How Can Hospitals Overcome Staffing and Supply Shortages Amid COVID-19 Surges?
Feature Story
By Stephanie Miceli
Last update August 7, 2020
Six months into the COVID-19 pandemic, many hospitals are still faced with staffing shortages due to the sheer volume of patients, staff illnesses, and non-COVID care that cannot be delayed.
“How do we acknowledge and reward what our employees are going through? You’re concerned about going to work, but [also] concerned about going home and possibly transmitting the virus to your family,” said Greg Adams, chairman and CEO of Kaiser Foundation Health Plan Inc. and Kaiser Foundation Hospitals, during a recent COVID-19 Conversations webinar on managing ongoing surges of the virus. The webinar was hosted by the National Academy of Medicine and the American Public Health Association.
COVID-19 surges — and resurgences in some states — have meant that some hospitals are forced to implement their crisis standards of care (CSC) plans. CSC plans help determine who gets what care when resources are scarce, whether that’s related to staff with specialized skills, ventilators, or treatments like remdesivir.
“Just looking at the crisis standard of care documents was a sobering experience,” said Rochelle Wallensky, chief of the division of infectious diseases at Massachusetts General Hospital and professor at Harvard Medical School. At Mass General, which has 12 hospitals, the number of patients on ventilators surged in mid-April — more than fourfold its standard ventilator use.
“We tried to ensure all our patients had living wills,” said Wallensky. “We didn’t want to give a ventilator to someone who didn’t want it — especially if someone else might.”
Those difficult decisions are often guided by ethics triage committees, rather than individual clinicians, she noted.
Panelists, who represented health care systems across the country, discussed their strategies for handling an influx of patients, including adjusting staff roles and responsibilities; pausing nonessential surgeries; and preserving staff morale and well-being. Some hospitals have provided child care grants, temporary shelter, and paid leave for employees who test positive (whether they contracted COVID-19 on the job or elsewhere).
“We’re looking, in essence, at running two systems — a COVID system and a non-COVID system of care,” said Jonathan Lewin, president and CEO of Emory Healthcare. “We’ve had to redeploy perioperative services staff to provide front-line testing, and redeploy people at the front desk to be temperature screeners. And, there are patients who depend on us for care for heart attacks, transplants, and brain surgery — and we need to be able to take care of them while flexing up our COVID care.”
What happens outside the hospital is just as important for managing COVID-19 surges, said Howard Zucker, New York State health commissioner. New York has gone from one of the worst-afflicted states to one of the most well-controlled states by sharing data and establishing public trust, scaling up testing and contact tracing, and ensuring consistent reopening efforts with neighboring states.
“But, we recognize this is not over and there are risks of this coming back,” said Zucker. “We still need national guidance on school reopenings, and we need national leadership on mask wearing.”
Panelists anticipate that we’ll have to coexist with COVID-19 for at least a few years. The pandemic has revealed that public health has been chronically underfunded and under-resourced — but it has also forced the health care system to reimagine new ways of doing things.
“It can be challenging at an academic health system with 11 hospitals. Every local unit wanted to live on its own, and their culture was sacrosanct,” said Lewin. “With COVID-19, every one of our ICUs across all hospitals are using exactly the same guidelines. Decisions that would have taken three to six months are being made in a week. It’s brought the people together, it’s brought the system together. I think that has been the biggest positive.”
