Posted: 20 Oct. 2020 20 min. read

Deloitte and Joint Commission Resources release COVID-19 lessons-learned document

In the early days of the COVID-19 pandemic, Joint Commission Resources—which helps thousands of organizations with accreditation readiness, regulatory compliance, and a myriad of quality and safety issues—began collecting experiences from hospitals and health systems. At the same time, consultants from Deloitte’s federal health practice were helping their health care clients navigate through the crisis. In April, the two organizations teamed up to develop a regularly updated “living document” that would highlight what health care leaders learned from the pandemic and how those experiences could be used to prepare for future emergencies. The full document is available here

Jason Ormsby, Ph.D., M.B.A, M.H.S.A., who leads Deloitte Consulting LLP's health Quality, Safety, and Improvement (QSI) Offering, recently spoke with two people who worked with him and many others on this effort: Mark Chassin, M.D., M.P.H, president and CEO of The Joint Commission, and Bruce Green, M.D., managing director and Chief Federal Medical Officer in Deloitte Consulting LLP’s federal practice. Here is an excerpt from that conversation:

Jason: Why was it important to develop a lessons-learned document?

Dr. Green: The pandemic was driving a lot of activity and our clients were asking us for help in improving the way they were responding, particularly after it appeared infection rates had started to decline. There were concerns about getting ahead of a second wave. We started talking about ways to capture some of the lessons learned from hospitals, health systems, and other provider groups. Then everyone could see what went well and where more focus might be needed next time around. 

Jason: In talking with hospital and health system leaders for this paper, is there anything that surprised you?

Dr. Chassin: One of the greatest surprises was consistency in the core principles. While many health care organizations came up with innovative solutions to address their unique challenges in working through COVID-19, the core principles they used were consistent, even as their individual circumstances and challenges varied. Transparency and collaboration, advance preparedness, resilience, and the core principles of high reliability have been keys to success working through this health crisis and others to come.

Jason: How do you expect this document will be used?

Dr. Green: My guess is there will be a lot of hospital leaders who read the executive summary. Other professionals within those facilities will look to the table-of-contents and appendices to find resources that are most relevant to their roles. We spent a lot of time determining the sections and subsections. Some people might only be interested in a particular section. This is exactly what Joint Commission Resources does for hospitals. It provides those checklists that every hospital should use to ensure they don’t have gaps in care or inadvertently create a safety issue. Seeing how other facilities responded to the pandemic is incredibly valuable. This gives hospital leaders a place to start. Supply chain and infectious disease control will be of interest to different people within the hospitals, but the broader discussion will be about resources made available by this report, the cataloging and appendices coupled with recommendations for leadership style, and ways to improve a facility’s culture to be able to respond better to future threats.

Dr. Chassin: While many of the lessons included in the document are tried and tested, many others are new learnings that continue to evolve. One of the most valuable elements about this document is that it puts all the information in one place—a structured template for all major considerations will be highly useful for health care organizations. The best practices, successes, and significant areas for improvement included in the document provide an overview of how organizations addressed the pandemic.

Jason: This document looks at how organizations responded to COVID-19, but could it also be used as a guide for responding to future public health emergencies or disasters?

Dr. Chassin: Yes, the document goes beyond COVID-19. The Joint Commission has studied health care organizations’ responses to every type of disaster as they have occurred over many years. We have developed appropriate accreditation standards and communicated lessons learned widely—including through JCR educational conferences. We view the document as a continuation of our long tradition of improvement. For example, The Joint Commission has continuously improved its accreditation requirements related to emergency management and planning…by gathering the experiences of health care organizations while dealing with the full spectrum of disasters, from mass casualty events to hurricanes, blizzards, and wildfires. The key areas listed in the paper build upon that work and are applicable to other types of disasters. For example, leadership, emergency readiness and crisis response, patient safety, and high-reliability are critical components that health care organizations need to have in place whether there is a crisis or not. This document, along with Joint Commission standards and requirements—particularly in emergency management—are meant to assist hospitals in planning their response to potential emergencies that fall on a continuum from disruptive to disastrous.

Dr. Green:  It doesn’t matter what the disease or disaster might be, this document will be extremely useful for anything that affects a community. Any type of mass casualty in terms of working with the worried well, or making sure ERs are not overrun. It will help hospitals maintain communications and ensure that supply chains aren’t disrupted. This is valuable for any event that has the potential to overwhelm a health system. There are a lot of components here tied to infectious disease, but for anything that could overwhelm the local health system, there is benefit in this report.

