COVID-19: How Hospitals and Health Systems Can Brace For a Pandemic
By Allen Miller, Principal & CEO, COPE Health Solutions
By Elizabeth DuBois, DNP, FNP-BC, AAHIVS, Vice President, COPE Health Solutions
By Margaret Peterson, PhD, Executive Consultant, COPE Health Solutions
See all this Month's Articles
Original Publish Date: March 26, 2020
As the United States’ COVID-19 confirmed caseload and resultant mortality grow, public anxiety continues to heighten with disease incidence and fears that hospitals may soon meet and exceed capacity. Hospitals are now trying to manage a changing demand for services under the unique and unpredictable conditions presented by the pandemic.
This crisis triggers a cascade of activities hospitals must undertake to activate
new protocols and committees, shore up resources and materials, establish
communication plans and enact a myriad of other steps to transition into emergency
mode. This includes adherence to the federal Emergency Medical Treatment & Labor
Act (EMTALA) guidelines to not turn away or redirect COVID-19 patients and/or any
persons who suspect they may have been exposed to COVID-19.
Increased pressures coming from patients, staff, physicians and the general public
put hospitals in a challenging position, requiring new strategies to address patient
concerns while mediating an alarmed workforce.
Hospitals must plan now to navigate four (4) key challenges:
1. Staffing shortages
- Hospital staff and physicians may be sick themselves and quarantined due to exposure to COVID-19
- Hospital staff are at risk of exposure, and given their unique role, it is essential
they adhere to both the universal precautions when caring for all patients
and the strict self-quarantine protocols when exposed to COVID-19 positive
- At-risk staff, those over the age of 60 or those with existing chronic medical
conditions, may be directed to stay home to avoid contracting the disease
- School and daycare closures may force others to stay home as caregivers
- Many employees and providers also may be fearful of reporting to work and call
- All of these issues may create staffing gaps in critical areas while managing an
expected patient volume increase in the coming weeks
Mitigation Opportunity: Augment the workforce with non-clinical staff and
- Should clinical staffing become strained and overwhelmed with patient needs,
hospitals should offload administrative and non-clinical activities to non-clinical
staff. These activities may include patient and equipment transport, on-the-ground
patient navigation and triage support, project management, data
analysis and simple administrative tasks supporting clinician efficiency with
Mitigation Opportunity: Increase outreach and prevention
- Use non-clinical staff to manage call volumes and support keeping patients in
their homes through scripted outreach and navigation. Train the non-clinical staff
to call at-risk patients to educate them on current best practice prevention and
self-quarantine protocols as well as potential symptoms and key indications for
when to come into the hospital.
- Use available telehealth resources to reduce utilization of onsite clinical staff.
Empower non-clinical and clinical caregivers with the use of apps to enable
video and audio communication, as well as monitoring and intervention planning,
among homebound patients, families, non-clinical support staff and remote
Mitigation Opportunity: Support vulnerable populations and/or staff through home
delivery of supplies needed during quarantine
- Use non-clinical staff to provide home delivery of food, medicine, equipment and
other critical resources to support in-home quarantine.
2. Administrative overload and planning volume
- Hospital administration is not only expected to continue with normal operations
but also must accommodate the expected growth in the patient volume requiring
testing or treatment.
- The federal government announced all hospitals will be required to activate
Emergency Operations Plans (EOPs). This comes with a tremendous amount
of effort and oversight, demanding time from leadership and staff alike. With
the increase in immediate responsibilities and ongoing public anxiety, hospital
administrators must be thoughtful about how to distribute tasks across
available staff, take steps to proactively manage the EOP and maintain optimal
performance in a highly dynamic environment.
Mitigation Opportunity: Add project management and planning support
- Establish a remote or on-site project management office (PMO) to help organize
and streamline work. Use temporary or outsourced project management
resources to provide risk monitoring and escalation. This will ensure optimal
deployment and use of resources, resulting in improved management decision making
- Task these resources with organizing specific projects and efforts, such as a
large-scale testing intervention, erecting temporary facilities and managing
vendors, while freeing up regular full-time staff to manage ongoing hospital
operations and patient treatment.
- Review and update EOPs for the current situation and develop detailed
implementation strategies for operational and staffing plans that will be needed
in the coming weeks.
- Establish a system to capture additional costs to the hospital based on the COVID-19 pandemic.
