Prescription for Change

The 4 questions physician executives are grappling with amid Covid-19

by Prianca Pai and Sarah Evans

The value of peer-to-peer learning during the Covid-19 epidemic is at an all-time high, but the demands related to addressing the outbreak make it particularly challenging to connect.

Your top resources for Covid-19 readiness

To help spread insights from your peers, Advisory Board's Physician Executive Council has been facilitating virtual discussions with leaders across the nation to discuss how systems are supporting clinicians through the surge. We've highlighted the top four questions that members posed to one another—and the solutions and guidance that came out of these discussions.

1. How can we better support non-critical care specialists who are providing ICU coverage?

Several physician executives said that re-deploying care team members to the ICU has been especially challenging since physician training is so sub-specialized.

Peer-proposed solutions:

  • Survey physicians, nurses, and APPs across the care continuum for the skillsets and willingness to cover the ICU and ED. Physician executives have found primary care physicians with inpatient experience and outpatient medical specialists, such as cardiologists, are often well-positioned to help cover critical care needs.

  • Don't recreate the wheel when it comes to training. Many systems are repurposing existing clinical education materials and training videos on topics like ventilator and the inpatient EHR. Others are leveraging free, online resources such as the Society of Critical Care Medicine's trainings for non-ICU clinicians.

  • Create dyad partnerships and shadowing opportunities to up-skill and support non-critical care physicians. Physician executives are pairing re-deployed physicians with tenured critical care specialists or with residents who are often more familiar with inpatient nuances of managing a unit, as well as ventilator use. An added benefit of these partnerships is that they can help ambulatory physicians get up-to-speed on the hospital EHR faster.

  • Sequence physician training and re-deployment based on readiness. In the first wave of re-deployment, focus on credentialed physicians who are already familiar with inpatient care. If you need more support, mobilize available physicians based on their level of readiness (and consider proactively training other physicians to be at-the-ready in the meantime).

2. How can our system maximize PPE to keep clinical teams and patients safe?

In light of sustained personal protective equipment (PPE) shortages, physician executives are creating and sourcing innovative solutions to maximize PPE.

Peer-proposed solutions:

  • Innovate on ways to decontaminate PPE using existing equipment. Physician executives are getting creative to maximize PPE—from repurposing fumigation machines used for hospitals rooms to leveraging decontamination machines such as Bioquell. Check out more peer-proposed solution for maximizing PPE here.

  • Rotate the care team roles you ask to enter patient rooms—and use an iPad for the larger team to provide virtual support. In response to tension among clinicians about protection and access to PPE, one organization created a team-based environment where nurses and physicians rotate entering Covid-19 patients' rooms.

  • Leverage tele-consults and work-from-home to reduce PPE use where possible. Many systems are facing infectious disease consultant shortages, or have specialists who are concerned about coming into the hospital. Hospitals are deploying iPads to enable specialists to provide tele-consults with the hospitalist or intensivist virtually from home—which extends capacity and preserves PPE.

3. How can I demonstrate executive presence and compassion amidst frontline staff distress and anxiety?

Physician executives are facing unprecedented leadership challenges and decisions—and frontline physicians are putting a premium on leadership visibility.  

Peer-proposed solutions:

  • Communicate daily with staff to show solidarity—and think beyond email. Physician executives are expanding the communication channels they consistently use week-to-week to increase visibility including in-person rounding (if PPE allows), enabling video on virtual meetings, and contributing to daily internal communications to ensure frontline-friendly messaging.

  • Double down on safety to demonstrate that you have your staff's best interest top-of-mind. The biggest thing physician executives can do for clinicians right now is make them feel safe. To do so, leaders are developing and enforcing stricter safety protocols and prioritizing messages about care team safety in organizational communications. See our recent post on how to talk to clinicians about PPE shortages for additional guidance.

  • Advertise and encourage behavioral health support. Some organizations are providing free access to mental health support apps such as SilverCloud or myStrength. Others are standing up in-person support to provide a listening ear for staff. Having an executive who openly encourages clinicians to tap into the support they need during this difficult time can be a powerful lever to decrease stigma.

4. What are physician executives doing to support ambulatory practices?

With elective surgeries on hold and patients postponing non-Covid-19 related care, medical groups are experiencing decreased patient volumes, and physicians are adapting to new workflows to meet with patients virtually. 

Peer-proposed solutions:

  • Consider adapting typical outpatient work schedules. Some systems are experimenting with temporarily consolidating practice sites or reducing clinic hours in response to decreased volumes. To comply with social distancing, some organizations are experimenting with rotating work schedules for physicians to alternate working from home and in the office.

  • Experiment with telehealth features and its potential to streamline operations. Physician executives are using this time to test both the potential and the limits of telehealth, from automating operations to evaluating which patient populations are best served virtually. One organization selected a video conferencing vendor with a waiting room feature—and even embedded it into its EHR. Now when an appointment is booked, the system automatically generates a meeting ID that is immediately sent to patients and put on the doctor's schedule—removing the manual work of scheduling virtual visits.

It is no doubt a challenging time in health care; however, one of the most predominant themes that came out of these discussions is that physician executives do not want to return to the status quo post-pandemic. Many are looking to solidify some of these changes as the "new normal"—from more flexible care team deployment, to improved communication in the hospital, to advanced telehealth capabilities.  

Looking for answers to your other Covid-19 questions? Access Advisory Board's Covid-19 resources page, updated daily.

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