Interdisciplinary approach to COVID-19 has roots in lessons learned 100 years ago
In 1918, healthcare was up against an influenza pandemic that claimed the lives of millions of people worldwide. One hundred years later, hospitals and providers are struggling with challenges created by this century’s pandemic, COVID-19.
The hospital system I lead experienced about a 50% decrease in revenue during the pandemic’s peak earlier this year, along with increased operating costs, as we established new respiratory clinics and special isolation units to meet patient needs. We also saw increases in the use and cost of personal protective equipment and other supplies. We temporarily reduced the salaries of our leaders and physicians by as much as 20% and furloughed other team members.
Lessons learned during the 1918 influenza pandemic are relevant as we address this ongoing public health crisis—specifically, that the best medical care comes from interdisciplinary collaboration. This concept stems from my organization’s beginnings in 1920 when three physicians, motivated in part by the global flu pandemic, created a group practice with all medical specialists under one roof. This was the start of Virginia Mason Health System and our embrace of “team medicine.”
Reflecting on our 100-year history and navigating the present reality, there have been key lessons foundational to our work that have been tested and affirmed by COVID-19.
Employ systems-engineering: We quickly retooled operations as part of our response to COVID-19, including evaluating workflows to ensure we protect all patients and team members. These complex pivots have been guided by our management method, the Virginia Mason Production System. Adopted in 2002 and modeled after the Toyota Production System, VMPS gives our team members a common terminology for defining barriers and standard processes for innovation and solution development.
The approach guided a nurse-led, companion-support program to facilitate end-of-life family visits with COVID-19 patients—something that wasn’t offered in many hospitals. While it was important for visitors to follow our PPE and safety protocols, it was also necessary for us to provide a safe environment in which family members could say goodbye.
Leverage interdisciplinary teams: From experience, we know that we work best as an integrated team of physicians, nurses, advanced practitioners, pharmacists, technologists and other specialists. This approach, in which people consistently share what they’re doing, seeing and learning, drives collaboration and care delivery that is appropriate, coordinated and patient-centered. During the pandemic, this has enabled us to quickly and openly address organizationwide challenges related to patient care, staffing and supply chain. For example, we have used kaizen events—short workshops focused on improving a specific process—to set up new respiratory clinics and isolation units, determine staffing ratios and virtual-care platforms. With virtual care, we were already on a multiyear trajectory that was expedited. Now we have televideo capability across the enterprise, including integration into surgical care with preoperative screening and postoperative visits.
Commit to continuous improvement: At the start of the COVID-19 outbreak, we anticipated a decline in revenue and the need to be innovative with staffing and cost-saving measures. In April, we developed a plan to temporarily consolidate our outpatient clinics to half as many sites.
We were also creative with staffing roles, including asking some team members from anesthesiology, hospital medicine and surgery to step into critical-care roles in response to changing patient needs. For the previously mentioned companion-support program to facilitate final family visits with COVID-19 patients, leaders reached out to nurses across ambulatory areas—some of whom were on furlough—and identified those who were willing and eager to participate.
While it’s not possible to fully prepare for a pandemic, providers can learn from each other to ensure we deliver the safest, highest-quality care no matter the circumstances. Even when events evolve daily or hourly, leaders should learn and adapt, lean into change, and strive to be better tomorrow than today.