Collaboration during some of the most challenging months of the COVID-19 pandemic brought out the very best in healthcare leaders, even among patient care organizations that have been local-market competitors. That certainly has been the case with Cleveland Clinic and University Hospitals of Cleveland, two of the dominant integrated health systems in the Cleveland metro area.
As a paper published in April 2021 and entitled “Stronger Together: University Hospitals and Cleveland Clinic—Covid-19 Observations, Lessons Learned, Partnership and Roadmap for the Future,” noted, during the worst of the pandemic, “Cleveland Clinic, University Hospitals (UH), the city of Cleveland and the state of Ohio faced many of the same challenges as the rest of the country. But, despite being competitive healthcare systems, Cleveland Clinic and UH collaborated in many ways to deal with the challenge. We also reached out to other regional hospitals, including Cleveland’s MetroHealth and St. Vincent Charity Medical Center as well as Firelands Regional Medical Center and Southwest General Medical Center, to work together on some initiatives. This necessitated collaboration across traditional silos, suspension of ego, and a willingness to explore creative relationships to address a set of immediate and critical needs. Of course disaster response plans were already in place, but our systems weren’t expecting a devastating event of this magnitude and duration to appear as fast as this one did. It is interesting that the previous Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) outbreaks and the onslaught of COVID-19 each occurred about a decade apart. Despite the challenges we faced, we were able to find common ground for the benefit of our patients, local communities, and State of Ohio, by quickly forming a cooperation model. Throughout this process, we’ve learned a great deal about pandemics, public health, healthcare delivery, collaboration and how to better prepare for future public health challenges.”
The paper further noted that, “Using a University of Pennsylvania open-source model, initial work by Cleveland Clinic’s Enterprise Analytics team suggested an unrestrained outbreak may lead to a maximum census of nearly 8,000 patients in its 21-county market area. The Executive Team quickly mandated that Cleveland Clinic prepare for a worst-case scenario and made plans to triple its regular nursing floor and intensive care capacity. The largest increase in beds was seen by converting the Sampson Pavilion of the Cleveland Clinic - Case Western Reserve University Healthcare Education Campus (HEC) into the “Hope” Hospital, creating over 1,000 additional patient beds for surging COVID-19 patients. This decision was made based on predictions from a variety of observations of the pandemic’s intensity in locations around the world but particularly in Northern Italy and New York City. UH using its own modeling approach, in consultation with its infectious disease experts, quickly pivoted its daily operations and prepared for a 300-percent surge capacity across all medical centers, increasing available beds from 1,700 to 5,100. UH also advised the Governor to help define which surgeries and procedures were essential, and should therefore be permitted to continue, in order to ensure Ohioans were properly cared for during the pandemic.”
The collaboration between the two organizations was noteworthy as it involved working together to use analytics to define risks of various communities, including communities of color, in the two health systems’ service areas in northeastern Ohio.
Two senior leaders involved in the collaborative work—James Simon, M.D., medical director of enterprise analytics at Cleveland Clinic, and Sam Brown, vice president of operations and logistics at University Hospitals of Cleveland—presented on that work at the Healthcare Innovation Summit in Cleveland in October, and at the end of last year, they spoke with Healthcare Innovation Editor-in-Chief Mark Hagland. Below are excerpts from that interview.
Tell me a bit about the origins of the collaboration, from your perspectives?
Sam Brown: In March 2020, as the pandemic started, University Hospitals and Cleveland Clinic had started to meet on a number of different topics, primarily around test development, operationalization of testing sites, and surveillance of the community. We partnered together to start sharing data; and we’ve been sharing data since mid-March 2020 and have been jointly using tools, and have been sharing data and collaborating.
James Simon, M.D.: Our two teams hadn’t had much of a relationship before this, and it started with the intention of being a local project, and we needed to share data, and the relationship developed smoothly.
How did you initially envision the collaboration? And how did things evolve forward over time?
Simon: Initially, the focus was to try to get as many Cleveland-area health systems involved as possible. Including all of University Hospitals and Cleveland Clinic data, we knew there would still be missing data and some holes in the map. And the initial idea was to get other systems involved. But we meet with representatives throughout the state weekly as well, and after they started seeing what was going on, they petitioned to have the entire state get involved as well—Ohio Department of Health. So what developed was a very local system that assists local health departments. So it turned into the only one of its kind, a statewide clustering map capability.
