Photo by Cristian Escobar | Unsplash
As the COVID-19 pandemic spreads across the globe, the usual care and deliberation that go into quality improvement in health care may seem a luxury of days gone by. Yet innovation is happening in real time, promising to leave a mark on a health care landscape that many believe will be forever changed once the crisis abates.
With no lack of grim news, it is natural to wonder, “is anything going well?” That’s a question that was asked during a recent WIHI audio broadcast on innovation in times of crisis. Kedar Mate, MD, IHI’s Chief Innovation and Education Officer, discussed a few developments that are shaping the response to the pandemic, some of which may bring lasting change.
Leveraging connectivity.According to Mate, in normal times, clinical discussions over Facebook might be frowned upon, because it is not an official mode of transferring and vetting information. Yet in the midst of the crisis, some are clearly finding the platform useful in helping to aggressively identify and disseminate new solutions at unprecedented speed.
Mate pointed to the use of social media and other connected networks as a means of sharing vital information. As an example, he cited a the COVID-19 Facebook Group for physicians and advanced practice providers (mentioned in this op-ed
by IHI President Emeritus and Senior Fellow Don Berwick), which began with 57,000 members and nearly doubled in just five days. These clinicians are sharing information about what works and what doesn't work to help treat patients with the novel coronavirus.
Accelerating technological innovation. Simultaneous to the unorthodox sharing of information is the fact that clinicians and researchers are accelerating the speed at which investigations into new methods of diagnosing and treating COVID-19 have gotten under way. “Overnight, essentially, we have a clinical trials group that's investigating new diagnostics and therapeutics,” Mate said. “It's just a remarkable, unprecedented technological advancement in very, very short order.”
Scaling up telehealth. To prepare for patients with COVID-19, health care organizations cancelled elective surgeries and cleared appointment schedules of non-urgent visits. Out of necessity, many have pivoted to televisits, not only to respond to patients who call with early symptoms of COVID-19, but also to help manage those with chronic illness. Scaling up telehealth has required rapid innovation, Mate said.
First it has required that health systems acquire the necessary technology, train clinicians to use it, and prepare patients for the experience. Secondly, policies related to payment for televisits evolved quickly. This month, the Centers for Medicare & Medicaid Services expanded telehealth benefits under Medicare, allowing older adults to access a broader menu of services than they could before.
The third innovation related to telehealth is how knowledge is being produced and shared. Just as health care professionals are using email, networks, and other platforms to exchange knowledge about the disease, they are also sharing challenges and best practices around telehealth, such as how to triage patients via video to avoid exposing them to a hospital environment overcome with COVID-19.
From Improvisation to Lasting Change
In the United States, the evolving use of telemedicine is perhaps the most lasting change the system will gain from the current crisis. Although the new Medicare benefits were presented as temporary, Mate said, “…I don't see a world in which we turn back the clock on telemedicine. This has been unleashed and it’s here to stay.”
IHI is among those looking to develop standards and guidance around telemedicine to help ensure that televisits are high quality and safe, and that patients who need to be seen in person are accommodated. Mate also sees the potential to use telemedicine in larger transformative ways, for example, to improve the management of chronic disease.
“We're moving away from institution-centric, exam-room-based medical models and toward weaving expertise and knowledge into people's lives on a more continual basis,” he said. “It’s just something that is being radically accelerated by this emergency we’re presently in.”
Workforce Safety, Psychological Safety, and Joy in Work
As the enormity of the pandemic unfolds, health systems around the world have faced shortages of critical supplies, including personal protective equipment (PPE) for clinicians at the point of care. In addition to the very real physical risks that clinicians face, they also bear psychological risks of seemingly endless days, limitless patients, and a great deal of tragedy taking place around them each day.
It’s hard to find anything positive to say about all of that. Now that it’s been illuminated, however, that spotlight on workforce safety can’t be turned off. Ensuring the safety of the health care workers is likely to be – and should be -- an enduring lesson of the pandemic.
In the midst of this crisis, IHI was just beginning a Joy in Work Results Oriented Learning Network, with participants from hospitals across the US joining together to apply the Joy in Work framework. Remarkably, when contacted recently, most participants wanted the program to continue because, they said, the psychological safety of the workforce is of paramount importance.
While the program may require some modification and revision, Mate said, “We'll continue to develop new ways of addressing joy, resilience, and safety of the workforce. There’s no way that our workforce is going to be able to help others unless it can be healthy itself.”
Pat McTiernan is IHI Director of Program Communications.
You may also be interested in:
WIHI podcast — Improvement and Innovation in Times of Crisis
Does Joy in Work Matter During a Pandemic?
More COVID-19 Guidance and Resources