ACHE offers Best Practices and Key Insights for Healthcare Leaders
At the 2021 ACHE (American College of Healthcare Executives) conference, healthcare leaders from across the continent shared best practices, lessons learned, and key insights. From increasing revenue to addressing social determinants of health, the range of topics impressed and inspired the team at Arena Analytics. Here are some of our top takeaways.
Highlights from Fireside Chat with Dr. Anthony S. Fauci
DR. FAUCI: We’re in a mostly good place because of the availability of vaccines, particularly vaccines that are highly efficacious. And we now have the capability of distributing them and administering them at a pretty good clip, about 2 to 3 million a day. The only thing that still concerns me is that recent big surge. Over this past winter it started to come really abruptly down, but now it’s plateauing at around 50,000 cases a day and that’s a bad place to be plateauing. We should be down less than 10,000, but we’re at 50,000.
Also, I’m afraid that people have the feeling that it’s all over and are pulling back on their mitigation activities and the guidelines for public health: Mask-wearing, distancing, avoiding congregate settings.
So, it’s mostly good news. However, if we pull back too soon, there’s a concern. We have a bunch of variants — which are mutational changes in the viruses — that are floating around. If we give them a chance to take hold, I’m afraid we may have another spike. We’re going in the right direction. Let’s just keep going.
My greatest concern is that we get to a situation with the vaccines that we have now, of not handling the variants well. We may need to do a major modification of the vaccine and I don’t think that’s going to happen. The reason I say that is, take one example of a variant: The 117, the one from the UK. Vaccines handle that very well. Even the one that we’re worried about a lot — the South African one, the 351 variant — even though it diminishes by about fivefold the efficacy of the antibodies that are induced by the vaccine, those antibodies in general are usually so high that even if you diminish it by fivefold, you’re still within the range of some reasonable protection. Particularly against advanced disease hospitalizations and deaths. We want to keep an eye on it but I hope it doesn’t disrupt our vaccination program.
DEBORAH BOWEN (ACHE CEO): Dr. Fauci, what are the primary lessons that you believe, healthcare leaders should take away from the pandemic?
DR. FAUCI: We have diminished the quantity, and quality, of our healthcare infrastructure — the public health infrastructure, such that it is more weakened now than it was decades ago. It’s really gotten weaker and weaker and it hasn’t been brought up to date. There are still some health systems that are using fax machines and xeroxing papers, instead of doing things online. We’ve really got to get that up to speed, that’s the first thing. Second thing, we have got to get items made in the USA, so that we don’t have to worry about materials for PPE, masks, and the ingredients and fundamental makeup of drugs and vaccines. And finally, it’s a lesson that I think society just needs to learn. We have been through the worst pandemic in over 100 years and we’ve done it in the context of a highly divisive society. So if ever we want to successfully address a pandemic of this magnitude, we can’t go into it where the divisiveness is such that, instead of fighting the virus in a coordinated way, we’re fighting with each other. It has really been a shame, but that’s the reality of what’s going on.
DEBORAH BOWEN: One of the unfortunate realities of the pandemic was amplifying the disparities and gaps in care. Are there specific things that cross your mind in terms of things we could do differently, to really close those gaps in a different way?
DR. FAUCI: There aren’t immediate solutions, but there is the bright light that has been focused on health disparities… There’s long range commitments to addressing the social determinants of health that you’re not going to turn around overnight, or in a week, or a month, or a year. It’s going to have to be a commitment at multiple levels, to just make sure that people of a minority demographic group don’t have — from the time they’re born — social determinants of health… that’s what we’ve got to address.
DEBORAH BOWEN: I’d like to ask you, as a physician, as a scientist, when you think about your own team, do you have any advice on how to build and retain resilience within the clinical workforce.
