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April 9, 2020

'This is a marathon, not a sprint': How WellSpan Health took early action to prepare for a Covid-19 surge

Daily Briefing

    WellSpan Health is an integrated care system with eight hospitals, 200 care locations and 1,600 employed physicians and advanced practice clinicians serving central Pennsylvania and northern Maryland beginning to see the effects of the greater New York City area Covid-19 epicenter spreading down the East Coast and into eastern Pennsylvania. WellSpan Health President and CEO Roxanna Gapstur, Ph.D., R.N., recently spoke with Steven Berkow, VP of Provider Research at Advisory Board, to discuss how WellSpan is amplifying its system-wide capabilities, and set up a centralized command structure to prepare for the projected surge in Covid-19 cases.

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    Question: Roxanna, thank you for taking the time to speak with me. To start off, can you tell me where you're at in the surge right now?

    Roxanna Gapstur: Right now we have about 100 confirmed or suspected Covid-19 patients in our hospital beds. We're feeling the beginnings of a surge coming from the East Coast to our region. While a bit on the smaller side, the ICU at our system's Eastern-most hospital is already experiencing increased demand. We're tracking the data across our service area so we can mobilize staff and move equipment to the regions with greatest impact. Overall, we're assuming a doubling rate of every 3 to 4 days, so we do expect to see a rise in our region over these next few weeks.

    Q: So you're right on the brink of this as a system. Looking back, can you share when WellSpan started to act, not just plan but truly take preemptive action?

    Gapstur: It was over a month ago on February 24 when we stood up our centralized system-wide command center. And this was no small undertaking.  

    The command center started out with about 25 people and has grown to more than 100. And we didn't just re-purpose team members with system responsibilities. We've pulled in a number of leaders from our hospitals as well as other care sites. For example, we have some of our hospital presidents rotating to lead our command center. We've asked our hospital leadership teams to stretch to free them up as they are called to serve in the system-wide command center.

    I think this blend of system and local leaders is crucial for two reasons. First, your command center is going to need buy-in from the ground up to be effective, and you're not going to have much time to secure it. And second, it must be operations oriented. Your command center is not about mid-range planning; it's about emergency planning and action. Its decisions must be anchored in a clear understanding of the situation on the ground and what's needed to make things happen.

    Q: So what has your system command center been doing?

    Gapstur: During the first week, they focused on shoring up our supply chain for PPE and ventilators through standard preparations as well as beginning collaborative work with area manufacturers. But by the second week, it was clear—from what we were hearing out of Seattle and New York—we would need to take a system-wide approach to prepare far beyond supplies to ready ourselves for a surge.

    So we decided to set up operations, logistics, and planning teams within our command center to begin thinking through how best to take a system-level approach to potential strains. We, like others, knew we needed to anticipate needs for bed capacity, staffing, and financial trade-offs. We operated that way for about the first two weeks. Then around the second week of March, we launched individual entity commands to align their efforts in support of the system command center.

    Q: Why the one-week lag between seeing the need to extend your command structure down to the entity level and launching the individual entity command?

    Gapstur: Even in a budding crisis, sometimes you need to go a bit slow to be ready to go fast. The last thing we wanted to do was create confusion over who had authority to make certain decisions. It was imperative to speak with one clear voice. We left our matrixed decision-making structure in place and used the small window of time we'd created to iron out how best to move to a more centralized approach. However, by that second week in March, we had patients in beds with either confirmed or suspected cases of Covid-19, and we all knew it was time to flip the switch.

    Today, the system-level command center develops the guidelines or direction for all bigger resource issues, and these guidelines are carried forward throughout WellSpan by a combination of our individual entity commands and new teams that have been pulled together from across our system and report directly to the system command center.

    Q: Can you give an example of how that works in practice?

    Gapstur: Many of our team members have experienced changes in their work, whether due to postponed elective surgeries or temporarily closed ambulatory facilities. We've connected with those team members to identify who has clinical skills or other expertise to serve in different areas of our organization. This common pool of talent is run by a system-wide HR team to redeploy those employees where our system command center decides they are most needed. This is how we're re-deploying physicians and nurses to areas where we’re starting to see increased demand and more critical patients.

