The COVID-19 pandemic continues to have a profound effect on healthcare organizations, as clinicians face heavier workloads than ever. Patients with non-COVID-related conditions have returned to hospitals for care, while waves of people infected with the Delta variant are hitting emergency departments and ICUs.
Becker's Hospital Review recently spoke with Jody Crane, MD, TeamHealth's chief medical officer, about how the pandemic has changed healthcare workplace cultures, as well as what care delivery and healthcare leadership may look like in the years ahead.
Organizations have become more agile in their pursuit of clinician and patient safety
COVID-19 has motivated many healthcare organizations to change their approach to nearly everything they do. When the pandemic emerged, one of the first things that TeamHealth did was to assemble a team of its brightest disaster medicine experts from across the country into an Emerging Infectious Disease Task Force.
"We paired the task force with our senior operational leaders. First and foremost, this allowed the experts to determine the best actions to protect our clinicians and patients, and the engagement of the operators enabled them to follow through on the execution of recommendations. This structure effectively strengthened the connection between our clinician base and our senior leadership team. The task force continues to meet, now as we are experiencing the Delta wave," Dr. Crane said.
In the early days of the pandemic, personal protective equipment was a major challenge. In response, TeamHealth flipped a portion of its organization to focus on the supply chain as business, clinical and operational leaders started searching worldwide for PPE. In addition, the company created programs for clinicians about how to don and doff PPE in accordance with OSHA standards.
"We were proactive about what clinicians would need on the ground," Dr. Crane said. "Since the beginning of the pandemic, TeamHealth has spent over $3 million on PPE and sent about 500,000 items out across our clinician base. We'll continue to send products out, even though the PPE supply chain in the United States is much improved."
On the patient side, TeamHealth has collaborated with its partners to implement protocols to isolate infectious patients. A lot of the potential harm to patients during the pandemic has been flow-related. "They may be in the emergency department, waiting to get admitted, but there are no beds available. We know that when patients board in the ED, they have worse outcomes," Dr. Crane noted.
Outside the hospital setting, TeamHealth has conducted drive-through vaccination clinics in Knoxville, Tenn., and other cities. It has also partnered with clients to launch campaigns to encourage patients to not avoid the hospital if they have non-COVID related health issues but are worried about being exposed to sick patients. Studies have shown that during the pandemic, many people were afraid to go to the emergency department. As a result, heart attack and stroke care may have been compromised.
"COVID-19 has required us to become more agile," Dr. Crane said. "We've abandoned the way that we've always done things in favor of fluid and timely transitions in the way we care for patients. To me, that's a good thing. You don't want to get stuck in bureaucratic ways of doing business."
Clinician burnout is a top priority and will be a challenge for years to come
The stress that medical professionals are facing on a global scale is similar to what occurs after a mass casualty event. "There's definitely a PTSD component to what we're going through right now. We are going to be dealing with this for years to come," Dr. Crane said.
Early on, the pandemic was extremely anxiety-provoking for clinicians. They would arrive at work wondering whether they would have a mask and then they worried about contracting COVID-19 from patients. When the vaccine came along, the levels of fear subsided, but then the Delta variant arrived.
"This is probably the most stressful time there has ever been in healthcare, especially on the front lines of emergency medicine, hospital medicine and other hospital-based specialties," Dr. Crane said. "The strain on the system is translating into incredible amounts of stress and burnout."
TeamHealth has doubled down on clinician outreach and wellness. To support its clinicians, TeamHealth has created webinars and education series focused on the signs of burnout and coping strategies. In 2020 alone, TeamHealth conducted over 16,000 wellness outreach calls with clinicians and it is continuing these calls. This year, in addition to the wellness calls, clinicians will receive periodic care packages intended to support the clinician and their families. This September, TeamHealth is sending out awareness cards for Suicide Prevention Month. In addition, the company has created a wellness director role to focus exclusively on clinician well-being. "The ongoing pandemic has definitely elevated the importance of clinician wellness to an imperative," Dr. Crane commented.
To confront healthcare's 'new normal,' TeamHealth is collaborating with its partners
High-quality patient care is TeamHealth's North Star and all of its hospital partners are aligned with that goal. Throughout the pandemic, challenges have arisen quickly. TeamHealth and its partners have attacked these issues together, thinking creatively and innovatively about solutions.
One site in South Florida has twice been a global epicenter of COVID-19. Over the course of a few weeks, TeamHealth expanded its inpatient hospitalist coverage by 25 clinicians to assist with the surge of patients with the Delta variant, caring for all COVID-19 patients admitted to the hospital. Another example is a Tennessee hospital system that can't find nurses. TeamHealth has placed nurse practitioners in nurse roles to support clinicians and patient flow.
"Each of our clients has a slightly different way that they approach various challenges. We need to support them at all times. It's impossible to be in this business without being completely aligned with your client partners," Dr. Crane explained.
The path forward will require strong leadership and a continued focus on clinician well-being
Looking ahead, healthcare leaders will be faced with a number of operational and economic challenges. "We will always have our eyes open for the next public health threat, whether that's an Ebola-like illness, another SARS virus or the flu," Dr. Crane said. "We will always be mindful of infectious diseases. We'll never care for patients with upper respiratory illnesses in the same way — clinicians will always walk in with PPE."
The significance of virtual care delivery will also grow. In 2020, TeamHealth clinicians participated in around 150,000 virtual visits. The company has now created an entire new service line around virtual care which will be available in all 50 states by the end of 2022.
Recruiting and retaining high-quality clinicians to respond to the next pandemic may be challenging, however, due to compensation pressures from managed care and CMS. Insurers are continually trying to reduce reimbursements and CMS recently released its fee schedule which reduces clinician reimbursements in hospital-based specialties quite dramatically. This will undoubtedly impair our ability to maintain the surge capacity for all of the potential infectious and natural disasters that require our vigilance and preparedness.
With regard to human resources, better collaboration is needed among physicians, advanced practice clinicians (APCs), nurses and other staff. TeamHealth has flexed staff across service lines, geographies and even across professional licensures to support clients during the pandemic. This trend is likely to continue.
Engagement of APCs such as nurse practitioners and physician assistants will take on greater importance. "Many APCs were sidelined during the pandemic because we lost patient volume. We will need to double down on our efforts to engage these clinicians who play an important role in the healthcare delivery system as physician extenders and an even more important role in rural, underserved areas," Dr. Crane noted.
There is little doubt that mental health care for clinicians and patients alike will be an ongoing issue. "Mental health issues will only continue to grow," Dr. Crane said. "We need licensed practitioners to address the need for stabilization, ongoing care and preventive care. Right now, the demand far exceeds the available workforce, so we'll have to think very differently about holistic behavioral care delivery model moving forward."
Conclusion
Given the uncertainty predicted for the months and years ahead, healthcare systems must embrace flexibility and get comfortable with change. "We've been vaccinated, but the patient volumes and the stress on the system are higher than ever," Dr. Crane observed. "It's challenging, but I don't know if there will be an answer in the short term until the pandemic goes away. What's different is our focus on clinician wellness and outreach. We are ultrasensitive to the issues our clinicians are facing due to resource constraints, patient demand and concerns about their own safety and the safety of their families."