The Healthcare Earthquake: Lessons From COVID-19

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The COVID-19 pandemic has fundamentally disrupted U.S. healthcare institutions. Hospitals faced shortages of drugs and devices and set up new intensive care units overnight. Care plans evolved out of necessity, and carefully constructed patient flow systems in hospitals were completed.

In an article published today in NEJM Catalyst Innovations in Care Delivery, leaders and clinical researchers from Beth Israel Lahey Health (BILH) suggested using complexity science – an area concerned with understanding unpredictable and dynamic systems, such as the human brain, economies, or climates – to define strategies. That healthcare organizations can use to better respond to the ongoing pandemic and to anticipate future challenges to healthcare delivery.

He said, “COVID-19 has been a painful reminder that healthcare – as an industry and as a series of complex organizations – has evolved slowly over time, and so have the metrics and models we use to assess quality, safety and accommodate future needs” Lead author Jennifer Stevens, MD, MSc, Center Director Healthcare delivery sciences at Beth Israel Deaconess Medical Center (BIDMC), which is part of Beth Israel Lahey Health. “The Principles of Complexity Science offer three strategies that health care leaders can use to manage operations during the COVID-19 pandemic: engage diverse perspectives in leadership teams, remain open to new metrics, and create forecasting tools that reflect complex healthcare systems.”

Engage diverse thinkers in dashboard design

Noting that individuals are often unable to see the “big picture” from within a system as complex as health care, Stevens and colleagues recommend bringing additional, and potentially unexpected, voices to leadership teams. For example, while epidemiologists have naturally guided healthcare leadership teams in the context of COVID-19, Stevens and colleagues suggest including patients and / or community representatives, physicians from specialties that may be more related to the current crisis, or clinical and operational staff from affected communities. Disproportionately from the epidemic to crisis response teams. “Voices from different perspectives can broaden the preference point, allowing healthcare leaders to see more of the complex system and implement strategies that anticipate future needs,” said Stevens.

Identify metrics that triangulate the various aspects of a complex healthcare system

Defining a broader range of related metrics can broaden leaders’ view of a complex system. For example, patient demographics were largely variable that had not been reported early in the pandemic – before clinicians had a clear picture of how race, ethnicity, and other socioeconomic factors were linked to the risk of COVID-19 infection and death.

“Getting a better understanding of the disparate impact of COVID-19 on communities of color can help healthcare leaders better anticipate the influx of patients coming to clinics, as well as the implications for clinical staff and personal protective equipment needs,” said Stevens. “Healthcare leaders must be open to new metrics and be alert to undervalued variables, or we may find ourselves focusing so tightly on one set of metrics that miss out on the importance of more important data.”

As an example of a variable-value scale, Stevens and colleagues described how the significance of the number of patients with COVID-19 in the BIDMC Intensive Care Unit changed with the shift of spring to summer in 2020. In the spring, patients with COVID-19 presented to a hospital with symptoms Acute respiratory and requires immediate critical care services. The increasing number of patients admitted to the COVID-19 virus means the hospital will need additional beds of intensive care units, ventilators, personal protective equipment, and other healthcare resources.

However, once Massachusetts and the hospital deemed it safe to bring back urgent and elective procedures as summer began, all patients were tested for COVID-19 upon admission. Comprehensive testing has resulted in infected but asymptomatic patients who came to the hospital for reasons unrelated to COVID-19.

“Suddenly, we were accepting asymptomatic patients with COVID-19 who would not need the same resources and care as patients with the new coronavirus,” said Stevens. “So the meaning behind the number of COVID-19 patients at BIDMC has really changed during the first months of the pandemic.”

Create forecasting tools that reflect complex healthcare systems

The team also suggests that forecasting tools should truly reflect the complex realities of the COVID-19 pandemic. To build a model that does this, the team used machine learning to pull relevant data from each of the 13 hospitals and three business units that make up the Beth Israel Lahey Health System, rather than relying on published reports from China or Italy. Then, they added local, publicly available mobile data to the model, revealing how much people move around and interact with other people. Collectively, these data sources – reflecting shifting local public health policies as well as changing new social norms of behavior as the pandemic continues – contribute to a model that is able to provide timely and locally relevant predictions.

“Our model leverages principles of complexity to guide hospital leadership, providing weekly updates to a group of healthcare leaders on how and when a new wave of infections may arrive,” said Stevens. “Models need to reflect the changing health and political landscape – to allow for the complexity of the pandemic itself – for any healthcare organization to be able to benefit from it meaningfully.

“Healthcare faces one of its biggest challenges,” said Kevin Tapp, MD, “partly because the metrics and dashboards that we’re familiar with, which are designed to deal with complex system problems, can’t see the” bigger “coming. President and CEO of Beth Israel Lahey Health. “Adapting to the new realities highlighted by COVID-19 requires healthcare leaders to build new models that reflect the true complexity we face, engage new voices, and remain flexible and curious about our metrics. We are still in the middle of this earthquake, and we have many aftershocks in the future.” .

Follow the latest news on the outbreak of the Corona virus (Covid-19)

More information: Jennifer P. Stevens et al. Healthcare Earthquake: Lessons from Complex Adaptation Systems to Develop Response Measures and Models for Covid-19. NEJM Catalys Innovations in Caregiving. October 23, 2020

Provided by Beth Israel Deaconess Medical Center

Quote: Healthcare Earthquake: Lessons from COVID-19 (2020, October 23) Retrieved October 23, 2020 from https://medicalxpress.com/news/2020-10-healthcare-earthquake-lessons-covid-.html

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