Activate incident command systems. In times of crisis, clear communication and the ability to implement change quickly is crucial. Every country has a different mechanism for managing this. Here are a few resources that can help:
Ensure there is an adequate supply of PPE, ventilators, and other supplies and equipment. This is not easy to do these days, as hospitals across the world are competing for the same resources. Develop a plan for rationing supplies in case you run out.
Maintain ethical standards when allocating resources. Especially in times of strain, healthcare systems must be judicious with how they allocate resources. However, the resource allocation decisions should be founded on the utmost ethical standards to ensure equity, quality, and respect for every individual.
Have a plan for continued surge. Calculate your expected daily census over the next 3-6 months. Convert anesthesia areas, such as ambulatory surgery centers and hospital PACUs, into critical care units.
Ensure safe staffing levels. This is likely going to be difficult to do, as hospitals are all competing for the same labor market. There are no evidence-based guidelines yet outlining a safe way to manage the severe shortages of licensed professionals as we can expect over the coming weeks. Hospitals should both continue to aggressively attract licensed help, but also to repurpose non-licensed staff with Just in Time (JIT) training to assist as appropriate.
Routinely analyze your facility’s risk. Especially in long term or resident care facilities, it is essential to analyze the current state of COVID-19 prevention and precaution measures with utmost frequency. Ensure that performance improvement processes do not start to slip as the situation changes and, if needed, implement new or change existing processes to optimize care.
Embrace continuous improvement and a culture of safety. The coronavirus pandemic has made this more important than ever, as our systems are becoming stressed beyond capacity. Creative, innovative solutions are necessary, implemented within a strategic approach to continuous improvement. The science of human factors tells us that we need to make workflows easy to get right and hard to get wrong, and healthcare systems should be doing everything they can to simplify care processes right now. Clinicians should play an active role in leading these improvement teams.
Establish safe discharge practices. As always, thorough communication within the healthcare team and with the patient and family members can create a successful discharge and minimize chance of readmission, especially for vulnerable populations, including new COVID positive mothers. In addition to clinically vulnerable populations, hospitals should pay special attention to socioeconomically disadvantaged populations upon discharge, as these populations are less likely to have access to rehabilitative care. Acknowledging and working to mitigate disparities due to social determinants upon discharge is especially relevant during the COVID pandemic to prevent worsening of existing chronic conditions, decrease chances of spreading the disease, and avoid preventable cases.
Ensure that proper cleaning protocols are implemented. Because the COVID-19 virus is easily spread on surfaces and after interaction with an infection person, thorough hospital cleaning protocols are essential to prevent the spread of the virus within the hospital and beyond. While there is still much to learn about the transmission and prevention, hospital cleaning protocols will play a large role.
Continuously involve patients, family members, and members of the general public in conversations around improvement.Especially during times of uncertainty, healthcare organizations must prioritize hearing the needs and concerns of those in their immediate community. Many organizations have Patient and Family Advisory Councils (PFACs) to aid in informing targeted interventions. Ensure thorough representation, especially for seldom heard voices, including those in low income communities of color.
St. Bernard’s Hospital: Community Town Hall on COVID-19 Vaccines: In January 2021, St. Bernard Hospital in Chicago held a virtual community town hall to address concerns about the COVID-19 vaccination and encourage residents to get vaccinated when they’re eligible. The event featured informative, straight-forward presentations from clinical staff and a wide-ranging question and answer session. We congratulate St. Bernard on demonstrating a high level of concern about patient safety and public education at this critical time.
Create a plan to resume normal operations. Surgeries and elective procedures have been suspended around the world for an undetermined amount of time. However, as we are understanding more about the virus and are working to develop strategies for treatment and prevention, these surgeries will have to resume shortly out of need and demand. Hospitals should develop a strategy to resume these services and ease their organization back into normalcy in small and safe increments.
Take care of your people, so they can better care for patients. This is a difficult time for everyone in healthcare and tensions are running high. It is more critical than ever that leaders establish open lines of communication with the frontline, so that concerns and barriers can be addressed real-time. Hold virtual support groups and engage pastoral care in debriefing with team members daily. Consider providing education/childcare, housing alternatives, and hazard pay.
Not only are hospitals tasked with the immense responsibility to provide care during a global pandemic, with limited resources and ever-changing regulations and protocols, hospitals also must prioritize the well-being of their own team members. It is no secret that the COVID pandemic has compromised the well being of healthcare workers around the world. In the general sense, hospitals should do the following to promote healthcare worker safety and well-being:
Continue to reevaluate and monitor healthcare and safety practice. Understand that priorities may change.
Allow those on the frontline to help problem solve. Defer to expertise. Conduct rounding to aid in learning the challenges.
Offer employee assistance programs and social work/behavioral health assistance if needed to keep the employees motivated and engaged.
Establish a debriefing protocol.
Incorporate resiliency training.
Do not tolerate retaliation behavior.
Maintain an open door policy.
Ensure staff are taking breaks.
Clearly define roles and responsibilities.
Establish systems of accountability for both healthcare workers and patients and visitors.
Reduce redundancies in the workflow.
Make it easy for your frontline to know what to do.