My colleagues and I have talked to dozens of clinical executives in the past month about how they're staffing for Covid-19—from those readying for a surge to organizations already on the other side of their market's apex. Here are four lessons learned from those conversations that I recommend that all clinical executives keep in mind as they customize their organization's Covid-19 staffing strategy.
Clinical executives are already using Covid-19 bed projections in their market to estimate their staffing needs. But they are accounting for more than just a surge in patient volume. They are also adjusting for the loss of productivity associated with Covid-19 care.
There are two reasons Covid-19 negatively impacts productivity:
Most organizations have already begun the complicated process of redeploying ambulatory staff to the acute care setting. For staff with inpatient experience or competencies related to Covid-19 care, their redeployment is critical to increasing capacity.
But there are clinicians whose specialty and previous experience aren't well suited to inpatient redeployment. Organizations should leverage this capacity to staff other hot spots in the local community:
Many organizations redeploying staff to acute care settings are increasingly investing in cross-training on inpatient skills and competencies—through online modules available through professional societies or in-person "boot camps." Unfortunately, these trainings have limited applicability in the current challenge, as it typically takes years for frontline clinicians to become clinically competent in caring for critically ill patients.
Organizations should instead consider investing more heavily in scaling the expertise of the experienced clinicians they have at the bedside to deliver quality care to critical Covid-19 patients. CNOs across the country report converting their ICUs to team-based staffing models led by an ICU RN or NP. For physicians, a virtual option may be the best answer. Several organizations have extended critical care or palliative care physician coverage by implementing a virtual provider consult model via FaceTime. In addition to providing an extra layer of clinical support, this approach also reduces the risk of those specialized clinicians contracting the virus themselves.
Frontline clinicians are experiencing an unprecedented level of grief and moral distress. Executives should equip leaders to facilitate conversations among frontline clinicians about their well-being.
One option more feasible for peak surge is to equip frontline managers to convert previously scheduled meetings, like unit huddles, into an opportunity to check in on frontline clinician well-being. If their staff have bandwidth, organizations can leverage chaplains, ethicists, or mental health clinicians with facilitating team conversations to collectively process emotion and reinforce resilience.
My conversations with our members in the hardest hit markets suggest that a new wave of staffing challenges will surface in the post-Covid-19 era, including staff burnout, increased union action, and a frontline clinician supply shortage.
Revitalizing our workforce to tackle these challenges will take a strategy beyond what most organizations already have in place—a strategy the Advisory Board is committed to helping you navigate. If your organization is already taking steps to prepare for post-Covid-19 staffing challenges and would like to share, please contact me directly at RewersL@advisory.com.
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