Posted: 21 Jul. 2020 8 min. read

As COVID-19 surges again, hospitals are trying to toggle between ‘on’ and ‘off’

By David Betts, principal, Deloitte Consulting LLP 

The song “Every storm runs out of rain” by country artist Gary Allan seems particularly fitting today. While the COVID-19 storm is lasting much longer (and is producing far more rain) than most of us anticipated, some clinical leaders see sunlight breaking through the clouds even as new storms build on the horizon.

In the early days of the pandemic, most hospitals closed their doors to non-emergency procedures so that they could respond to anticipated surges in COVID-19 patients. That strategy translated to billions in lost revenue and forced some facilities to furlough staff. It also might have kept some patients from seeking life-saving emergency services.1 With COVID-19 infections now rebounding in many states, hospitals and health systems are trying to balance their ability to respond to COVID-19 cases with their need to keep other revenue streams flowing by providing necessary non-COVID-19-related care.

In May, the Deloitte Center for Health Solutions asked 50 clinical leaders about their concerns, approaches, and the steps they have taken to open their doors to non-emergency procedures. Most respondents (82%) said they were most concerned about a resurgence in COVID-19 activity. That concern appears to have been well-founded.

Finding the mode between ‘on’ and ‘off’

Hospitals should find ways to avoid completely turning off the spigot to non-emergency care whenever COVID-19 cases spike, just as they shouldn’t fully open the floodgates when the infection curve flattens. We should all find ways to operate in more modes than just “on” or “off.”

Finding a middle zone between on and off will likely require data-driven decision making and real-time situational awareness. Clinical leaders should consider developing some forecasting capabilities so they can anticipate possible spikes in cases before patients begin arriving. High infection rates in a community, for example, could foreshadow a spike in hospitalizations. Being able to predict increased COVID-19 volume could give clinical leaders the ability to quickly scale back non-emergent procedures when needed. Having access to deep pools of data from multiple sources could give clinical leaders the real-time situational awareness they need to make more rapid-cycle decisions.

Better situational awareness and faster cycle, data-driven decision making can allow leaders to moderate volumes appropriately to effectively compartmentalize care. Such forecasting might also be useful in ensuring adequate levels of personal protective equipment (PPE), medications, and staff. If ICU use increases, staffing demands increase, too. One nurse typically staffs two ICU beds, compared to staffing five or six non-ICU beds.

In the early days of the pandemic, hospital leaders often relied on infection-rate data from their emergency rooms (ERs). That information, however, often came too late and was too incomplete to adequately prepare for a sudden jump in COVID-19 admissions. Combining ER information with data compiled from search engines, labs, and public-health agencies could offer more warning when infection rates increase in communities. However, most data isn’t standardized or integrated. Although labs and public-health agencies gather a lot of data, much of it is collected manually, and it might not be accessible to hospitals and clinicians.2 That means it’s still up to the hospital leaders to figure out a way to forecast admission surges. Health systems also need more visibility into other facilities so they know where to shift patients to maintain bed capacity.

COVID-19 is now a known risk

Health care systems are learning systems. Even if there is a spike in COVID-19 infections, hospital leaders and staff now have experience they didn’t have in the early days of the pandemic. They are better equipped to protect themselves and patients. Learning how to live with a contagious virus might make it easier to navigate this storm. However, clinical leaders should still be wary and determine how to resume services with while effectively managing risk.

Clinical leaders who are facing another (or a first) wave of infections are likely motivated to implement more safeguards to keep patients and staff safe. Nearly three out of four survey respondents said they were concerned that they might not have enough PPE. More than half of our respondents said they worried that safety concerns among consumers could translate to low demand.

Increased testing, more and regular cleaning of surfaces, and converting semi-private rooms to private rooms (to ensure social distancing) can help mitigate infection risk inside the facility and could help patients feel safe. But adding such safeguards can also slow processes and create new inefficiencies. This could mean more time will be needed to get back to pre-pandemic procedure levels.  

Clinical leaders see business returning

We conducted our survey in early May, before states began phased-in re-openings. Even then, respondents were surprisingly optimistic that business would rebound with a lower threat from COVID-19.

I see this optimism as encouraging, but it’s important that clinical leaders try to temper that optimism. I understand they are anxious to bring back patients who deferred care and treat everyone who needs services. They want to have their staff working again and they want to get the revenue streams flowing. Bringing non-emergency services back to pre-pandemic levels will likely require an agile management strategy. Time horizons should be far shorter. Visibility and situational awareness should be greater, and the ability to respond to the changing needs of patients should be heightened.

This disease is not going away anytime soon and bringing non-emergency procedures back to near 100% capacity might take longer than expected, particularly for organizations in areas experiencing outbreaks. However, despite the dark clouds all around us, I am confident they will eventually run out of rain.

Endnotes

1. Heart conditions drove spike in deaths beyond those attributed to COVID-19, analysis shows, Washington Post, July 2, 2020

2. Faxes and email: Old technology slows COVID-19 response, Associated Press, May 13, 2020 

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David Betts

David Betts

Public Health Transformation Leader

David Betts is the leader for Public Health Transformation for Deloitte Consulting. He focuses on assisting clients in the public health arena to create a more resilient public health infrastructure building on lessons learned in the pandemic. Betts brings more than 17 years’ experience working with clients in the private sector health care industry where he drove significant transformations focused on creating a more human-centric health care system. Betts holds a BA from the University of California, a master’s degree from The University of Texas at Austin, and an MBA from the Tepper School of Business at Carnegie Mellon University.