The quick work health care organizations did in 2020 to continue patient care and keep staff on the job helped maintain their operations in a fashion through the vagaries of Covid-19.
These days the industry is looking at what of that period could work and what won’t in a post-pandemic world.
Leaders are being challenged to create a mode of business sensitive to the new demands of patients and staff, such as remote access, that will last well into the future and withstand lockdowns, partial reopenings, social distancing, masking, and other safety measures that might accompany another outbreak.
Area health-care professionals gathered recently to discuss their shared experiences and options during a recent Panel of Experts event at Buffalo Business First.
One panelist, Dr. Robert Zielinski, an oncologist and associate medical director of the Buffalo Medical Group, best captured health care’s challenges of the post-pandemic era.
“Any big stressor like the pandemic ushers in dramatic change and accelerates change that was ready to happen anyway,” he said. “It also shows you weaknesses in your system that are not ready to accommodate that change.”
Joining Zielinski on the panel were:
- Dr. Maritza Baez, medical director, CINQ Care,
- Dr. Renier Brentjens, deputy director and chair of medicine, Roswell Park Comprehensive Cancer Center
- Michael Lee, chief operating officer, Evergreen Health
- Charlene Ludlow, senior vice president of nursing, Erie County Medical Center
- Joyce Markiewicz, chief business development officer, Catholic Health
- Dr. Michael Mineo, interim chief medical officer and vice president, Kaleida Health
- Dr. Nilofar Sarvaiya, psychiatry specialist, Spectrum Human Services
Anticipating an outbreak
At Roswell Park, the new normal is the cancer center’s readiness to respond to another outbreak, Brentjens said.
“We are slowly trying to bounce back,” he said, “but very cautiously, because we need to be cognizant of the fact that with each new strain that is identified and expands in our population, we need to be prepared to go back to some of those draconian precautions that we had at the height. We can’t let our guard down.”
The mask mandates, social distancing, limitations on caregiver visits and other safety measures imposed during the height of the pandemic, meant to protect all who use or work at the cancer center, were the cause of much stress on faculty, staff, and patients, he said.
More open lines of communication, particularly between staff and supervisors, will address any strain that could come with another outbreak.
“Communication between staff and supervisors has become more profound than it was pre-pandemic when much was taken for granted,” Brentjens said, adding supervisors now are tuned into whether staff are successfully balancing home life and work life and how their situations can be accommodated, Brentjens said.
Rise in telehealth
Panelists identified the biggest imprint from the pandemic on their organizations is the dramatic shift to telehealth services. Baez called the new option an “explosion.”
“We’re calling patients on the phone or video, reaching them where they are, whether they are in our neighborhood or wherever they are,” Baez said.
This has led CINQ Care to create a 24-hour nurse line that is staffed by nurses as well as physicians, physician assistants and nurse practitioners. The service also allows CINQ Care to triage the patients’ health care needs so they are prepared should providers need to physically go to see the patient, Baez said.
While telehealth has become popular for the convenience of providers, staff and patients alike, it posed some difficulty at Evergreen and its mission to serve the safety-net population. Poor access to technology and the Internet created a barrier for some and limited the organization’s ability to use it fully, Lee said.
The Buffalo Medical Group was poised pre-pandemic for the shift to telehealth, having made an investment in infrastructure that would accommodate it well, Zielinski said. The medical group is running up is the willingness or ability of patients and staff to use it.
“We have the availability to do things and people are not very good at it,” he said. “They’ve been able to get by up until now, but when this became the more prominent way to do things, the efficient way to do things and in some cases the only way to do things, we hit a big barrier. That’s an obstacle to progress.”
However, there is a subset of patients who are using the technology successfully and going into the medical office less often “without one ounce of compromise in their care,” he said. The administrative offices, too, are less populated, and staff increasingly are working remotely, which will continue to be important for any practice to stay competitive, he said.
Staffing issues
Staffing indeed has taken on new and different dimensions as organizations offer benefits previously unheard of to attract and retain workers.
Recruitment is a challenge as numbers of people going into the health professions, across all types of jobs, are low, Ludlow said. From nursing to the new positions such as mental health techs and navigators, who help direct patients through the health-care system, the interest does not meet the demand, she said.
Recruitment has consumed every level of Catholic Health, not just the nursing staff, Markiewicz said. The shift to remote work has been successful in some areas but also created new challenges: how to best communicate, manage productivity and getting work done, she said.
“Keeping patients’ access to care, keeping the building open, keeping everything moving along has been impacted by the staffing shortage. Getting qualified staff, keeping them, retaining the talent you have is difficult,” Lee said.
Attracting workers
Health-care organizations have been creative in their efforts to fill positions left by anticipated retirements and unplanned departures brought on by pandemic fatigue. The need is in entry-level positions on up, in every department, Markiewicz said. An aging physician population also is worrisome.
Each of the organizations represented on the panel concentrated on looking attractive to potential hires.
Initiatives at Catholic Health have included on-the-spot hiring during a recent job fair and working with the Ralph C. Wilson Jr. Foundation in a program called Transformational Healthcare Readiness through Innovative Vocational Education, or Thrive, which helps new hires manage and overcome work and home stressors during the first year of employment.
Evergreen’s no-weekends, no-evenings schedule has helped with recruitment. The federal student loan forgiveness program, which applies to those who have worked in health care or a nonprofit, has been beneficial, Lee said. Significantly, the organization also has aligned its human resource and diversity and inclusion teams, which has had an impact on recruitment.