DR. FAUCI: The one thing you don’t want to do is, what I do. I’m not the good model. And the reason is that by necessity, in the winter and early spring, I was doing something that I would never recommend to anybody. I was sleeping three hours a night for weeks at a time, and then if it wasn’t for my wife — who is in the business, she was a nurse and is now the chair of the department of bioethics at the NIH — She grabbed me and said, timeout. This is a marathon, and you’re acting like it’s a 50 yard dash and this is not gonna last. And I think that’s the advice we need to give to people who are on the front line. That as much as there are demands on you, you’ve got to realize that when we are in the middle of a pandemic, it really is a marathon. It’s not a sprint and we got to just treat it that way. We’ve got to figure out a way to organize what we do, the planning sessions, how we look at on-call schedules — that it is a marathon, and not a sprint.
DEBORAH BOWEN: We know there are people who are hesitant to take the vaccine. Is there anything we could do in terms of reducing that?
DR. FAUCI: I think what you have to do is, rather than have a negative response to vaccine hesitancy, respect the fact that people have questions. And it’s not a monolithic group. There are people who, for good reasons, just like to wait and see. “I’m a little bit concerned about safety…” “I’m a little bit concerned about the speed with which it was made…” There are others who historically, and understandably, don’t trust a federally run medical program…When you think about the egregious violation of ethical principles during the Tuskegee experiments… you don’t want to blow people off who are hesitant. You want to try and find out why they’re hesitant and respect the fact that they are. Then try to explain to them, each of the points that bothers them. For example, people think we’ve gone too fast. “You keep saying it takes years to get a vaccine. This one took less than a year, you must be rushing it. You must be cutting corners. There must be safety problems…” Then you explain, “No, we did it in 11 months, but that’s based on decades of science that preceded it.” So you defuse the issue of going too fast. The same thing with decisions about whether or not it’s truly safe and effective. Get people to understand that that decision is not made by the company. It’s not made by the administration. It’s made by an independent Data and Safety Monitoring Board and also, the FDA has an advisory committee that’s completely transparent. I don’t think most people appreciate that. Each of the things that they have hesitancy about are really explainable.
DEBORAH BOWEN: Is there any advice you give to people who want to pursue healthcare careers?
DR. FAUCI: Oh, yeah, if you have even an inkling that that’s what you want to do, it can be really one of the most exciting and rewarding professions you could possibly imagine. It’s multifaceted, you don’t have to just be a physician or a nurse. There are so many aspects of the healthcare industry — if you want to use that terminology. The satisfaction you get out of being in a field that’s devoted, very specifically, to the health of the American public as individual people and as society in general, I cannot imagine anything more exciting than that.
Session: Mental Health Crisis: Patient Care in the Right Place at the Right Time
Presenters: Leslie Zun, MD, Medical Director of Lake County Health Department and Community Health Center; Stephen M. Merz FACHE, Principal, Mertz Healthcare Consulting; Howard J Gershon, LFACHE, Founding Principal, New Heights Group.
According to national figures, approximately 15% of all emergency department patients present with a mental health crisis. Understanding the difference between a mental health crisis and an emergency is essential to determine the best care option.
Emergency departments are not the best place to treat psychiatric emergencies. They are chaotic, loud, bright, and often have a lack of experience in mental health. There may be long waits due to competing patient priorities and almost all psychiatric patients in crisis are admitted. This session discussed the benefits of establishing a Psychiatric Observation Unit where a patient can be held up to 72 hours.
- Reduction in admissions,
- Better flow out of the ED to the most appropriate level of care,
- Gains in earlier functional independence,
- More immediate use of community resources,
- Higher level of patient satisfaction, and
- Promotion of better-coordinated and more cost-effective care.
Session: The Healthcare Workforce of the Future
Presenters: Ghazala Sharieff, Corporate Senior Vice President/CMO, Acute Care, Clinical Excellence and Experience, Scripps Health, San Diego; Kevin B. Mahoney, Chief Executive Officer for the University of Pennsylvania Health System (UPHS); David Schreiner, President/CEO of Katherine Shaw Bethea Hospital in Dixon, IL.
