Contributors: Hisham M. Valiuddin, DO, WG’22, Keith C. Hemmert, MD, and Erika James, PhD
To learn more about Hisham, Keith, and Erika, click here.
Every organization in the world has had to rethink operations due to the COVID-19 pandemic. Facing a global pandemic on a scale not seen in over a century, organizations in every industry faced massive disruption. The healthcare industry faced perhaps the most difficult challenge: not just to survive the pandemic, but also to care for the victims of it. Although hospitals manage “emergencies” routinely, the types of crises hospital administrators and healthcare professionals are accustomed to are generally narrowly focused on medical emergencies, not sudden, massive business disruptions such as those caused by the pandemic.
One way to define a crisis is an event that threatens the financial viability, reputation, and mission of an organization. Hospitals were vulnerable to all three risks during the height of the pandemic. Over the past 2 years, hospitals and healthcare staff have been thrust onto the front lines of a battle not only to save the lives of coronavirus patients, but also a battle for their own institutional survival. Declining revenues, a weakened workforce, and skepticism of management combined as a potent threat to even the most robust healthcare systems. Based on the experiences of an internationally renowned tertiary care academic health system, we outline the crisis management strategies that were used to survive and thrive through this crisis.
Management and Trust
As with any crisis response, one of the key challenges to leadership during the COVID-19 pandemic was trust. As the world looked to healthcare systems for answers, healthcare leaders had little accurate or reliable data to understand and predict the virus. Rapidly developing projections were frequently unreliable. Hospital leaders were asked to provide immediate answers to their staff and the general public, while navigating the tension between maximizing transparency and unreliable information.
As the massive scale and deadly threat of the pandemic became apparent, hospital staff asked tough questions that had a real impact on their safety: how could staff without access to appropriate Personal Protective Equipment (PPE) be obligated to care for patients who could infect and kill them? How could healthcare workers protect their loved ones? What were the best strategies to allocate scarce life-saving resources? How could a balance be struck between COVID-19 care and non-COVID-19 care? These frank questions called for frank answers.
One way to build, maintain, and operationalize trust is by delineating trust in communication. In doing so, transparency – including transparency about the unknowns – was crucial. Daily communication and frequent town hall meetings relayed the latest information, successes, and developing threats to employees. Full disclosure of the information available, as well as disclosure of the reliability of that information, was paramount for developing and maintaining dependable relationships.
Operational Disaster Plan
Over the past two decades, healthcare systems have faced the crises of SARS, H1N1, Ebola, and now COVID-19. There has been a trend of novel viruses causing pandemics roughly every five years, with each subsequent one being more disruptive than its predecessor. Hospitals have been able to tackle these sudden crises by preemptively establishing a “command center” strategy for corporate governance before the next threat manifests – a game plan that can be quickly implemented when a massive threat emerges.
A command center strategy consists of organizing a command structure, that includes leadership personnel, key stakeholders, and operations managers. The purpose of the command center is to coordinate logistics, briefings, finances, and recovery. This strategy builds a clear chain of command and organizes resources at precisely the moment when the confusion of a crisis threatens clear communication and assignment of responsibility.
When time is of the essence, executives feel pressured to provide answers about matters that are not in their area of expertise. Accustomed to being the source authority for the most difficult dilemmas within the organization, they are thrust into an unfamiliar position which, without an appropriate strategy, can lead to grave errors in judgment. Fueled by the stress of a massive threat, these errors can rapidly degrade into chaos, with people thinking and acting for only themselves or their units, rather than for the organization. The key to navigating these complex situations is investing in relationships before a crisis occurs. Leveraging preexisting relationships allows for team members to clearly understand roles, responsibilities, and limitations.
As with all the previous communicable pandemics, respiratory protection was the most significant vulnerability with COVID-19. As supply chains broke down, many people within the organization generated ideas for solutions; some even invented their own equipment. With a clear hierarchy and clear communication streamlined by the command center, leaders were able to identify high-value ideas and use a team-based approach to rapidly overcome barriers to implementation, such as scalability, an intricate regulatory environment, and complex logistics to quickly implement life-saving solutions.