“If we look at our staffing, we know that the Gen Z population makes up the biggest component of our workforce,” he said. “These folks are much more interested in work-life balance, what your organization is doing as far as social justice and racial equity component.”
Organizations need to ensure that they have a racial equity and inclusion plan and are committed to it, Lee said.
Retaining workers
To retain workers, Evergreen introduced a hybrid model, depending on the job, that allows workers to work from home some days, and some from the office, Lee said. Evergreen’s shift to remote work forced by the pandemic was a challenge faced by most employers.
“We didn’t have a remote work policy prior to the pandemic, so launching that was not quite as easy as saying, ‘You can work from home now’,” Lee said. “Can the role work from home, can the person work from home, do we have the technology to pull that off? Do we have the physical assets to do that? That’s been the challenge.”
Addressing the exhaustion, the burnout, among caregivers, particularly those who worked through the height of the pandemic, has been a focal point for Kaleida leaders, Mineo said.
“The one tool we all have against that is to remind them of the meaningful work they do,” Mineo said. “As much as they are exhausted, we need them to keep coming in because the community still needs our health-care workers every day.”
Spectrum introduced four-day work weeks to offset burnout among those who prescribe medication, Sarvaiya said. Also, greater communication and support between supervisors has been welcomed by staff, she said.
Similarly, ECMC has regularly scheduled Schwartz Rounds, which are grand-rounds style events that focus on the emotional impact of patient care that care team members experience. It allows staff to talk about work-life balance, mental health and other issues that are affecting their jobs, Ludlow said.
Listening is the best, Brentjens said. He holds regular town-board meetings to do just that.
“That goes an extremely long way,” he said. “One thing I have found is you can’t tell them, ‘OK, we’ll fix it tomorrow’ but ‘We’re in the process. It’s going to take a while, but I hear you.’ I do that on a more continual basis so that staff that does most of the care for the patients feels like they are participants in that care.”
All the organizations are doing little things, too, to express appreciation to staff members: gift cards, weekly kudos, doughnuts, employee-of-the-month recognition, healthy snacks, brunches, lunches and picnics, visits by administrators.
“Some of them, they sound kind of silly when you say them, but the staff really appreciate them,” Ludlow said. “The C-suite people walking around with an ice cream cart. It sounds basic, but when you’re doing that at 2 o’clock in the morning, it’s helping the staff know that someone knows they have been there all night.”
Location
Mineo sees a significant shift in patient demands at Kaleida. They don’t want to travel for care in major hospital centers. Instead, they value the convenience and lower cost of treatment that can be done remotely or in a nearby ambulatory surgery center. There also is greater focus on keeping people healthy rather than treating illness, he said.
“Health care is moving toward a consumerism model where you need the convenience. People are busy,” Mineo said. “They will travel to tertiary centers for more sophisticated surgeries, but for the more basic they want to be in their community.”
Catholic Health remarkably began building a hospital in the middle of the pandemic.
The 10-bed hospital, which will replace the bankrupt Eastern Niagara Hospital in Lockport, will become a second campus for Catholic Health’s Mount St. Mary’s Hospital in Lewiston when it opens in 2023.
“What we want to achieve with the new hospital is to examine new care-delivery models,” Markiewicz said, “so that we’re not doing things the way they have always been done. That’s the mantra. We can’t go back to the way things were. We have to see how patients want to receive their care and how do we do it in a way that’s sustainable.”
ECMC, too, embarked on a significant project, opening a new emergency department in the early days of the pandemic. The much-needed 50-station facility doubled in size from the unit it replaced, and continues to be at capacity, Ludlow said.
Mental health services
The medical center also has seen an increase in patients seeking mental health care services, putting ECMC’s psychiatric emergency room “to its limits often,” she said.
The facility also added ambulatory mental health services, which have been accessed by a surge of patients who haven’t sought such care in the past. It was a service that the facility had not anticipated opening just yet, but changed its plans and quickened the pace of the project to meet the demand for services.
“That’s what this pandemic has done, changed people’s lives in ways they never anticipated,” Ludlow said.
Spectrum, too, has experienced the increase in demand for mental health services and treatment for the psychosocial challenges have come along with it, Sarvaiya said. These include transportation interruptions, childcare issues, bereavement, post-traumatic stress symptoms, depression, anxiety and domestic violence.
Spectrum, trying to be convenient for patients, has responded with remote sessions, and evening appointments, for example. It also has a well-developed case management service that can help patients engaged in treatment and address some of those psychosocial issues, Sarvaiya said.
The panelists’ hopes for health care during the next five years span all aspects of health care delivery. They include interoperability of health networks and patient records, tort reform, greater access and more possibilities for remote care, and social services such as housing and transportation.
An improved payment structure is critical, panelists said.
Mineo is looking forward to the shift to population health, one that recognizes results over services rendered.
“Kaleida is no longer going to be supported by a fee-for-service model, that the more I do the more I get reimbursed, but the less we do the more we can invest in providing care to the community,” he said. “My job, then, isn’t to do the colon-cancer surgery, it’s to make sure that the patients get their colonoscopy when they hit the requirements.”
Zielinski said the current system has only resulted in spiraling costs that aren’t balanced by quality. Put a doctor in charge, and start over, he said. Ask a patient who is in the best position to balance the science around the available diagnostic and therapeutic options and balance that against the cost.
“We think they are going to say, 'You and I, and not the insurer,' ” Zielinski said. “But that’s who’s making it now.”
The Future of Health Care: Roundtable - Buffalo Business First (bizjournals.com)