Photo by Nick Fewings | Unsplash
A year into the pandemic, it has been heartbreaking to bear witness to rising and falling (and rising again) case counts that can numb us to the daily realities of COVID-19. But we all have certain people, experiences, or stories that stay with us. They’re the ones that keep us from getting too detached. They’re the ones that remind us why we do what we do.
One person I met in the middle of this pandemic is a Northwell Health palliative care physician. She witnessed many of her patients who, at the end of their lives, were forced to say their final goodbyes using phones or tablets. It pains me to imagine the heavy toll on patients separated from loved ones as they took their last breaths.
I also think of the people holding the iPads, like this physician, who have witnessed this kind of anguish again and again. She, like so many others, also contracted the coronavirus and transitioned from caregiver to care-receiver, navigating physical suffering and fear for both themselves and their families.
Alongside the challenges and traumas experienced during the pandemic, I have also seen reasons for hope. Many organizations, for example, have demonstrated inspiring ingenuity as they bridged the divide between health and social care to meet the urgent needs created and exacerbated by COVID-19. Communities have been collaborating, partnering, and supporting each other to do what one sector could never do as effectively on its own:
- Cincinnati Children’s Hospital Medical Center (Ohio) applied quality improvement (QI) and systems thinking to support the infrastructure their community was developing to deliver masks, food, and reliable information where they were needed most. They now support coordinated local organizing units to help scale-up vaccination efforts.
- At a time when the coronavirus has limited the number of support persons who can be present during and after birth, participants in IHI’s Better Maternal Outcomes: Redesigning Systems with Black Women project adapted the physical and emotional support they offer pregnant women and new mothers. They’ve used various kinds of telehealth support aimed at addressing inequities and reducing maternal mortality and severe maternal morbidity in Black women.
- Southern Humboldt Community Healthcare District (Humboldt County, California) partnered with their local community hospital, Department of Health, Office of Emergency Services, local service groups, and other stakeholders to help seniors who were isolated while sheltering in place to avoid COVID infection. They assisted those older adults by providing basic needs, including groceries, clothing, hygiene supplies, housing, and transportation.
Now that we’ve seen the benefits of such collaboration, I predict there will be more partnerships like these in the future. Truly multi-sectoral approaches are key to getting to scale faster, which has been essential during a fast-moving pandemic.
Using Proven Methods and Frameworks
In the early stages of the pandemic, some people wondered about the value of using QI methods during a major public health crisis. Was QI too incremental? Did it make sense, some asked, to test small changes with PDSAs when we need big changes, big innovations, and big ideas to face off against a pandemic?
These questions were answered by the work of those who have leveraged quality methods to rapidly combat the pandemic. Their efforts bear all the hallmarks of high-reliability organizations, systems thinking, and rapid-cycle learning and testing.
Yes, we’ve used innovation to deal with COVID-19, but we’ve also seen organizations like East London NHS Foundation Trust (ELFT) in the UK use their improvement skills to inform their response to COVID-19. ELFT adapted their ongoing use of the IHI Framework for Improving Joy in Work to address new threats to the physical and psychological safety of their staff. Hospital Civil de Guadalajara Dr. Juan I. Menchaca (Jalisco, Mexico) built on their experience using IHI’s Psychology of Change Framework and other QI methods to improve pediatric cancer care to ensure that children would continue to receive high-quality care during the pandemic. HealthPartners in Minnesota is using their QI structures to build their vaccine deployment system and scale up its capacity.
These and so many other examples help us see the possibilities for using the skills, tools, and methods we already have at our disposal to take on many of the challenges COVID-19 puts before us. How might we address vaccine hesitancy, for example, by respectfully and humbly asking our patients and fellow health care workers what matters most to them? How could we use components of the IHI Framework for Health Care Organizations to Improve Health Equity to address multiple determinants of health and develop community partnerships to build community trust and more equitably distribute testing and vaccines? How could we apply what we’ve learned from IHI’s Psychology of Change Framework about co-designing change, building trust, and distributing power to create environments that empower clinicians and create agency in the populations we serve? I look forward to learning more from those who leverage their QI capability and use proven improvement tools and methods to support creativity and innovation over the course of the pandemic.
The last year has been challenging for all of us in different ways, but I’ve seen that when we focus our skills, experience, and attention, we can surmount any obstacle, no matter how high or how hard to overcome it may be. I am hopeful that we won’t forget these hard-won lessons that may have the power to change how we build health and care for years to come.
Editor’s note: Look for more each month from IHI President and CEO Kedar Mate, MD, (@KedarMate) on improvement science, social justice, leadership, and improving health and health care worldwide.
You may also be interested in:
How Improvement Science Can Meet the Moment (or Miss the Mark)
How Leaders Can Promote Health Care Workforce Well-Being