Collaboration and Flexibility
Novel circumstances require novel solutions. Threats from an external crisis provide a unique opportunity for organizations to develop new collaborations while facing a common adversity. Enterprise-wide problems, such as the shortage of PPE, managing non-urgent medical procedures, and the occupational hazards of caring for COVID-19 patients, brought about system-wide innovations and provided a profound moment for breaking down barriers between departments. Innovations such as integrating new telehealth technology into a large healthcare system – a process that would typically take years – were achieved in mere weeks, capitalizing on the sudden alignment and flexibility of disparate teams. New collaborations with the neighboring School of Engineering led to creative solutions, such as manufacturing our own PPE. These examples of rapid innovation and massive change in a short period of time highlight the potential for organizations to strengthen during a crisis.
One of the biggest vulnerabilities throughout the pandemic has been the workforce. Contracting the virus, exposure to the virus, and quarantine requirements thereafter created a dynamic challenge both to individual staff and patient safety. Decisions to modify staffing models were made with a highly visible commitment to both missions of caring for patients and safety of staff. By unifying under these dual commitments, healthcare workers and management teams successfully developed multiple staffing contingencies, including building teams to work in rotations to have a reserve staff in case of an outbreak among workers. Focusing on flexibility, collaboration, and commitment to the mission, allowed the organization to leverage the crisis to foster a culture of solidarity.
Financial Viability
Financial survival was not made a priority over health, safety, and wellness of staff. Given the global health crisis, a public display of financial incentive-driven reasoning would have alienated staff and patients and fostered a reputation of fragility rather than of strength and durability. However, conducting a financial analysis in the background was necessary for organizational survival. Healthcare systems ultimately needed to survive the pandemic in order to continue the mission of serving patients. Business impact analysis, or hazard vulnerability analysis, and business continuity planning were essential for the survival of the organization’s employees and its balance sheet. Such analyses can identify key areas of risk that represent opportunities to mitigate losses.
Financial crisis response was as important as the operational crisis response. Immediate reactive measures such as cost savings from staff reductions were tempting, although not the appropriate sustainable solution. Such a strategy would have had a longstanding, detrimental effect on the organization’s identity: the organization abandons its employees at a moment of shared vulnerability resulting in a longer-term deterioration of trust. Additionally, the human resource costs of firing and later rehiring employees may have outweighed the cost savings achieved in the short-term. Not knowing when the pandemic would ease, our healthcare system did not pursue a strategy of downsizing, despite the massive fluctuation in demand for care. Rather, the healthcare system redeployed staff who were not being used for patient-facing services to help with the crisis response.
With the national pandemic, supportive laws and regulations assisted with financial optimization. Government support for essential services mitigated short-term losses and provided supplemental revenue. The federal government offered minimal interest rate loans to businesses, recognizing organizations' acute financial needs. In healthcare, rapid amendments to the Medicare Physician Fee Schedule by the Center for Medicare and Medicaid Services to include parity for telehealth services provided an opportunity not just to reduce financial vulnerability but also to continue caring for patients.
Conclusion
The COVID-19 pandemic provided a rare opportunity to stress test every organization. Each organization could be judged on how they coped with the same universal adversity. An organization’s mission, vision, values, and culture were pressure-tested through the historic crisis. Institutions with a strong foundation in crisis management shined, while those with cracks in the foundation had those weaknesses exposed. The principles outlined herein highlight the need for leaders to prepare proactive crisis management strategies. Doing so will enable them not just to survive a crisis, but to convert the threat into an opportunity to reinforce the mission, vision, and values of the organization.
Acknowledgement
We would like to thank Gary L. Scheib, previous University of Pennsylvania Health System COO and previous Hospital of the University of Pennsylvania CEO for his thoughtful insights and perspectives.
Contact Hisham at:
[email protected]
www.linkedin.com/in/drvaliuddin
Contact Keith at:
[email protected]
https://www.linkedin.com/in/keith-hemmert-3010932/
Contact Erika at:
https://www.linkedin.com/in/erikajames/