With Covid hospitalizations down over 70% from their January peak, clinical executives are refocusing their attention on evergreen priorities like improving inpatient quality metrics. Yet it isn't obvious where leaders should begin these efforts. Most hospitals radically shifted their inpatient protocols and staffing in 2020 to accommodate Covid-19 surges. And it's unclear how inpatient acuity and volumes will shift as Covid-19 infections continue to decline. As a result, 2020 quality performance may not be an accurate indicator of where organizations' improvement opportunities are.
The clinical executive's 2021 burning question: What is the state of post-Covid inpatient quality?
Despite gaps in public quality reporting, there is evidence to suggest inpatient quality was shaken by the pandemic response. For example, Covid-19 patients tend to have longer lengths of stay and are more susceptible to infections in the hospital. Many organizations also shifted personnel away from quality improvement efforts to respond to inpatient surges. While far from definitive, emerging reports indicate an increase in drug-resistant infections, falls, nosocomial Covid infections, and an overall decrease in inpatient quality indicators.
What remains unclear is whether inpatient quality metrics will stagnate even as Covid-19 volumes decrease. Given the paramount importance of quality, the reflexive reaction of many clinical leaders will be to launch an intensive "back to basics" campaign. For example, they may hold frontline leaders accountable for improvement in all areas and re-educate frontline clinician skills on all important protocols. But while quality improvement efforts will (and should be) a priority for many, clinical leaders will need to lay the right foundation for their workforce to be successful. In other words, quality improvement efforts won't be effective unless leaders prioritize workforce recovery.
Workforce recovery is the foundation of inpatient quality improvement
According to a recent poll from the Kaiser Family Foundation and the Washington Post, 62% of health care workers said worry or stress had a detrimental effect on their mental health. Pre-Covid studies suggest that this burnout presents a threat to the quality and safety of patients. And if the clinical workforce reaches a breaking point and leaves the organization, lower staffing levels will further harm quality.
Consider the following three steps to bolster workforce recovery:
- Immediate: Make support services opt-out (if you haven't already). Most organizations have seen low utilization of emotional support initiatives, even across the last year. This is a result of health care's "I'm fine culture." Having employees opt-out, rather than opt-in, encourages greater utilization across the organization.
- Near term: Assess your support services for breadth, depth, and accessibility to meet your staff's individual and collective needs. The healing process will look different for different people. Identify what your staff needs physically and emotionally for their recovery, and make sure your organization has a wide selection of accessible options to meet those needs.
- Long term: Commit to workforce recovery as a 2021 priority. The C-suite must make strategic and financial tradeoffs to prioritize recovery. If clinicians don't emotionally recover, organizations risk a mass exodus that will damage patient safety, inpatient quality indicators, and engagement long-term.