Brown: This became a tool—we were identifying risks together and saying, this particular building has high aggregate risk, it has its index case, and so health departments were sharing learnings. And we’ve developed collaboratives around congregate learning as well. We’re focusing on determining where surge will come to hospitals, but initially we were trying to manage in place and trying to prevent disease spread. And UH and CC developed our own testing process. We had the predominant testing and density in our region. And the ODH side helped to round out the gaps that we didn’t have visibility into—such as FQHCs, etc.
So those two things were approached in tandem?
Brown: Yes, they’ve been providing us with the data, and the mapping tools have been shared between CC, UH, and Case Western University. And we overlay geospecific data around ethnicity, race, what we know about certain areas clinically—we overlay this with a multitude of SDOH, on top of what ODH was giving us.
Simon: The surges were occurring in highly concentrated areas of ethnic minorities, and we overlaid an area deprivation index, a method of looking at social vulnerability, with infection patterns. We were able to see patterns in African-American and Latinx communities. Certain times, members of the Black communities, the surge would be apparent only after the surge had become bad. The assumption was that outpatient testing was not being pursued; we couldn’t say for sure.
Brown: When you plot things at a community level—and we understand factors around age and technology engagement, etc.—we focused on several community engagements, where the two of us would talk with housing representatives or members of the faith-based communities. Testing, masking, vaccination—these things helped us be very specific with our time and expertise, to focus on different elements in different neighborhoods. So it was helpful to overlay some of the political or social data.
So you had data?
Simon: Both for testing sites and vaccination sites, we were able to target. And for public health. We could say, there was a building that was having an outbreak. So people could go to a specific building, from public health departments, and distribute masks and educate. But their responses developed pretty fast, and it was heartening.
Were there any data challenges involved?
Brown: The biggest barrier we had was probably the trust barrier and the legal exercise of sharing data. I’m really proud of how these teams collaborated together. And our legal teams made sure we were in a safe space to share information. And in terms of COVID and other opportunities—we’re having some discussions about other areas where we could collaborate together outside of COVID.
Simon: Yes, there are already thoughts in mind about how we could use this in other areas. But the ODH has not extended the data agreements. That was a finite period of time that ODH. It expired about three or four months ago, in mid-2021.
What were the biggest lessons learned in this, on any level?
Grown: On a macro level, the ability to create visibility in areas neither one of us could see alone. There are certain areas where CC has density in a population and UH doesn’t, and vice-versa, and we were able to build much richer data sets; and the more comprehensive the data set, the more proactive you can be.
Simon: You’re better together than each of you side by side. The data together was greater than the sum each. Each of us would have missed outbreaks had we not had each others’ data. Our teams learned a ton about how to work with data. And the relationship with the Case team has been very fruitful and rich. And it’s one area where our two health systems have learned how to work together during the pandemic; and hopefully, that holds in the future.
Brown: Dr. Simon and I are going to be involved in discussions at the state level. The data side created the opportunity to engage in operationalization, standardization, and response. So when you think about what’s going on, we share very macro-level data around hospital capacities, etc.; so it’s created a space for us that helps the two health systems to analyze and plan for such elements as transfers, load balancing of capacity, clinical practice guideline development. All of those have emerged on top of the data-sharing and how we respond to this pandemic in the community.
Simon: That kind of collaboration, around transferring patients, etc., that’s happening out of necessity between and among all the hospitals in the zone. But now in this project, we recognize each other and have built
What kind of advice might you offer those who might want to build this kind of collaboration in their communities?
Brown: The investment the Clinic made in our analytics group before the pandemic, has paid off for this. We already had the teams and relationships with the departments that had the data, and we knew how to access the data and collate it to develop a good picture early on in the pandemic. This isn’t something you could stand up overnight. It’s really important for health systems to prioritize to invest in their analytics capabilities.
Simon: From my perspective, it’s being willing to reach out and build relationships. In the normal course of business, we’re very strong competitors in a lot of areas and communities we serve, we compete head to head. So there are certain times where you have to get past that and recognize it’s about the community: these are our neighbors, families, friends. Getting past whatever historical cultural issues have existed through competition, is important to get over, to serve your community. Anybody can do it, if everyone focuses on the right mission.