Policy Researchers: Hospital Leaders Need to Think Strategically About COVID-19-Related Surges

June 4, 2020
A team of healthcare policy researchers has examined some of the strategic planning that they believe that hospital leaders need to pursue in order to prepare for COVID-19-related patient surge issues going forward

A team of healthcare policy researchers has authored a op-ed published on June 4 in The New England Journal of Medicine that argues that the leaders of patient care organizations will need to work forward strategically to ensure that they are able to attract and retain a sufficiently stable workforce going forward into the future, in the context of the COVID-19 pandemic.

In their “Perspective” article, “Ensuring and sustaining a Pandemic Workforce,” Erin P. Fraher, Ph.D., M.P.P., Patricia Pittman, Ph.D., Bianca K. Frogner, Ph.D., Joanne Spetz, Ph.D., Jean Moore, Dr.P.H., Angela J. Beck, Ph.D., M.P.H., David Armstrong, Ph.D., and Peter I. Buerhaus, Ph.D., R.N., examined a range of issues, as well as a range of occupations, including two that are critical to caring for COVID-19 patients—respiratory therapists and nurse practitioners.

As they write, “Current efforts to fight the Covid-19 pandemic aim to slow viral spread and increase testing, protect health care workers from infection, and obtain ventilators and other equipment to prepare for a surge of critically ill patients. But additional actions are needed to rapidly increase health workforce capacity and to replenish it when personnel are quarantined or need time off to rest or care for sick family members. It seems clear that health care delivery organizations, educators, and government leaders will all have to be willing to cut through bureaucratic barriers and adapt regulations to rapidly expand the U.S. health care workforce and sustain it for the duration of the pandemic.”

On the policy and regulatory leve, the researchers write, “Where the threat of postpandemic legal consequences hampers action to expand capacity, such barriers could be removed by governors enacting emergency orders that modify or temporarily rescind medical malpractice policies that inhibit health professionals’ ability to expand their scope of practice as required. Most organizations, however, will find that outdated internal policies such as workflows, task-delegation protocols, or union agreements are the main culprits in restricting the shifting of tasks and responsibilities among personnel.”

And while the Centers for Medicare and Medicaid Services (CMS) has recently made major changes to regulations impacting personnel, via changes to its 1135 waiver program, there is much that patient care organizations need to do in the coming months, the authors believe. “While government and private efforts focus on obtaining and producing ventilators, hospitals will require personnel who can operate these machines,” they write. “Hospital associations can develop strategies to deploy respiratory therapists to the hospitals most in need and to develop programs to quickly train workers who can operate this technology competently; respiratory-therapy education programs can accelerate the preparation of therapists.”

Other solutions? “Medical students in their third and fourth years who are no longer in clinical rotations can help expand the workforce by performing various medical tasks to free up clinicians for Covid-19 care. They can, for example, triage and assess patients, collect and analyze data needed for institutional decision making, and perform administrative tasks.” Meanwhile, “[E]ducation programs can develop classes to train students in the skills most immediately needed. Accreditation bodies can allow students to count work hours toward graduation requirements. State licensure organizations can issue emergency or temporary licenses to fourth-year medical students, and to nurse practitioner, physician assistant, registered nurse, and other health profession students who are near the end of their programs. Students’ health care organizations can waive the background checks that most require as a condition of employment. Inflexibility and lack of creativity could stall efforts to expand the current workforce and jeopardize longer-term workforce stability at a time when health workers are critically needed.”

Meanwhile, as for surge capacity, not only can hospital organizations bring back retired physicians and nurses to work during the most overwhelming surges, the authors note that “There are many other opportunities for creating surge capacity. Dentists, dental hygienists and assistants, dental therapists, optometrists and optometry technicians, chiropractors, and hearing technicians are among those whose practices have closed because of Covid-19. Such health professionals can be trained to conduct screenings, take vital signs, provide telephone follow-up of quarantined people with Covid-19, collect epidemiologic data, and provide community education. Short online courses and training documents could be developed to prepare these workers for such roles and to quickly scale up the capacity of the community workforce.”

The researchers focus on a variety of policy and regulatory actions that could potentially be entered into. In the end, they note, “How well the country handles the Covid-19 crisis depends largely on how effectively our health workforce is used. Much can be done to ensure that the workforce is prepared to defeat the pandemic. Some actions discussed here are temporary, whereas others — such as expanding scopes of practice, cross-state licensure, and allowing greater use of telehealth services — probably make sense in general but are especially critical now. Now is the time for pragmatic steps to expand and sustain the health workforce. Once the pandemic has subsided, workforce changes should be evaluated and the results used to inform wiser use of the workforce and improved responses to future pandemics.”