposed the need to work deliberately with trusted voices in those communities, said Dr. Tamarah Duperval-Brownlee, senior vice president and chief community impact officer for the health system Ascension, as well as president and CEO of Providence Health System in Washington, D.C. In the midst of these challenges, “I think we’ve grown exponentially to understand the needs of our communities that much more,” she said.
Within the brick-and-mortar hospital, facilities have had to adjust on the fly to meet the needs of the pandemic. That first meant an immediate, what-do-we-do-now response, said Chris Bormann, senior vice president at HDR, an architectural design and consulting firm that works in the health care space. He said that many HDR clients all discovered “creative and innovative makeshift solutions” to meet the physical challenges around finding additional beds, for example, and implementing distancing practices.
Some lessons already learned include the need for flexible spaces that can work up and down the patient “acuity chain” as needed, he noted, as well as better patient flow and workflow management. He also stressed the need for more isolation or negative-pressure treatment rooms and better airflow mechanics. “When the pandemic is ultimately somewhat resolved, and we can start to focus back in on those infrastructure concerns, those are going to be very important issues to look at for the future – to be able to create another level of protection” for dealing with an unforeseen disease, Bormann predicted.
Dr. Marjorie Bessel, chief clinical officer at Phoenix-based Banner Health, talked about the need to keep health care workers safe “so that we can save as many lives as possible.” She said that notion has become “an essential core component of every single conversation that we had during the pandemic and is going to continue to catapult us forward into the recovery phase.” Not only do these front-line heroes treat the ill, she noted, but they are often the source of the solutions needed in an emergency. Allowing staff to be safe so they can be creative “really was a huge success factor” in meeting the significant surges they have faced in Arizona, she said.
Collaboration across the community has also been key, panelists noted. Banner Health asked chief medical officers in both Arizona and Colorado to hold meetings and in-depth discussions, often across competitor lines, to make sure that “not one of us got too far out in front or one of us fell too far behind,” Bessel said. Finding solutions often took working together “across different, previously unknown entities” – even the Phoenix Symphony, which offered to play music at health care settings as workers changed shifts to help brighten their stressful days. “It just provided so much solace for many of them in a way that we probably never would have thought of pre-pandemic,” she said.
That “tension of competition and collaboration,” as Duperval-Brownlee called it, helped drive other innovations as well. For example, her organization partnered directly with a school district in Austin, Texas, to find space for vaccinations and worked with churches to promote vaccination. “It’s been transformative,” she said, which has helped build overall community engagement. “Trust goes a long way.”
In fact, while in “normal” times health systems often reach out into the community when they want to do something, the pandemic demonstrated “a 180 of that,” where “we had the community reaching out to us saying, ‘What can we do to help you?'” Bessel said. She and the other panelists listed many examples. Hotels offered vacant rooms to put up front-line workers. Restaurants offered meals. Businesses (even a drive-in movie theater) offered parking lots to be transformed into mass vaccination sites. Church members sewed masks. Local philanthropists helped with significant supply problems.
Bormann posited that the pandemic has helped everyone recognize that “health and wellness and community health is not just your responsibility, as the health care provider; it’s everybody’s responsibility.” It has also revealed gaps in issues like transportation, mobility and child care.
Many of the challenges there must be met with solutions at a higher, government-policy level, Sikka said. For instance, the pandemic has revealed an underinvestment in public health in the U.S., he noted, and he worries that the health care system has become the default setting for public health.
“As we get over this, it’s going to bring people together to talk about those things,” Bormann said, “and not just what happens in the hospital as the built structure, but everything that happens outside the hospital.”