From front-line providers to C-suite executives, the healthcare workforce has been challenged immensely over the past year. Hospital and health system leaders are facing growing provider shortages along with a workforce that is at a highly increased risk of burnout and mental health challenges. At the same time, some systems have implemented a variety of innovative staffing approaches to leverage current skills and provide much-needed support to promote the health and safety of their employees.
Care delivery models have changed: more providers and clinicians are working from home and they love it. It brings more work-life balance; cost savings also. Patient experience scores have improved with Telehealth. There are more deliberate communications with the patient and family, and coordination of care is more efficient and aligned across the system.
We have seen both resilience and ambiguity; things changed so frequently, we had to be open to doing things differently. We had to support each other as a team and be open to discussions about employee well-being and confronting structural racism.
With more remote work, there is competition across the country for talent. Provider shortages and burnout have amplified. In September, 2020, Modern Healthcare released a study that said 58% of providers were burned out and 76% of healthcare workers as a whole were burned out. Our workers need rejuvenation time and support.
- Make sure employees are working at the top of their license with support for lower-level tasks.
- Assign other employees to do non-clinical tasks to support clinicians.
- Change the pace, for example, working 4 days in clinic and a day from home and do Telehealth.
- Hospital at Home initiative (launched in 2020), introduces a new workforce format for those who enjoy being on the road and deeply knowing patients.
- Leaders must also take care of themselves also. Ask yourself, what are you NOT going to do this weekend?
- Leverage AI to replace lower-end jobs, example: having a repetitive work chatbot.
- Retrain the workforce to move forward in their career. Example: since patients are now self-scheduling their appointments online, move the patient service rep resources up a level to function as a concierge patient rep.
Session: Leading Through a Lens of Healthy Equity
Presenters: Nick Macchione Director of San Diego County’s Health and Human Services Agency; Ronald L. Copeland Senior Vice President of National Equity, Inclusion and Diversity Strategy and Policy/Chief Equity, Inclusion and Diversity Officer for Kaiser Permanente; Airica Steed, System Executive Vice President/Chief Operations Officer, Sinai Health.
Everyone deserves access to high-quality healthcare, but systemic inequities in access to and delivery of care have only been exacerbated by the COVID-19 pandemic. Healthcare leaders play a unique and critical role in the fight to reduce these inequities, and it is an ethical and business imperative that healthcare leaders reflect the populations they serve.
Given the events of the past 12 months; there is an urgency to figure out what we can do in this moment to improve health equity. To take this journey, where does the organization stand on the following questions:
- Do we value all individuals equally?
- Are we required ethically to rectify inequities, and
- Are we courageous enough?
Our day-to-day lived experience has more influence on health than the few moments interacting with the health system. With that in mind, specific tactics include:
- Address racism as part of quality improvement efforts. Look at everything you do related to quality, hiring, and promotions through the lens of equity.
- Support economic development for black and small businesses who have no access to funding and loans.
- Invest in understanding intergenerational trauma, its impact on wellbeing, and methods of breaking the cycle. Example: when young children witnesses trauma to classmates or family members such as shootings, it can impact health over time.
- Invest in training focused on having culturally responsive and linguistically meaningful conversations.
- Invest in supplier diversity: women and minority-owned business. Example: a landscaping business hired ex-convicts and changed their lives, giving them dignity and pride, providing a second chance to those who would be overlooked, creating a different trajectory for the future.
- Attempt to mirror the population we service, employ caregivers that match and know realities in communities; be purposeful in hiring; build cultural competence; work with the community to connect with the community and build trust.
Measure and monitor success using the following metrics:
- Improved life expectancy,
- Reduction in hospitalizations and readmissions,
- Improved access, reduced no-shows and cancellations for appointments,
- Higher rates of preventative care/chronic condition treatment appointments