    This requires far more than simply telling these valued team members to report elsewhere for work. You've got to support them. For example, centralized teams have arranged places nearby for them to sleep, and we've been securing hotel and dorm rooms close to our other facilities so we can re-deploy staff there as well should the need arise.

    Q: I want to go back to how you've addressed PPE challenges. Can you tell me a bit more about your MacGyver team?

    Gapstur: WellSpan has deep ties to the communities we serve, and our communities have deep roots in manufacturing with many operational plants still in existence. Our governor's proclamation regarding non-essential businesses, however, halted most area manufacturing needs. Many of these local businesses approached us asking, "How can we help?" They told us they would do anything in their power to pitch in to make necessary materials and supplies. This collaborative innovation has been a terrific example of how our community unites in challenging times.

    To fully benefit from their heartfelt offers, we temporarily repurposed a small army of supply chain experts to help quantify PPE needs, and we pulled in Lean experts who were working on internal improvement projects to lead MacGyver Team efforts in determining how best to "MacGyver" creative solutions.

    The output has been significant. Seven thousand face shields were recently received from one local company. Another is developing a mask with enhanced filtering capability a step beyond hand-sewn face coverings, and local distilleries are working with us to produce a consistent supply of alcohol-based hand sanitizer. Also, our supply chain and Lean experts are now tracking solutions being created elsewhere in the country and working with our local manufacturers to replicate them.

    Q: I want to turn to telehealth. With so many outpatient visits being canceled or delayed, WellSpan supersized its telehealth volumes in roughly a month—going from around 200 visits per week to over 15,000 in the last two weeks. What are the keys to this leap?

    Gapstur: First, you need to have a stable telehealth platform readily available to all providers.

    WellSpan has had an online urgent care platform in place for two years now, starting with just our employees in year one and opening up to all our patients in central Pennsylvania in year two. Last year, we launched a primary care video visit platform, offering video visits in four or five of our innovation pilot practices. We expanded this work into online primary care which generated a lot of interest with 400 to 500 employees in the first year. While these care options didn’t see overwhelming utilization, they did create a strong base to build upon quickly.

    Second, you must engage your providers in the shift to digital care. When the Covid-19 surge started to scale, we had phone calls with our medical group three times per week. We explained we don't want people to come in because they could infect other patients. We asked our physicians to engage with us to determine how to reach out to patients needing care.

    Finally, it's critical to equip your users, both providers and patients, with easy-to-use tools to get up and running on digital care. We've been pleasantly surprised by the adoption of our tools over the past month, even without an organized campaign to drive their use. We simply brought our physicians into the decision-making process about how best to care for our patients virtually and equipped them with the know-how to use our telehealth platform, and they took it from there.

    Q: One of the themes we keep hearing from health systems now facing a surge is that you can't over-expand capacity. No matter what they did to get ready, it wasn't enough. How would you advise peer executives to use whatever window they have left to prepare their organization?

    Gapstur: I would say establishing clear and trusted lines of communication is most important. We've been openly transparent with all 20,000 employees, from executives to frontline team members, about what this journey may look like. And we've asked for everyone to give as much as they can give to help with the effort.

    We wanted to jumpstart action without alarming our team, so we were careful to balance our communications around preparedness. When things started to set in six weeks ago, we made it known we were starting to prepare for what we see coming and would start shoring up our supply of PPE.

    Second, fast-forwarding our system-wide approach has been critical to responding as fast as feasible. We've learned so much from different parts of the system. Being able to use that knowledge and shape one integrated response has been key to our success.

    It's also important to remember you have great resources all around you. For instance, being able to depend on our community in central Pennsylvania has been tremendous. I don't think we would have even reached out for some of these things, but we had people calling us with innovative ideas and offers to help. We've also experienced a real sense of collaboration with other health care systems in our region. The shared learnings are benefitting us all.

    Finally, you have to hold your team's wellbeing as your highest priority. Find ways to focus on their wellbeing and offer them time to rest and recharge. You have to make sure you're rotating people through command centers and frontlines. Remember, this is a marathon, not a sprint.

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