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January 21, 2022

The 2 big omicron trade-offs health care leaders must make

Daily Briefing
    By Darby SullivanNatalie Trebes, Sara Zargham, and Kirsta Hackmeier

    The extraordinary spread of the omicron variant has demonstrated yet again that Covid-19 is nothing if not unpredictable. Omicron won't be the last variant to contend with—and health care leaders must consider the strategic pressures of the future while they grapple with the immediate challenges of today.

    More than any past variant, omicron introduces tough decisions without easy answers. How leaders weigh these trade-offs will resonate in their responses to later variants. We took a deep dive into the two biggest trade-offs: navigating the workforce crisis and strategizing public health messaging.

    Access our new omicron surge toolkit 

    Trade-off #1: Maintain normal services or pull back on select strategic priorities

    Overwhelming demand is colliding headlong with an unprecedented labor crisis. Provider organization leaders can either try to maintain as many normal services as possible or significantly pull back on select strategic priorities. 

    In the face of a record breaking number of cases, hospitals are grappling with crushing patient need and a workforce that is smaller, sicker, and more burnt out than ever. Hospital and health system leaders are left with a with a difficult choice:

    Option 1: Ask a dwindling, struggling staff to shoulder more responsibilities amid the surge

    Some leaders may choose this option to avoid canceling scheduled procedures and further deferring vital non-Covid-19 care. They may mandate grueling hours with leaner teams or require staff to work below license and fill non-clinical roles to maintain normal functioning.

    This strategy might get an organization through the worst of omicron without sacrificing too much revenue—essential amid an extended period of financial uncertainty and tight markets. But it also might push the workforce to the brink. Burnt out and disengaged, staff turnover would likely increase. The additional strain on labor budgets as hospitals and health systems fight to keep and attract staff may outweigh the financial benefits of keeping non-Covid-19 services up and running.  

    Option 2: Sacrifice some key operations now to preserve longer-term workforce sustainability, expecting more surges in our future.

    Other leaders may prioritize mitigating further staffing losses above all else. They may dedicate funds from increasingly tight margins toward retention bonuses and travel nurses to fill out care teams. This will require leaders to deprioritize or pause some profitable services to deploy staff where they are needed most.

    While this might reduce long-term costly staffing challenges, it will challenge near-term finances when there is little to spare. Capital expenditure projects must be put on hold yet again, halting forward progress in an increasingly competitive provider market. Hospitals and health systems also risk losing patients to other providers that continue to offer elective services.

    Not all provider organizations are equally burdened by this choice. Large health systems can flex staff across facilities if some locations are experiencing fewer cases, and they are more likely to have the capital necessary to boost pay and hire travel nurses. This could exacerbate the divergence in performance between large systems and their smaller counterparts that we first noted at the start of the pandemic.

    Independent clinics and medical groups may also have an advantage, becoming more attractive options for burned out frontline clinicians who want to stay in medicine. Physician allegiance is a powerful driver of utilization and referrals. Losing physicians to other settings could position a longer-term volume challenge for acute care executives, who are already focused on retaining volumes amid an industry-wide site-of-care shift.  

    Trade-off 2: We're all navigating evolving information and regulatory guidance. Health care leaders can stay out of the mess—or wade right into it.

    Omicron's rapid surge prompted a host of policy changes to isolation and quarantine guidelines. However, complicated and unclear messaging has caused widespread confusion about how to adjust behavior. Health care organizations need to fill the void in coherent public health guidance to make a dent in the surge. Though different communication strategies have their trade-offs, both options below risk exacerbating public frustration and mistrust—just in different ways:

    Option 1: Simplify guidance to improve the likelihood that people understand it, even if broad messages are unrealistic for some groups.

    Let's consider testing. The rapid increase in consumer demand in certain areas has left retail shelves empty, contributed to long lines at testing centers, and challenged labs to deliver timely results. Some hospital and health system leaders may not have the capacity to help their communities navigate shortages, and so decide to leave that element out of their testing guidance. Simpler messaging with fewer group-specific caveats can help mitigate confusion and frustration as people tire of shifting guidelines. But this approach advantages the most privileged patients who are technologically savvy, have higher incomes, and enjoy flexible work hours. If testing becomes concentrated in certain areas, the communities left out will face greater spread and worse outcomes—exacerbating inequities.

    Another example is the new group of Covid-19 therapeutics, often hailed as a pandemic 'game changer.' This messaging builds awareness about the new care option, which could leave to life saving interventions. But it fails to acknowledge the hurdles that patients face in gaining access to the drugs—securing a test and receiving a positive result, obtaining a provider referral, and initiating treatment within a matter of days. As with testing, this will largely benefit the most privileged.

    Option 2: Incorporate detailed guidance into messaging to account for realities in testing, treatment, and human behavior—but face the risk of increased public confusion.

    Leaders that choose this option will take a more active role in helping their patients navigate testing shortages and therapeutic access. That entails providing realistic guidance that helps patients make decisions in non-ideal scenarios, including what to do if patients can't find a reliable test, what types of tests to prioritize, and which patients will likely be able to benefit from the therapeutics. This guidance is tailored to the realities patients face, making it more useful to many.

    But this type of guidance is also more complex and acknowledges the weaknesses of essential elements of the United States' pandemic strategy. This approach might inadvertently lead patients to forgo testing and treatment, as they decide it's not worth the effort to track down tests with seemingly reduced efficacy or therapeutics with a narrow use window. If the public doesn't believe that these key mitigation strategies still remain useful, the United States will backtrack on its fragile progress toward ending the pandemic.

    Parting thoughts

    When the next variant comes, keep omicron's lessons in mind: workforce supply matters just as much as Covid-19-induced demand when gauging hospital capacity and the seriousness of a surge, and staffing and public health messaging strategies must take a harm reduction approach. All the options presented have their drawbacks, and different strategies may benefit different organizations. No matter which decision you make, be prepared for the long-lasting implications. 

    Learn more: Check out our new omicron surge toolkit

    We've collected our best resources and insights for creating capacity, supporting staff, communicating with patients, and more. This page will be a consistent work in progress as we compile the newest and most helpful resources. Check out all the resources, including:

    Access the toolkit

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