At the Helm

10 takeaways: What health systems must consider as they mull reopening

by David Willis and Christopher Kerns

The Covid-19 epidemic continues to spread across the United States. To help navigate the developments, we have compiled a list of 10 key takeaways on Covid-19, consolidated from our webinar on May 7. Join us Thursday, May 14, for an update on where things stand.

Covid-19 weekly webinar: What health care leaders need to know

  1. US case count tops 1.2M

    The number of confirmed Covid-19 cases in the United States now exceeds 1,200,000 as of May 6, with more than 70,000 deaths attributed to the virus.

  2. Global death rate stabilizing—but US and other countries still see sporadic upticks

    Continuing a trend from recent weeks, evidence suggests that the worldwide death rate is stabilizing and in some countries declining. However, the pace of the decline is slow, and several countries (including the United States) continue to see sporadic upticks on any given day.

  3. In the US, most states aren't seeing a sustained decline in deaths

    Within the United States, only New York State at this point is showing signs of a sustained, albeit slow, decline. Other states are still showing significant variability from day to day and week to week, and still other (typically more rural) states are only beginning to see the impact of the virus.

  4. States start to reopen—and data suggests that will increase mortality

    Economic pressures have pushed many states to begin reopening businesses, and many health systems are in the process of restarting elective procedures. As expected, with each state operating independently, the timing and structure of reopening varies widely across the country. The move to reopen will almost certainly lead to a significant increase in mortality—a risk that will remain highly likely until an effective treatment or vaccine is developed and widely available. Mortality projections from the Institute for Health Metrics and Evaluation have almost doubled just in the past week; other models based on different assumptions show similar projections.

  5. Health systems must weigh decisions in 5 topic areas as they mull reopening

    As health systems consider resuming normal operations, they will need to navigate a set of interdependent decisions across at least five disciplines: confirming their ability to safely provide procedural care; prioritizing which services to offer first; implementing new policies to ensure safety and protocol compliance; ensuring they have a fully-engaged staff; and establishing a robust communication plan aimed at patients, referring physicians, and the community at large.

  6. To ensure safety, health systems must ensure adequate PPE supply, testing capacity, and more

    Ensuring the safety of patient and staff will require more than just appropriate clinical protocols and infection control. Systems will need to comply with widely varying state requirements for reopening. Supply chains will need to ensure adequate supply of personal protective equipment (PPE) not only for anticipated volumes, but also for future surges of Covid-19 cases. Perhaps most importantly, all provider organizations will need to have reliable sources of testing supplies and test processing capacity.

  7. Systems must weigh multiple factors when prioritizing which services to offer first

    When prioritizing which services to offer first, systems will need to weigh clinical urgency, strategic importance, financial impact, and feasibility. Each of these factors will vary significantly across service lines. Cardiovascular services will almost certainly have to prioritize the most complex patients first, requiring longer lengths of stay, higher acuity beds, and appropriate clinical staffing mix. And all surgical procedures will be dependent upon the availability of upstream care such specialist pre-op consults and diagnostic testing.

  8. Patient experience is more critical than ever

    Decisions around the availability of supply are only one part of the equation. Systems will need to consider factors influencing demand, perhaps none more significant than consumer perception of safety. With recent survey data confirming that consumer sentiment leans toward delaying care or foregoing it altogether, provider organizations will need to focus on the patient experience more than ever before. The signal value of social distancing signage and policies, pre-operative testing, virtual consults, and universal masking may well be even more important than the impact of these efforts on safety.

  9. Hospitals must reach out to their communities to build trust

    In addition to communicating with patients, health systems will need a broader communication strategy focused on building trust with their communities. Recommended actions include multichannel campaigns describing approaches to safety, decision tools that help patients access the right site of care for different needs, and a public education campaign on the risks and negative outcomes associated with foregoing essential care.

  10. Systems must engage surgeons and referring physicians

    Lastly, health systems will need a concerted effort to engage surgeons and referring physicians, who will likely significantly influence patient decisions around timing and location of care. Successful systems will work with their medical staffs to design workable policies and procedures, expand hours and locations appropriately, and assist physicians in managing their own increased burden of communication and preparedness.

Slide deck: The grand experiment in reopening economies and hospitals has begun

Following an overview of the latest developments in Covid-19, Advisory Board’s Shay Pratt discussed how health systems should plan to “reopen” for business: which services and service lines to prioritize, how quickly to reopen, how to work with physicians and nurses to ensure smooth operations, and the unexpected challenges that providers will have to overcome.

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