Jason: We are referring to this as a living document. What is a living document?

Dr. Green: I’m from the military and we know very well that a plan is always the beginning. When reality meets the plan, things change. This is an organized approach for dealing with a pandemic or other disaster. On the other side of that, all facilities could face different realities…both with this pandemic or the next disaster that forces them to adapt quickly and to be clever in terms of how they leverage this knowledge to solve problems that weren’t anticipated. No disaster ever goes according to plan. But this document will help organizations evaluate their readiness. As we continue to learn more from the COVID-19 pandemic, those lessons will be added to this living document.

Jason: You were essentially gathering lessons learned as those lessons were being learned?

Dr. Green: That is correct. We were using people who were at the forefront and we supported them to take a little time when they had breathing space to get everything documented.

Jason: How do you see the cross-entity collaboration take place between health care providers and the regulatory side?

Dr. Green: When you have an event this complex, no one organization can make key decisions. The level of collaboration that is required is pretty amazing. Just within a hospital—when critical care needs are soaring and the facility is being overrun by demand for services—everyone has to come together to determine how to most effectively use the available resources and how to expand that capability. Leveraging facilities outside of the hospital where care could be provided, for example, goes beyond public health. It gets into city, county, and state requirements. Capturing the lessons learned is important, and capturing it accurately is equally important. It is not like just one part of the hospital was dealing with the pandemic, it affected every department and every employee. It was important to develop collaborative teams, not only locally, but also collaborative teams that work at the local county, state, and federal levels.

Jason: Early on in the pandemic, the focus was on identifying alternate care sites. The priority has since shifted to making it through the backlog of deferred care. What are hospitals doing to help patients feel safe?

Dr. Chassin: Many actions are being taken by hospitals to help make patients feel safe. This includes the use of masks and other personal protective equipment, visitor restrictions, pre-screening processes, cleaning and disinfection, and much more. Hospitals that continue to treat COVID-19 patients while resuming more routine care have the special challenge of separating and isolating COVID treatment areas from those used for non-COVID patients wherever possible. Hospitals and other health care organizations across the nation have had to adapt quickly. The Joint Commission has been compiling resources and guidance to provide health care staff with the most pertinent information to best meet their needs as they battle COVID-19.

Jason: Who contributed to this report? How was information gathered?

Dr. Green: We worked side-by-side with leaders from hospitals and health systems as they tried to solve difficult supply chain issues early on during the pandemic. We worked with them as they faced infectious disease issues and communications challenges. Everyone was facing a similar set of issues. That is why the document is organized the way it is. There were issues that all facilities faced, and we were able to bring it together in a way that is succinct. The lessons outlined in this document will look familiar to people who lived through it. We aren’t trying to give them novel approaches, the idea was to capture what happened and make that information available to facilities in areas that were not hit as hard by the pandemic. Hospitals in New York City were in the epicenter early on, and we were heavily engaged with them to set up call centers and determine how to get information out.

Jason: Once the world has moved past this pandemic, how will hospitals be different than they were a year ago?

Dr. Chassin: The pandemic has certainly accelerated positive change in many ways, not only in offering virtual services to ensure safety and improve convenience for patients, but also in how other stakeholders—such as The Joint Commission, Joint Commission Resources, and our Center for Transforming Healthcare—work with health care organizations. As soon as the pandemic halted The Joint Commission’s ability to conduct on-site surveys, we rapidly innovated to deliver our surveys and engagements virtually. Our virtual solutions allow us to review policies and procedures with accredited organizations, conduct interviews and discussions with patients and health care staff, and even conduct building tours, all via video conferencing. We believe that many of these accelerated innovations will remain well beyond the current crisis and result in more efficient and creative interactions between health care stakeholders, and most importantly, between health care providers and their patients across the country and around the world.

This article is part of an ongoing series of interviews with executives. The executives’ participation in this article are solely for educational purposes based on their knowledge of the subject and the views expressed by them are solely their own. This article should not be deemed or construed to be for the purpose of soliciting business for any of the companies mentioned, nor does Deloitte advocate or endorse the services or products provided by these companies.

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