3. Uncertain and quickly changing environment
- Many local and state governments have announced bans on large community
gatherings. Private companies and academic institutions have shifted to a
work or study-from-home model or closing down temporarily. Food hoarding
is occurring across the country, thus potentially putting low income and frail
populations at risk for access to food. Hospitals must understand the immediate
and specific local impacts of this pandemic and produce regular, real-time
updates and corresponding actions regarding any areas of risk, including
resource availability, process efficacy and financial impact.
- As disease incidence continues to rise, panic and confusion may spread in the
community. Hospitals may be inundated with high-risk cases, lower acuity
patients and a large volume of calls from concerned patients. Strategies for
education and outreach are key to dispel rumors and increase evidence-based
awareness, promoting community safeguards and prevention.
Mitigation Opportunity: Dedicate an internal “czar” with deputies for 24/7
- Designate a single executive, such as the chief medical officer (CMO), chief
operations officer (COO) or chief nursing officer (CNO), to oversee emergency
operations and communications.
- Ensure consistency in communication; the designated executive should review and approve all
documents and communications to physicians, staff, patients and family and to
the larger community.
- Rotate other support deputies or executives to provide coverage 24 hours, 7
days a week as well as serve as backup should the designated “czar” themselves
need to self-quarantine or otherwise take time off.
- Appoint an internal leader to screen daily the multitude of local, state and federal changes to regulation that impact care delivered to patients.
Mitigation Opportunity: Develop a communication plan
- In times of health crises, patients look to their clinical providers for answers.
Provide staff with regular information updates, talking points and resources for
unanticipated questions so they can deliver clear and up-to-date messages to
- Beyond individual messaging, develop an overarching communication strategy
that leverages a full range of communication channels so that the hospital can
translate national news, hearsay and misinformation into the local reality and
support public health efforts. This includes a highly structured social media
strategy and coordination with local public health agencies
Mitigation Opportunity: Leverage data analytics and reporting
- Leverage data from existing systems to define metrics that monitor the changing
status and serve as leading indicators of needs or issues. Through regular
reporting and review of these metrics, hospital administration can make timely
decisions and remain proactive to mitigate risks.
- This data will be key in properly managing test utilization and patient treatment
and empowering emergency operations teams to meet critical targets.
4. Disruption of standard workflows
- Current workflows and staffing may be inefficient and insufficient to
accommodate growing needs. Managing affected high-risk individuals along
with lower-acuity patients will require immediate workflow augmentation to
properly mitigate issues such as the spike in respiratory care needs, reduction of
bed availability, limited intensive care unit (ICU) capacity and equipment such as
ventilators and resource allocation.
- With the lifted regulations and crisis situation, front line staff may find themselves
with new authority to make critical decisions. Many facilities have EOPs in place
but never operationalized them. It will be critical to put them into practice.
Establish processes and guidelines to maintain order in what can be chaotic
Mitigation Opportunity: Implement process design
- Optimize baseline processes, caseloads and staffing to distribute resources
according to a new reality of patient needs. Maximize the utilization of resources
against potentially overwhelming demand and redistribute resources away from
services that may see utilization declines, such as elective surgery.
- Modify methods of triage, escalation and care when the standard route is
unavailable. With lifted regulations, scopes of clinical practice may expand.
Review and adapt EOP processes to address this and all changing regulations
- To get ahead of on-site demand, consider implementing a nurse hotline that can
field and triage patients before they enter the facility and leverage community
resources as other organizations implement their crisis responses. The 96-hour
restriction on length of stay has also been lifted, which will allow more rapid
discharge to skilled nursing facilities (SNFs) to free up inpatient capacity.
Hospitals and health systems will need to embrace planning efforts immediately
even if severe cases do not start showing up for weeks. Expect in the coming days
additional guidance and details on the types of waivers the Trump administration will
allow. “Business as usual” will no longer be an option for American health systems but
amidst the uncertainty, hospitals and health systems can take steps to improve the
circumstances around our new reality.
For additional information on how to prepare your hospital or health system for
COVID-19, please contact Allen Miller, Principal & CEO, at
firstname.lastname@example.org or 310-386-5812 or Elizabeth DuBois, DNP, MSN-BC, AAHIVS,
Vice President, at email@example.com or 213-369-0571.