The challenge now is to institutionalize many of those process improvements in order to enhance medical care going forward. JL
Melinda Buntin and Kristine Anderson report in Stat:
Anesthesiologists no longer (doing) elective surgeries help with intubations, cardiologists volunteer on Covid wards, medical assistants reallocate from specialty practices to primary care, teams modify facilities to accommodate pop-up ICUs and local staff figure out what safe health care looks like in their hospitals. We saw bureaucracy decrease, hierarchical structures flatten, siloes shatter and talent unleashed. Cross-departmental problem-solving achieved results. Emergency load balancing meant more people had access to lifesaving care. Innovative workflows contributed to the fastest vaccines ever. Health systems need to apply such agility and collaboration to long-standing needs.Ayear into the Covid-19 pandemic and the U.S. is still battling this crisis. As the country enters its second and third waves of cases, we know it won’t be back to “business as usual” soon. But was “business as usual” in our health care system really working?
The two of us have devoted our lives to health care and to thinking about its future. We’ve watched the pandemic expose critical fissures in the country’s infrastructure, like supply chain challenges that left health care workers without essential protective gear, tragically unequal access to care, too many Americans dying from treatable diseases, and public health capacity constricted by underfunding.
We’ve also observed with awe as care teams — grappling with workforce shortages and other long-standing problems — have continuously risen to the challenge with formidable innovation, decisiveness, and collaboration.
During this health crisis, we have the opportunity to ask: How can the U.S. emerge from it stronger?With our collective perspectives from government, academia, the private sector, and federal contracting, we recently considered where the system is strong, where it is weak, and where it can go from here. To our surprise, we came away with a sense of optimism — and urgency.
Health care is innovating right now
To keep patients, staff, and communities safe, frontline health care workers have battled urgent and enormous challenges like understaffing, space shortages, and supply issues.
Through swift, centralized decision-making within organizations, we’ve seen anesthesiologists who were no longer assisting with elective surgeries step in to help with intubations, cardiologists volunteering as “super residents” on Covid-19 wards, medical assistants reallocated from specialty practices to primary care to support chronic disease, and local staff figuring out for themselves what safe health care looks like in their hospitals.
Care teams modified facilities to accommodate pop-up intensive care units, created ad hoc cooling systems to support more ventilators, and more. These efforts saved time for overworked staff and helped reduce exposure, maximize available personal protective equipment, and facilitate patient treatment and safety.
“How can I help?” has become the mantra in health systems nationwide. Even after the pandemic subsides, this resourcefulness, resilience, and real-time problem-solving will be essential for hospitals and other care facilities to harness the full potential and talent of their staff to drive the future of health care.
It’s faster than we thought
Slow adoption of technology, such as telemedicine and the glacial shift to electronic health records, has been a long-cited obstacle to getting innovation into the hands of care providers and patients. Covid-19 has kicked technology adoption into overdrive. Along with businesses and schools, health care became remote at an unprecedented rate in March 2020. Areas not previously associated with telemedicine, like post-surgery follow-ups, physical therapy, and rehab, pivoted to remote delivery made possible by technology like smartphones and high-capacity networks.
This momentum can be harnessed to accelerate innovation in other areas of the health system. Progress needs to continue in the stubborn area of electronic health record interoperability and in speeding the process of credentialing and onboarding care providers. Systems must take advantage of technological innovations like real-time data analytics and AI-powered tools. Consumers should also have improved access to telehealth in addition to easily accessible follow-ups on appointments, lab results, billing and pricing information, and care options to help make more informed health care decisions and attain better care outcomes.
And it can be quite agile
As care teams rallied to respond to Covid-19, we saw bureaucracy decrease, hierarchical structures flatten, siloes shatter and talent unleashed.
Necessity fueled new practices like hospitals and government agencies coordinating large-scale emergency response plans and directing patients to the most appropriate digital or physical care channels. It also loosened regulations and facilitated new practices. For example, 24 states relaxed or suspended laws to allow the real-time expansion of ICU and acute care beds to make them available in emergencies.
Restrictive state-by-state licensing for doctors, nurses, and other clinicians continues to hinder access to care. It prevents health practitioners from practicing to the full extent of their training at a time when the medical community faces a shortage of health care workers and makes reimbursement for telehealth care provided to patients out of state incredibly complicated. Making Covid-19 telehealth and telemedicine solutions permanent can expand the reach of care teams and health care professionals’ scopes of practice.
The cross-departmental and cross-organizational problem-solving of the past year achieved remarkable results. Emergency load balancing across health systems meant more people could have access to lifesaving care. Innovative workflows contributed to the fastest vaccines that have ever been created. Health systems need to apply such agility and collaboration to long-standing community health needs, such as unequal access to preventive care in low-income communities and the creation of much-needed drugs.
The future of health care starts now
As the country rebounds from Covid-19 and focuses on other complex health issues — lowering drug-discovery costs, preparing for the next public health crisis, revitalizing our health care workforce, and more — it cannot afford to simply drift back to “normal.” This national crisis exposed fissures, but it also produced collaborative disruptions that transformed and strengthened U.S. health care systems.
From quickly adopting a telemedicine-first posture to ensure that patients had access to care to demonstrating the need for flexible bed and staffing capacities to meet the rising patient demand and to proving the ability to conduct real-time dynamic surveillance, the combined resources and ingenuity of public and private entities at all levels generated groundbreaking innovations that might not have occurred without the pandemic.
When faced with crises, our nation has openly reflected on the causes and consequences and come together to foster change. This pandemic should be no different. Once cases subside and the nation begins to recover, the Biden administration and Congress should empanel a national commission to capture, institutionalize, invest in, and accelerate continued adoption of these innovations. This commission should have three chief tenets:
- First, it should have the power to make tough calls without political interference or lobbying, similar to how the Base Realignment and Closure Commission has operated, ensuring autonomy in making the necessary choices to efficiently and effectively support U.S. troops.
- Second, it should be given sufficient resources to formulate a national road map for closing gaps and building capacity, much like the 9/11 Commission accomplished through development of a thorough and actionable report.
- Third, and most importantly, it must look beyond this crisis and define how future national investments can build on these innovations to strengthen our health care system and produce additive effects.
We believe that the development of the U.S. Global Positioning System offers an intriguing model. This revolution in positioning, navigation, and timing technologies, initially developed to support a military mission, was scaled to create new businesses and services that have transformed the lives of all Americans and is now ubiquitous in technologies we use daily.
Catalyzed by a crisis like no other and working together under a common vision and an established commission, the U.S. can realize a new future for health care that’s far better than business as usual.
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