4 Lessons for Navigating a New Reality

Strategy and innovation leaders from hospitals and health systems across the country recently came together to share lessons learned and plans for the future as the field moves from response through recovery and on to rebuilding. The virtual “Navigating a New Reality” program Sept. 14-16 from the AHA Center for Health Innovation and the Society for Health Care Strategy & Market Development generated a wealth of insights for health care leaders. Here are four key lessons from the program.

1. Hospital-at-Home Could Be Virtual Health’s Future.

Given the exponential growth that nearly all providers achieved during the pandemic, speculation has begun about what long-term changes may result for regularly engaging consumers remotely. Charlotte, N.C.-based Atrium Health has a solid idea of where it’s headed.

In April, it launched a hospital-at-home model for patients with moderate to mild symptoms to free up hospital beds for its sickest COVID-19 patients while providing 24-hour comprehensive care remotely. The two-tiered model comprised observational care and acute care. For observational care, nurses provided protocol-driven telephone assessments while virtual provider coverage was available 24/7 and a get-well loop was established for patient engagement and feedback. Acute care services included nurse and physician coverage; home monitoring for oxygen levels, blood pressure and temperature; advanced therapies including EKG monitoring, IV treatments, respiratory protocol and labs; community paramedicine and nurse home visits; plus daily virtual provider rounds.

With a 10-year head start on implementing virtual care, the health system quickly razed organizational silos to treat more than 15,000 patients, noted Scott Rissmiller, M.D., chief physician executive. Only 3% had to be transferred to a higher care level. Within a week of the program’s launch, no-show rates dropped from 25% to 10%, a level that has persisted.

Atrium now is reimagining what virtual care could be. In June, when patient volume decreased, it paused the virtual hospital for a month to adjust and create a more cost-efficient model to expand beyond COVID-19 patients. The health system is now focused on easing inpatient volume, decreasing length of stay and readmissions. And instead of focusing on specific disease sets, clinicians are beginning to concentrate on subpopulations — those who will benefit most from care — as the organization tries to perfect its virtual care strategy. Among the virtual services it’s designing or refining: critical care, hospitalists, inpatient infectious disease, ambulatory units, school nurse programs, neurology, stroke and behavioral health.

2. The New Financial Imperative: Mastering Uncertainty.

Hospitals and health systems are rebounding financially from the worst impact of the pandemic as patients have begun to return for nonemergent surgeries, diagnostic tests and other services. But there’s a long way to go to reach a state of normalcy, consulting leaders from Oliver Wyman noted. They expect wide variability in financial outlooks in 2021 depending on providers’ ability to effectively manage cash liquidity and capital, reduce costs and to address regional spikes in the virus and workforce reduction moves by major employers in their region.

As for how to deal with these greater levels of financial uncertainty, the speakers offered these five recommendations:

• Make decisions today to consider a range of potential outcomes, with a clear view of epidemiological and economic scenarios.
• Rapidly refresh results with the latest information and changing future outlook. Use real-time tracking/monitoring to address rapid changes.
• Test the impact of deviations in assumptions in areas like consumer demand while always linking back to the business impact.
• Create a governance playbook and response framework, pre-agreed upon by executives, on actions for worst-case scenarios.
• Effectively respond to heightened attention and inquiries from senior leadership, board committees and external stakeholders.

3. Addressing Burnout Must Go Beyond Reducing Negative Experiences.

Forty percent of clinical teams report experiencing burnout, a situation only exacerbated by COVID-19. Yet, focusing solely on negative emotions when measuring or addressing burnout is a common mistake many leaders make, said panelists in a session on increasing clinician resilience. Organizations should measure burnout, but also emotional thriving and emotional recovery.

Once an organization understands its baseline, it can improve the resiliency of its workforce by using a number of tools and techniques shared by the panelists, including experience mapping. With this technique, teams map their daily work experience with the goal of not only reducing friction, but increasing gratitude and opportunities for human connection, particularly during patient encounters.

4. Get a Firmer Grip on Consumer Insights.

Understanding consumer data and applying it to organization and business unit strategy was critically important before the pandemic. Today, it’s imperative to achieve growth, noted Northwell Health’s Jeffrey A. Kraut, vice president of strategy and analytics.

Through consumer surveys it conducted every two weeks during the pandemic, the New York-based organization learned where patients were in their care journey, key demographics, health status and history and how they wanted to engage with the health system. They also wanted to understand the economic impact the pandemic has had on consumers as well as their emotional state, attitudes toward getting medical care and medical distancing.

Among the learnings: The digital front door will be a critical success factor, with telemedicine being the first stop for most health care interactions. Northwell Health is seeing increased acceptance of new home-based and post-acute care models. It’s now looking into how to redeploy the Northwell workforce into virtual care in the home. It can’t do this alone. Instead, its role is to establish a platform to turn separate services, technologies, solutions and data into a continuous care experience for the consumer. And it’s not all just digital. Bricks and mortar will change as well. The way patients come in, how they register, how they move through the system, their disease state and preferences in how they want to be engaged are all vital success factors in meeting consumer expectations.