A version of this article ran in the March 2020 edition of Healthcare News.
The coronavirus (COVID-19) was declared a pandemic by the World Health Organization on March 11, 2020, and it has disrupted the global health community, sparking immediate concerns for all types of health care organizations.
With more than 414,000 global cases known at the time of publication—and approximately 75,000 of those in the United States—your organization should be asking important questions, including the following:
- Does our health system have a readiness plan?
- Are we prepared for patients and families presenting with symptoms, concerns and questions, and demands for access and treatment?
- Are our teams and facilities equipped for increased pressures around staffing, communication, triage and treatment, and more?
Lean methodologies—an approach to health care that focuses on continuous improvement and long-term success, rather than finding quick fixes—help provide insight into improving patient and staff safety. Our lean health care professionals—including physicians, clinicians, and former health care C-suite administrators—have confronted similar health crises with these practices, including the Ebola scare and the Swine flu, and can guide you through a pragmatic lean approach to help you prepare.
Below, we explore how lean can help your organization combat the coronavirus and establish best practices in the following categories:
Leadership responses and actions will need to vary by level.
During times of increased stress, it’s important that leadership stays focused and aligned to support the organization as a whole. Executive leadership should prepare by taking the following actions:
- Formulate a structured leadership response at the highest levels of the organization
- Create a clinical champions team that meets daily and reflects the structured executive leadership response
- Establish an easily accessible information hub for all staff maintained with accurate and timely information, protocols, announcements, and practices
- Make sure that administrator-on-call, incident command, and other critical phone numbers are up to date and readily accessible on this information hub
Leadership at the management level will want to focus on how effectively current processes within the organization are operating, and how they can be improved or amended based on patient influx or other unpredictable events.
With a crisis at hand, leadership will likely have to make many tough decisions in a short period of time. Avoid planning through excessive administrative meetings in conference rooms. Instead, learn by going to the gemba, or the place where the actual work is being done.
Here, leaders can better observe current conditions and practice humble inquiry—the act of asking rather than telling—to more immediately identify issues affecting patient care that require attention. Your leaders will see firsthand how patients move through your system, and how caregivers interact with them.
In addition to observing your people, your leaders will also be able to assess the use of:
By going to the gemba, you can determine what your teams need to do their work most effectively and experience the barriers that get in their way.
Consider planning a kaizen, or continuous improvement, workshop to evaluate and make changes to your current processes and operations. Kaizen workshops help to quickly:
- Identify the problem you’re trying to solve
- Map your current processes
- Create solutions
- Test on the gemba
- Run Plan-Do-Check-Act testing cycles
These workshops can also help management create standard practices and provide methods to train staff. Workshops also allow management to explore better methods for organizing workspaces.
With an increased workload and pressure to act quickly and effectively, management will need to stay focused and organized. Help keep important plans front of mind through the following actions:
- Avoid email clutter in your own inboxes
- Don’t contribute to staff email traffic unless necessary
- Rely only on trusted information sources when distributing information to staff
Daily Management System
Implementing a daily management system can build quality into your processes and help reduce clinical variation that prevents timely and appropriate care. Once in place, a system provides the structure and standard procedures needed for continuous improvement, against which you can reliably measure progress. Consistent use of a daily management system includes the following best practices:
- Use visibility boards for prominent display of cases, metrics, goals, and alignment
- Create efficient and effective huddles and shift start-up meetings
- Use frequent and short-burst coaching to solve problems and develop frontline staff
A3 thinking—a structured problem-solving approach that relies on critical thinking and root cause analysis—can help your organization identify and solve issues within your processes. By doing so, you’ll want to consider the following questions related to problem-solving:
- What actions are we taking?
- What are the expected results or benefits?
- How do we measure to know the impacts of change?
Kata Coaching—or Structured Teaching Routines
In a complex, rapidly changing setting, it’s often hard to know where to start in problem solving. Kata coaching is a consistent practice that can help you deliberately form new habits that spur improvement.
Management should help train staff members to form patterns of behavior that develop their skills to the point where actions become second nature. When confronting challenges and aiming for continuous improvement, leadership should ask staff structured questions to help them move from their current, or actual, condition to their target, or future, condition and to define barriers that need to be overcome.
These questions include:
- What is the target condition—or your ideal state if you succeed in improvement?
