If you could get a mulligan back to January 2020, what would you do differently?

It's hard to predict how to best respond to a crisis.

With enough time, it becomes easier to see which decisions were good ones, and what could have been done better. Becker's Hospital Review interviewed a range of hospital and health system leaders, and they each highlighted some of the biggest things they'd do differently if given the chance to go back to January 2020.

Showing greater appreciation and offering more flexibility to employees was cited more than once, and one leader said that communication between the medical community and the public might be the biggest thing he'd change.

Note: Responses have been edited lightly for clarity and brevity.

Rose Polasky, RN. Administrative Director of Patient Care and Perioperative Services at RWJBarnabas Health Monmouth Medical Center (Long Branch, N.J.). The one thing I wish we had done differently was listen more closely to the fears of our nurses we put into new roles, and place them in the most appropriate areas from the beginning. I think our seasoned nurses would have stayed to provide the non-clinical support that was given once the new roles were created. Since 2020, our organization has been laser focused on supporting our staff and providing them with additional resources for their mental health and physical well-being. Some of the people who left have returned and were able to move into remote roles when we had our surges. Our engagement scores have improved, and the staff feel they are being heard.

Jerry Pickett. CFO of Burke Medical Center (Waynesboro, Ga.) and Bosque County (Texas) Hospital District. If I could call a mulligan for the last two years, I would better prepare for all staff whose duties do not require direct patient care to have the ability to work remotely. We are located in a rural area in central Texas, so not all of our staff have broadband available. When the pandemic became an issue in March 2020, we moved all of our patient accounting, health information management and IT staff out of the hospital. Even though we were able to set up shop in our fitness center, we still were unable to keep everyone working. Those who could not work in the fitness center or from home were paid, but we did lose some ground on cash flows.

Joseph Szokol, MD. Clinical Professor of Anesthesiology and Executive Director of Mentorship and Physician Development at Keck Medicine of the University of Southern California (Los Angeles), and Chief Health Policy Officer of the American Society of Anesthesiologists. We should have moved cases to ASCs quicker. Also, we would not have been in such a hurry to cancel cases in such volume if the organization had adequate staff and PPEs for providers. That took a huge economic toll on providers and hospitals, and much more importantly on patients not getting needed care for cancer, etc.

Alexandra Morehouse. Chief Digital Officer and Chief Marketing Officer at Banner Health (Phoenix). We have a natural language programming tool in place in our call centers. NLP is a software that gives us the ability to pick up themes of patient conversations and understand what's top of mind for them. 

If I could go back to January 2020, I would've used that NLP much sooner than we did. We were operational within a couple of months, but especially in the early weeks of the pandemic it would've let us know what concerns and misinformation were being circulated.

Within eight weeks, we were able to use NLP analytics at the end of each day to understand key customer trends. By 6 a.m. the next morning, we were able to update the scripts for our customer experience reps so that they could quickly and accurately address the evolving concerns of our patients.

Kathy Bailey, PhD, BSN. President and CEO of UNC Health Blue Ridge (Morganton, North Carolina). If I could go back, I would focus more on our teammates and their well-being and resilience during this pandemic. They were recognized early on as the true healthcare heroes they are, but as the pandemic lasted much longer than anyone expected, they fell out of the spotlight of appreciation. While many in our country politicized COVID-19, these heroes came to work day after day, putting their lives on the lines to provide care in very stressful times. They deserve our ongoing appreciation and gratitude.

Catherine Llavanes, CEO of HealthCare Management Services (Houston). I think my do-overs will be recognizing how "Zoomers" work from home effectively. I believe the pandemic has changed the way we work and learn, and by understanding the changes and the challenges, we identified that other work processes can be done at home with proper guidance and protocols. 

Frank Pearson. Director of Syracuse (N.Y.) VA Medical Center. I arrived at the Syracuse VA in August 2020. I was able to observe from afar the start and progression of the pandemic prior to my arrival, but no one anticipated the pandemic would endure as long as it has nor the nursing shortage that developed. Many of our outpatient nurses had prior inpatient experience, while others did not. We needed to get nurses trained to work in our inpatient areas, and refresh skills for others. 

When I assumed the CEO role, I immediately identified the need for an improved cross-training program. The reality was that we weren't as nimble as we should have been in developing this program as rapidly as we would need to deploy it. 

So, if I could call a 'mulligan' and go back to August 2020, I would have insisted on expediting the nurse cross-training program, and I would have made cross training nurses a much greater priority. 

Shannon Connor Phillips, MD. Vice President and Chief Medical Officer of Community Based Care, and President of Intermountain Medical Group Kem C. Gardner Transformation Center (Murray, Utah). If I could get a 'do-over,' I would have had a deeper intention in active well-being in our teams. When I look now at the innovative ways we have and are caring for each other, we have grown a lot. It is tempting for healthcare teams to just take on more and get it done. We're tough, right? There is a price to be paid for this in safety, quality and experience of our caregivers and patients. We have de-stigmatized speaking up and time needed to recover. Let's not lose this as we emerge from the pandemic. 

Adam Bruggeman, MD. Chief Medical Officer of PSN Affiliates (Irving, Texas) and President of Texas Orthopaedic Association (Austin, Texas). I think going back from a healthcare system level (and governmental level), we clearly missed on shutting down cases in Texas in 2020. The solution to reducing deaths in the United States likely does not involve stopping elective surgeries except in specific hospital by hospital situations. These changes and reactions have continued to reverberate through the medical community, further pushing providers toward ASCs out of fear of having their businesses substantially disrupted regarding hospital procedures.

We also missed on appropriately compensating nursing staff for the unique situation and providing retention bonuses. By the time we got around to appropriately incentivizing employees to stay, the dominoes had already fallen. 

I think perhaps the most important failure of our response was really communication. As a medical profession, we must learn to communicate complex topics in a simple way. We do this every day in our practices when trying to condense decades of training into a short clinical visit so a patient can make a well-informed decision. 

In the future, we may need to look at identifying physicians who are skilled in communications to provide a more clear and consistent messaging. Be clear in what we know and clear in what we don't know, allowing for better decisions to be made. What is published in journals goes through a very clear process, but what is said in an opinion article, on a podcast or in front of the media requires little to no oversight and can create mass confusion among non-clinicians.

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