Between shifting patient flow, the need to expand capacity for COVID-19 patients and revenue losses from shutting down services early on, the pandemic has caused numerous challenges and disruption for health systems across the country. For Gary Kaplan, MD, chairman and CEO of Virginia Mason Health System in Seattle, these challenges have underscored the importance of being open to new ideas and using lessons learned during the public health crisis to improve patient care.
"We are seeing a consistent upswing across the country in new cases. There is, in many regions, an increase in pressure on hospitals, on bed capacity, tremendous pressure on staffing," he said during a recent interview with Becker's. "Yet, we've come a long way, so we're able to do a much better job of predicting our volumes and predicting the demand side. We’ve learned about the need to ensure adequate capacity. So, I think the challenge and the opportunity is to even better address the patients who are acutely ill with COVID-19 who need us, but do so in a way that we embrace the lessons learned from the early initial experience."
Lessons learned
At Virginia Mason — which had eight COVID-19 patients in the hospital as of Oct. 19 — Dr. Kaplan said leaders learned about the importance of being visible and present for employees, and to adapt quickly when conditions can be changing every day, even every hour.
Health system leaders also learned about the importance of staying flexible and nimble and continuing to invest in telehealth to ensure patients have the healthcare access they need.
Staying flexible has meant retooling Virginia Mason operations, including reviewing and creating new workflows to ensure patients and employees are protected, said Dr. Kaplan. This has been guided by the health system's management method, the Virginia Mason Production System.
Regarding telehealth, "I am a primary care internist, and some initial thinking was, 'This is fine for primary care.' But it turns out it works almost across the entire continuum of care, including subspecialty care, including preoperative screening and postoperative care. It was quite amazing to me to see how our teams embraced and expanded the virtual platform," said Dr. Kaplan.
He said increased virtual care has also allowed healthcare providers to see patients in their home setting.
"That's been a real accelerant of not just the technology platform but how we can engage with our patients — and for them, the ability to be seen how, where and when they need to be seen — takes away a lot of the perceived barriers to access and to care for patients," he said. "Virginia Mason is a referral center. We see a lot of Alaska-based patients, so the ability to have some of your pre-op or post-op care happen close to home — which could be 1,000 miles away — is powerful."
Additionally, Virginia Mason leaders learned that great ideas could come from various places in the organization. For example, nurses developed the Support Companion program for families to visit their loved ones dying from COVID-19. Under the program, nurses, called "support companions," help families enter the hospital room of a loved one nearing end of life while ensuring proper safety measures are adhered to, according to 425 Magazine.
"Our nurses were so sad in the early days [of the pandemic] that patients were dying [and] couldn't be with loved ones because of visitation limitations, and they redesigned the process where they became the companion for these loved ones who wanted to be with their ill family members," Dr. Kaplan explained. "They became their companions and found a pathway forward that was still consistent with what we were trying to do to try to prevent spread of infection. We're continuing to embrace these [support companions] every day."
Dr. Kaplan also noted the power of collaboration during the pandemic, both internally and externally with employees and community partners including other delivery systems and public health agencies, the state department of health and others. Internally, Virginia Mason has used kaizen events — short workshops with employees focused on improving a specific process — to set up new respiratory clinics, isolation units, determine staffing ratios and expand virtual care platforms.
Advice for peers
Dr. Kaplan encouraged executives at other health systems to focus on relationships and communication with employees, a philosophy he said is critical to providing safe, quality care and maintaining the flexibility needed to handle this pandemic one day at a time.
"Relationships, as I think about them, are the glue within our organization. They are the manifestations of our culture, and leadership needs to be deeply engaged in understanding those relationships with our team members," said Dr. Kaplan.
He said that standard communication methods are necessary, but not enough, and that health system leaders should constantly reinvent themselves whether it is through virtual town halls, rounding or other means.
For instance, Virginia Mason completed a series of town halls on issues related to health disparities and social justice and has also focused these meetings on COVID-19. Dr. Kaplan said the feedback from staff about the town halls has been positive because they're feeling engaged and that leaders want to hear from them.
"It's not just one-way communication. It's not just me sending memos," he said. "It's more about, 'How do we dialogue and how do we engage together to have the discussion, build the trust that's so important to the relationships that then become so important as we go into this fall season and even more challenging potential pandemic and influenza issues?'"