The hospital CEO agenda: What 4 leaders are starting, stopping

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The COVID-19 pandemic has forced hospital and health system CEOs to rethink how their organizations operate. This means not only starting something new to improve and innovate medical care, but also stopping, halting or quitting approaches that may not fit well in the new healthcare environment.

To dive deeper into the issue, Becker's asked hospital and health system CEOs to share the systems and processes they are starting and stopping. Below are their answers:

Lily Henson, MD. CEO of Piedmont Henry Hospital (Stockbridge, Ga.).

Starting: As with many other healthcare systems, we have struggled with the shortage of nurses as the pandemic surged everywhere. We had to bring in agency nurses to help us care for our patients. It is not clear what the future of nursing looks like in the post-COVID world, and we are envisioning how to manage staff that may not be long term — how to train them in the best practices that we have found to be successful in reducing hospital-acquired infections in the pre-COVID era, how to incorporate them with our long-term staff in a way that allows for strong teamwork. In the past, this occurred while working side by side with someone, but is a luxury we no longer have.

Stopping: We learned from managing COVID that we have to be ready to do rapid cycle "Plan-Do-Study-Act." We didn't have the luxury of spending a lot of time analyzing the pros and cons of a particular action. We did our best to make a plan, discuss it within the incident command structure, implement and monitor effectiveness. We would tweak our plans based on the ever-evolving situation. An example of that is our bamlanivimab [antibody therapy] infusion clinic, which we implemented just as the vaccines were approved. We stood up the clinic and adjusted the schedule based on the community infection rate weekly to accommodate for the demand. As the number of infections dropped and the need for bamlanivimab also was reduced, we reduced the number of days per week we gave the infusion while ensuring that patients were still able to access the drug in a timely fashion.

William Jennings. President and CEO at Reading (Pa.) Hospital.

Starting: Prior to the pandemic, we had a "doc of the day" program that provided one in-house attending 24/7 to cover our obstetric units. This person covered all our women's health center patients (which represents about a third of our obstetric volume) as well as urgent patient needs of our five employed and two independent practices. We relied on call coverage from practices to cover their own patients for routine care.

The pandemic threatened our resources because of potential exposure and/or illness as it may impact our attendings.

In response, we implemented a mandatory in-house two-attending coverage program. This was developed by our providers from all our employed practices to provide us with adequate obstetric coverage 24/7 while preserving our workforce to provide coverage for all inpatient and outpatient areas besides just our obstetric units. 

There were concerns about patient satisfaction and potential impact on continuity of care of patients. We found ways to accommodate the continuity and ensure appropriate transitions of care while maintaining quality of care and patient satisfaction. Moving forward, we are keeping the collaborative call coverage, as it does provide us with adequate coverage of our inpatient units, improves provider schedules, and allows us to increase providers in the ambulatory and other women's healthcare settings. We continue to make adjustments to improve patient satisfaction and continuity and maintain quality. This modified "Laborist" model is here to stay.

Stopping: Two transformational changes were introduced in nursing. First, the nursing division designed and instituted a significantly abbreviated nursing disaster documentation flow. This change may have been one of the most popular process changes we adopted. I knew it would be hard to go back to the pre-pandemic and surge flow, but we have done so. And finally, in response to the surge of COVID-19 patients and the exhausted use of surge beds of inpatient surgical and surgical ICU beds, our surgical services team adapted their schedules so all inpatient surgical patients remained in a post-anesthesia care unit/procedural areas until discharge. This, too, has reverted to its pre-pandemic workflow, much to the satisfaction of the surgical services team.

Dennis Murphy. President and CEO of Indiana University Health (Indianapolis). 

Starting: In June 2020, IU Health started a service to flip primary care no-show appointments to virtual care if an in-person visit isn't medically necessary. Started in one large physician practice group, the new service has been able to convert about 50 percent of in-person no-shows to a virtual encounter with a caregiver. The result: More patients keep their appointments and care can be delivered in a way that makes patients feel safer.

Stopping: During the pandemic, IU Health has aimed to reinvent the traditional ways hospitals interact with patients by giving new options for care. We have taken the first steps to stop requiring patient registration in person. A mobile-enabled service being piloted allows patients to complete check-in virtually, avoiding in-person contact. They can securely submit photos of their government ID and insurance cards, e-sign required forms and fill out demographic information. On the day of their appointment, they can even respond to a text when they are within one hour of appointment time, allowing our care team to give a concierge-style welcome to the patient upon arrival and guide them right where they need to be.

Terry Shaw. President and CEO of AdventHealth (Altamonte Springs, Fla.).

Starting: AdventHealth has started accelerating our focus on expanding whole person care outside of the hospital setting. We will open more doors for people to access healthcare services and create care systems that allow the consumer to be treated without having to go through the emergency department. Investing in our digital platform that puts consumers at the center, strengthening our capabilities in the management of insured populations and launching virtual and in-home hospital care are some of our key post-pandemic strategies as we reimagine the living room as the point of care.

Stopping: AdventHealth has taken significant steps to reduce our reliance on international manufacturers for personal protective equipment by partnering with, or investing in, domestic producers of supplies like gowns and face masks. At one point during the pandemic, we had to stop certain services like elective surgeries to conserve supplies. We need to have mechanisms in place that help us flex up or down so we always have access to what we need to support our communities, especially during a widespread health crisis. This also means having the ability to efficiently move supply chain inventory and vital equipment across our system based on each community's unique situation and redeploying team members to areas of greatest need.

More articles on leadership and management:
Biden to commemorate COVID-19 anniversary during first prime-time address
Healthcare awareness calendar: Key months, weeks and days in 2021
Mercy Health-Youngstown to open COVID-19 memorial 

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