As I have been home with my family, living and working in social isolation over the last five weeks, we’ve developed a new daily routine that might sound familiar. We get out of bed, shower and eat before heading to our new home offices. Our free time is spent going outside for fresh air, a trip to the grocery store for the essentials or we catch up on the latest news.
Watching the news lately has been like riding a roller coaster for the first time. At first there are small yet unpredictable twists and turns that then get incrementally larger, each laden with uncertainty and anxiety. You also know there is that big hill coming, the one that comes after a jolting stop, followed by a long slow climb that seems to make time stand still. As you crest the hill there is a chance to pause and take in the view, if only for a moment. You know the ride down will be heart stopping with even more unexpected thrills ahead until it comes to an end.
I could only wish that this pandemic was like a real roller coaster with a finite end and the choice to take another ride (or not). As we flatten the curve and approach the top of the hill, I think it will be very important to pause, look around and remember what we saw. While it has been very devastating for many, and there is a long road ahead, it is also an opportunity to prepare for what we need to do moving forward. But what comes next? What are we going to do to get things restarted and more importantly to avoid this again?
In Healthcare, as in many sectors, most of the things that traditionally happen on a day-to-day basis have come to a halt. An annual check-up, a trip to the dentist, a routine colonoscopy, a pain injection or even a much-needed elective surgery will all hopefully resume soon, as people need these services to stay healthy and the system requires them to stay in business.
But what will the restart look like? Most Healthcare providers have been working overtime to handle the apex with little time to think about after the surge. Some of the facilities that will provide these services are still undergoing modifications to serve the critically ill and, in some cases, will also need time to be converted back to resume normal operations. These providers are already assessing which of the delayed examinations and procedures need to be rescheduled, and how quickly. Emergent, urgent (which can be delayed for up to a month), planned (which can be delayed for three to six months), and cosmetic (which can be indefinitely postponed), will all have different priorities and physical needs. There is also uncertainty in what the real demand will be, as waiting lists for some procedures were already many months out in some cases and other complications might have developed as a result of the delay. In some cases, people may not feel safe getting care and may even choose to cancel their planned procedure.
Regardless of how this all plays out; we must ask ourselves how can we provide a safe and efficient environment when they are ready to return? Without certainty on when a vaccine will be available and how susceptible people might be to re-infection, the whole patient encounter that happens will likely need to be reengineered. While I don’t pretend to have any of the answers, my mind is already thinking about things we need to get our hands around in order to help our clients address the next surge that is coming. Then after that, how will our planning principles change for the long haul? Revenues are down and expenses are up. The Wisconsin Hospital Association is reporting that revenues are down over $265 Million per week and the first stimulus package equated to $305 Million, covering roughly 8-10 days of lost revenue. Systems that were targeting single digit positive margins are now looking at double digit negative margins. The pressure to expend available capital with the greatest return will be more important than ever before, focusing on what small incremental things can be done to open doors and restart procedures. CDC, AHA and other regulatory agencies are releasing guidelines on how to prioritize and assess the ability to bring back cases with the greatest need and least associated risk. This will undoubtedly require changes to an organization’s existing physical assets both now and forever. Some questions regarding readiness in existing facilities already come to mind in addressing these emerging challenges:
- Entry sequence, parking and valet. How do you direct, and screen arriving patient and family members and keep them safe while entering your facility?
- Check-in and waiting. How can you leverage technology and minimize the need to wait in communal environments to create safe environments?
- Caregivers and family access. How many caregivers or family will be allowed to accompany patients to aid in the delivery of care?
- Hand washing and PPE for patients and visitors. Who provides PPE and where do you locate places for hand hygiene and supplies?
- Digital and virtual care. How can you keep patients out of your facilities and/or accommodate routine tests, lab work and follow-up?
- On stage and off. What are the space drivers for PPE and how do you accommodate places for respite?
- Dedicated and universal rooms. How can you maximize flexibility and utilization while keeping costs down?
- Hospital cafeterias and communal food. Will we ever see another salad bar?
As we continue the work from home roller coaster ride, I feel it is imperative that we learn from this experience and apply these lessons to the spaces we create in the future. In the short term, I think we need to take part in this conversation and be prepared to help evaluate existing spaces so we can all get back to some sense of normality. The EUA Healthcare Team is working on a COVID-19 Response Guide to that will allow you to start planning for both the short and long term. In the meantime, I’d love to hear from you; thinking about your next planned healthcare visit, what do you think will change?