- What is the actual condition now?
- What obstacles prevent you from reaching the target?
- What is the next step you need to take?
- When can we go and see what we learned from this step?
During an outbreak, patient volumes and demand for appointments and advice will increase across all points of access, from scheduled and walk-in visits to phone calls and emails. It’s likely your organization will be inundated with information requests and communication needs, both internally and externally. Actions that can help support these influxes include the following:
- Prepare phone trees for higher volumes and routing to appropriate experts
- Prepare for stress and possible failure of your phone access systems
- Consider how you might redesign access strategies in innovative ways to improve everyday function and future readiness
- Fortify scheduling to accommodate staff who may become ill
- Plan for ambulatory pathways to avoid access paralysis
Preparing phone and front-desk scripts for staff to share with patients can help address their anticipated concerns. Helpful messaging directives could include the following:
- If you have symptoms, go here…
- If you’re a member of a vulnerable patient population, such as the elderly or the immuno-compromised, including cancer patients, take these precautions…
- If you have anxiety about illness, here’s what to do…
Consider how infected patients will move throughout your organization if demands for care increase. You can address these issues by working to:
- Create access and intake pathways for patients
- Anticipate protocols for various types of patient arrivals such as the emergency department, ambulances, and walk-ins
- Ensure that infected patients remain separate from noninfected patients and visitors
Keep in mind how the virus and dealing with its effects may impact your staff schedules and care teams. Support their well-being through these actions:
- Create deliberate staffing resources for absences
- Create, post, and socialize protocols for staff who may themselves be ill
If patient population numbers increase, you could experience an increased demand for supplies, as well as an influx of new test kits and safety materials. Keep procedures in place around organizing and monitoring necessary supplies through the following actions:
- Stock, organize, and train staff on protective equipment and testing kits
- Have contingency plans for supplies and supply management
- Establish clear protocols for equipment sterilization, cleaning, storage, and disposal of contaminated supplies
With increased activity across your organization, it will be easy for misinformation to spread or for directives to get lost in the shuffle. Keep your staff organized and updated with crucial information through the following actions:
- Establish a communication and information hub for staff who have questions or need materials to talk about the virus, treatment options, symptoms, questions, and concerns
- Identify champions who can serve as information hubs for questions, policies and procedures, and protocols
- Provide anticipatory guidance for staff around anxious or demanding patients, including scripting, coaching, and modeling
Triage and Treatment
Your frontline teams are often your best resources in determining how to confront problems that arise. Help empower your staff to prepare for a situation like the coronavirus with these actions:
- Create a clinical champions team and ensure that it closely aligns with executive leadership
- Identify clinical champions or leaders in key departments such as the ED, ICU, and primary care
- Facilitate champions in their taking the lead in communicating and supporting clinical care teams with triage, treatment, and notification and response in the event of a suspected case of coronavirus in your facility
- Establish, regularly communicate, and post clear protocols for triage and treatment
- Create conditions for an optimal response and to review, revise, and improve it at daily team huddles.
Consider how you will need to interact with patients based on the setting in which they’re being treated. Actions based on settings may include the following:
- In ambulatory settings, conduct phone, email, and virtual triage of patients if possible, including at the front door for an anticipated influx of walk-in patients
- Determine specific adjustments as needed for nursing homes, long-term care facilities, and home health care visits
Compose and implement separate evidence-based triage and care pathways for ambulatory patients who call, email, or walk into your clinics and hospital settings, including the following categories:
- Low-risk patients without symptoms
- Low-risk patients with symptoms
- High-risk patients without symptoms
- High-risk patients with symptoms
Patients will be worried and look to your professionals for information and reassurance. Keep patients properly informed and comforted through the following communications tactics:
- Create and post simple, straightforward messages and materials about hand hygiene and other relevant infection control practices
- Produce and distribute simple educational materials for patients to understand symptoms, precautions, and protective measures
- Arm your organization against disinformation and establish consistent and accurate messaging and patient information
We’re Here to Help
To learn more about how lean methodologies can help your organization prepare for and manage cases of coronavirus that could present in your health system, or to start testing your preparation process, contact your Moss Adams professional.
For regulatory updates, strategies to help cope with subsequent risk, and possible steps to bolster your workforce and organization, please see the following resources: