By Eric M. Stone
Prior to the outbreak of COVID-19, the healthcare industry in the United States was in the midst of an intense refocusing on patient-centered care. This evolution was defined by a number of innovations, policies, and even federal reimbursement programs that prioritized emphasis on and impact to the patient experience. It led to changes in everything from the quality of hospital food, valet parking, and room amenities to fundamentally reimagined standards of care for even mundane procedures like blood draws.
The rapid spread of coronavirus and the consequences of the resulting pandemic on health systems around the country are significantly reframing this dynamic. An all-in focus on treating COVID-19 patients sidelined elective procedures, routine care, and caused many patients to avoid or defer timely treatment for conditions like heart attacks and strokes. The result is that our country’s health system is just now emerging from “on pause” with truncated timelines and “build the plane as you fly it” mentalities for how to restart and even contemplate a new abnormal.
As we peer ahead to imagine what the future might look like, it’s clear that patient experience as we knew it just earlier this year will cease to exist. Instead, it will be replaced by the dual and interrelated realities of patient and practitioner demands. These two groups harbor pandemic-driven negative perceptions, fears, and concerns about our healthcare infrastructure that have the potential to impair the practice of even the most basic medical care.
Routine Care Avoidance
These fears from a patient perspective were brought home to me twice in the past few weeks. Since I was diagnosed with Crohn’s disease as a teenager some 30-years ago, I have had regular visits with my physician. Normally, I am a “people person” who prefers face-to-face interactions with those in my personal and professional lives. But last month, I conducted my first-ever telehealth appointment for a routine check-up because I refused to set foot in a hospital.
It simply makes sense to handle the routine at a remove – why expose myself and my subpar immune system unnecessarily? I was pleasantly surprised by the experience itself. At a time when we’re all meeting over Zoom, having my regular check-up “at a distance” felt natural and informative – and it was just about the only way I’d ever consider engaging with the hospital…at least for now.
Amidst this all, my three-year old terrified my wife and me when he developed a 105-degree fever. We are no strangers to childhood fevers, but this was a frightening scenario made all the more so because of the growing prevalence of COVID-19 at the time. After much consultation, handwringing, and debate, we decided to treat him at home instead of risk exposure in the hospital.
I’m relieved to say that everything turned out fine and it was a short-lived spike, but it’s a telling insight into the mindset of patients today – including those of us who work in the healthcare industry. Even a minor fever normally sends most parents rushing to their child’s doctors office or emergency room. To incorrectly assume that a hospital was a greater risk to my child then self-treating a 105-degree fever speaks to the irrational fear and misinformed decision-making this pandemic has fostered and its power to keep us all out of the healthcare system.
Practitioner Skepticism and Resentment
This same basic risk-reward computation will also surely play out for our healthcare workers. We’ve already seen nurses and physicians critique their employers for what they feel is inadequate protection or faulty leadership and priorities during this outbreak. While many have remained on the job out of a sense of duty to their patients, the growing doubt and resentment will certainly linger long after the pandemic has (hopefully) subsided.
As we learn to live with the virus and we begin to see electives and routine care once again allowed, it’s easy to envision a range of workers from transport and cafeteria staff to nurses and aides deciding to stay away from the job until they feel reasonable expectations about safety, prevention, and compensation are being met. And the number of clinicians and healthcare staffers who will either retire, or seek employment in alternative industries, could unfortunately become significant.
Planning for the Hospital of Tomorrow
Health system leaders must begin planning now for this new reality. Conversations have certainly already begun about the hospital of the future and what changes lie in store for standards of care, physical infrastructure and layout, budgets, workplace safety and practitioner well-being, and innovation paths.
But, top-down decisions based on historical trends or projections absent real input from patients and practitioners in this moment will lead to a long-term undermining of confidence in the system. There is simply no modern precedent for this sudden and dramatic shift in expectations, and Patient Advisory Councils alone won’t cut it.
The reality is that the lists of “nice to haves” and “need to haves” for patients and practitioners will become increasingly polarized, with the latter defining the table stakes they will require before returning to the hospital. These demands will then become the financial lens through which health systems and leaders must make future decisions about standards of care, innovations, and investments.
If they have not already, providers will soon realize they are no longer in the driver’s seat when it comes to care decisions and that employee and consumer trust in them has been severely compromised. They must begin to take strong and decisive action to meet patient and practitioner demands or people will not walk back through their doors. Over the coming months, no decision about a hospital or its operation will be made without first asking how it not only satisfies patient and practitioner demands, but also reassures and delights both stakeholders.
So how must health systems think about and plan for this eventuality?
Protection & Safety
Outbreaks of antibiotic-resistant bugs or Ebola have always made patients and even practitioners queasy about entering the hospital, but these were often short-lived episodes. Now, health leaders must double down on promises to keep patients and practitioners safe in the face of an invisible but persistent virus that has changed our trust in the system.
This response could take the form of deliberate decisions on hospital infrastructure and layout, bringing changes to the very physical plant that supports our medical care. The concept of “social design” looks at how everything within a hospital’s walls contributes to the level and quality of care it can deliver. From the placement of beds to ventilation systems to the flow of staff into and out of a nursing station, leaders must revisit these basic assumptions post-COVID. And a new onus exists for administrators to communicate these decisions and capabilities to patients and potential patients.
Systems will also likely maintain existing social distancing guidelines, perhaps even taking them a step further with wayfinding in the halls and waiting rooms using explicit signage and direction. Enforcement of these protocols will be essential. And of course systems must stock and deploy adequate stores of PPE…easier said than done.
New infection standards will also emerge. Consider the fast boil of Kinnos, an upstart founded amidst the Ebola crisis with a new technology that enforces real-time quality control and compliance every single time a surface is disinfected.
We have already seen the dramatic remaking of care in the midst of COVID-19. The boon in telehealth is just one example that will certainly continue to grow and expand. Our own work at Velano on One-Stick Hospitalization and removing the needle from inpatient blood draws has taken on new urgency in the fight against the pandemic, and we hope will continue to change the way patients and caregivers interact far after.
But there will certainly be more changes on the horizon, perhaps new robotic technologies for arms-length treatment protocols and remote or personal health monitoring from home, as a result of this outbreak. But it will all be focused on transforming how patients and practitioners engage with health systems across the country – while both reassuring and delighting.
Finally, recent events remind us that we are all members of the community, and hospitals have an integral seat at the table as facilitators of population health. Systems and leadership cannot rely on philanthropy and good corporate citizenship, they must actively engage on the issues that matter most to their staff and patients – as these stakeholders are members of the extended community.
From food drives to financial education to emerging health policies, hospitals must become more deeply entrenched alongside those in their communities. The early and immediate signs are promising, as our hospitals are our extended homes. I’m cautiously optimistic, and appreciative of all that our caregivers and administrators are doing to keep us healthy.
Eric M. Stone is a health care entrepreneur, patient advocate, chronic disease sufferer, advisor to several healthcare upstarts, and co-founder and chief executive officer of Velano Vascular.