Across the country, health systems are facing—or anticipating— shortages of clinicians who can care for Covid-19 patients. Gundersen Health System, based in La Crosse, Wisconsin, hasn't faced a surge of Covid-19 cases yet. But to prepare for a potential influx of patients, leaders have spent the last few weeks standing up its "Plan C": identifying and training clinicians who are willing to redeploy to its ED, hospital, and ICU across the system.
Gundersen's 'Plan C' for clinician redeployment
The hope is that the system will never have to go beyond its standard backfill protocols and put "Plan C" in place. But if it does, the system will have clinicians equipped and ready to care for critically ill Covid-19 patients, as well as non-Covid patients in these units.
To learn about how the organization put its plan in place, we spoke with Gundersen's Chief of Medical and Clinical Staff, Jon Zlabek, about how its team quickly matched clinicians to ED, hospital, and ICU roles and its recommendations for organizations who are actively ramping up their clinician staffing.
Below we round up Zlabek's four key recommendations for success:
1. Survey clinicians to see where they feel comfortable redeploying—if at all.
Gundersen's approach to redeployment is founded on individuals' willingness to shift roles. To start, they wanted to understand who would feel comfortable in another role, and where they would feel most comfortable practicing. To assess interest, Zlabek sent a brief e-mail survey to all clinicians across the system asking them to identify their willingness and comfortability performing a range of tasks across different tiers.
Clinicians sent their responses to their clinical lead or manager, who shared consolidated responses with the system leadership team. Over 90% of all clinicians responded that they were willing to redeploy to the ED, hospital or ICU, or serve in other capacities.
2. Launch tier-specific listservs to connect and communicate with clinicians before redeployment.
System leaders tracked survey responses in a simple Excel spreadsheet. Using that information, they used sortable rows to match clinicians to the appropriate "tier" based on their willingness to serve in different roles in the hospital and ED. Then, they created a list-serv for each tier that they use to communicate with clinicians about logistics and share trainings specific to each group's redeployment.
3. Turn to internal experts to identity the best educational resources to share with redeployed clinicians.
To fill skills gaps for redeployed clinicians, Zlabek reached out to internal clinical leaders to ask them to recommend training resources on need to know topics for each tier. Through this process they surfaced an online ventilator training class, a brand-specific ventilator training video with an in-house respiratory therapist, 20- to 40-minute video overviews of Gundersen's inpatient and ED EHR systems, hospitalist skills trainings developed for interns, and videos from leaders in family medicine and pediatrics on assessment of respiratory disease. They supplemented internal trainings with publically available, vetted videos and resources and will turn to in-person shadowing in the ICU and ED if they see Covid-19 cases start to rise. In the case that clinicians are redeployed, they can apply for expedited additional privileges through credentialing.
All the resources are available on a central website that breaks them down by tier of redeployment. Clinicians receive CME credits for completing the online education.
4. Repurpose existing technology, such as staffing center dashboards or patient texting notification systems, to manage day-to-day redeployment.
To streamline redeployment logistics, Gundersen repurposed the online dashboard it typically uses to match non-clinical staff to sites of need to function as a "Covid Staffing Center".
The health system also repurposed its text-based patient appointment reminder system to send notifications to redeployed clinicians when they're matched to a shift in their redeployed role. Members of Gundersen's MEC will review the dashboard and send a text notification to redeployed clinicians with their assignment. All the clinician has to do is reply "Y" to confirm their availability.
Gundersen's advice for scaling redeployment quickly
Although Gundersen had the benefit of time, we asked Zlabek what his recommendations are for systems that are building the plane while they're flying it. His advice: Start with a quick, informal survey about clinicians' willingness to serve in an alternative role—then use that as the basis of your model. Another no-regrets step is to make sure you have all the best internal and external training resources collated on one page—and consider what trainings you can repurpose for this group.