When it comes to managing health care in the age of coronavirus, the biggest hurdle is uncertainty.
“I don’t know if I’m preparing dinner for 10, dinner for two, or dinner for 800, so I choose to be prepared for all three of those,” said Dr. Cathy Faulds, a palliative care physician at St. Joseph’s Health Centre and staff family physician at London Health Sciences Centre, referring to personal protective equipment (PPE) for health-care workers.
Faulds was part of a panel of health-care experts discussing planning for the COVID-19 pandemic for a webinar called Leadership in Practice: Frontline Healthcare. Hosted by The Ivey Academy, it also featured Jon Hantho, MBA ’89, President and CEO of CBI Health Group; and Lauren Cipriano, HBA ’05, an associate professor of management science and expert in health policy. Here are some key takeaways.
A holistic approach is critical
Both Faulds and Hantho said they worry about certain groups, such as Aboriginal Peoples and home-care patients, being at risk because the current emphasis is on the acute-care system. Faulds said, before the pandemic hit, there had been a move to integrate the hospital and community sectors and switch the emphasis from acute care to primary care and this still needs continued attention.
“We’re just witnessing the gaps and difficulties that we have in our regular health-care system and, if we’re not careful, it’s going to really be an issue because we have not put enough into our community and our health-care system in primary care,” said Faulds. “My mantra here (in Southwestern Ontario) has been nobody is left behind.”
Hantho pointed out that eventually patients will be transferred from hospitals to home care and he said he worries there won’t be enough home-care workers with the right training and PPE.
“What keeps me worried now is that we’ve had such a great focus on the response at the acute level and now it’s shifting very quickly to long-term care facilities, but we don’t want to forget about home care,” he said. “We continue to advocate for a more holistic approach to the management of PPE.”
Cipriano said it’s also important to focus attention on the homeless and incarcerated individuals.
“We have a number of vulnerable populations and potential places where an outbreak would be catastrophic to our health-care system and to our local health-care resources,” she said. “Right now we're talking about what does social distancing mean for people who sleep in shelters or sleep on the streets? And, if you're able to provide some sort of temporary housing, what does that mean in terms of all of the wrap-around supports?”
A new kind of health-care leadership is emerging
If there is a bright side to the crisis, it’s that it’s ushering in important changes to the health-care system. Hantho said creative strategies are being employed to move patients out of the hospital and into their homes with continued access to therapeutic care.
“We are seeing enormous innovation so I think there are some real benefits for the system that are going to go way beyond the pandemic in just how agile and creative we’ve been together,” he said.
Faulds added there has been a shift to virtual care in some areas, such as mental health and addictions, home care, and primary care, that will likely continue. There is also a move toward having 24/7 response for primary, palliative, and nursing care as well as increased attention placed on how to support caregivers.
“There is something to be said about a pandemic changing the way we do business. I think a lot of good things are going to happen,” she said. “New leadership styles in health care are really coming to the surface and they’re more collaborative.”
It’s going to be an endurance game
In the long run, Cipriano said the focus should be both on managing the virus and ensuring people are getting access to other types of health care. She said data-driven modelling will be an important tool for getting a pulse on communities and planning the continuance of normal operations.
“If we're running at 70-per-cent capacity in our hospitals, we know that's because people are foregoing health care that they need potentially and that elective surgeries are not happening,” she said. “So even just knowing what's going on in our community is going to allow us to step back and make sure that everybody gets the other types of care that they need.”
But she warns it’s going to be many months before we can reopen businesses or resume travel. Even if it looks like we have the virus under control in our region, she said we have to be mindful of its activity in other areas.
“The first thing the models told me that was different than what I was reading in the press was the amount of endurance. This is going to be an endurance game,” she said.
