To support health systems as they cope with or prepare for a rise in COVID-19 cases, IHI’s Innovation Team harvested the hard-won lessons from organizations who experienced the initial surge of the pandemic. The result is the Hospital Preparedness for a COVID-19 Surge: Assessment Tool. The following interview is with Mara Laderman, the IHI Innovation Team’s Senior Director. In it, she describes how the tool was developed and how best to use it.

How did the IHI Innovation Team develop the new Hospital Preparedness for a COVID-19 Surge: Assessment Tool?

During a 90-day innovation cycle, we looked at the literature and talked to people. We reviewed guidelines from governmental agencies, professional associations, and other organizations. We also conducted interviews with health systems around the US to understand what they did that worked well to deal with COVID-19 and what they might want to improve in the event of another surge. Our goal was to get granular about the best practices around some of the key domains of COVID-19 surge preparedness.

An incident command team — along with unit leaders and relevant staff from across an institution — can use the tool we developed to assess the processes they have in place in these key domains:

• Structure for Planning, Decision Making, and Communication
• Monitoring and Improvement
• Infection Control Preparedness
• Space and Supplies
• Staffing
• Staff Mental Health and Well-Being

We specifically walked through their policies, how those policies are communicated to staff, and how staff are engaging in behaviors that are concordant with those policies. We also wanted to help organizations understand how to monitor the work they’re doing and how they’re improving. Each item of the assessment indicates not only what they should be doing, but also how to make sure it’s being translated into action. We hope that incident command teams will use the tool to assess their own preparedness and identify gaps they need to fill to be better prepared for future surges of COVID-19.

What advice would you give to a team to take full advantage of the tool?

We hope that an organization’s incident command team will be the primary group completing the assessment. If a hospital or a health system doesn’t have an incident command team, whatever emergency response group they have in place should come together to use the tool.

This group will need input from various parts of the organization. There are questions specific to facilities. There are questions specific to staff, staff well-being and mental health, and infection control. So, while the incident command team is typically the center of the response efforts, it’s important that they collaborate with those who oversee these other pieces of the work. This helps to ensure that they are filling out the assessment accurately and have a good sense of what’s happening throughout their system, including areas where members of the incident command team might not have necessary day-to-day knowledge and ready access to some of the data.

Completing the assessment should be a collaborative effort to get an accurate picture of the current state. This will then guide discussions of how to address the identified gaps.

Why is it so important to do this kind of assessment?

An organization doesn’t typically have the time or bandwidth to carefully reflect, plan, and be most strategic in the middle of a crisis. By acting on what’s identified with an assessment, an organization can put systems into place more proactively and systematically to prepare.

COVID-19 response is, like many other hospital-wide efforts, multifaceted. There are a lot of different parts of the institution that have a role to play. Bringing together those different pieces to understand what’s currently in place, and what they might need in the future, is better than leaving individual departments to optimize for their particular part of the system.

Would you describe why staff wellness is part of the assessment? It’s the component that can be most easily overlooked.

COVID-19 is aggravating issues with health care burnout that existed before the pandemic. IHI included staff wellness as a specific section of this assessment because organizations need to think very critically about how they are supporting their staff. There’s been a lot written about the significant psychological impact that caring for patients with COVID-19 has had on them. It’s important that organizations pay special attention to this issue because, if their staff are not doing well, they are less able to care for themselves, for their families, and for their patients.

IHI has summarized the research into evidence-based “psychological PPE” recommendations. This guidance can help leaders of health systems at the individual, team, and unit levels to support their staff, so they are better able to face down the multiple challenges posed by the COVID-19 crisis.

Editor’s note: This interview has been edited for length and clarity.

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