effects of the COVID-19 pandemic (huc8)

HCA 3305, Health Unit Coordination 1

Course Learning Outcomes for Unit VIII Upon completion of this unit, students should be able to:

8. Debate the management of the COVID-19 pandemic by federal, local, and state health care agencies. 8.1 Describe supply chain and resource issues related to the pandemic. 8.2 Illustrate health care facility design strategies relevant to the management of the COVID-19

pandemic response. 8.3 Explore ways in which patients and visitors should be managed to ensure safety during a

pandemic. 8.4 Analyze the staffing crisis and psychological factors attributable to a pandemic. 8.5 Summarize key leadership strategies to benefit staff during a pandemic response.

Course/Unit Learning Outcomes

Learning Activity

8.1, 8.2, 8.3, 8.4, 8.5

Unit Lesson Article: “How to Lead Health Care Workers During Unprecedented Crises: A

Qualitative Study of the COVID-19 Pandemic in Connecticut, USA” Unit VIII Reflection Paper

Required Unit Resources In order to access the following resource, click the link below. Adeyemo, O. O., Tu, S., & Keene, D. (2021). How to lead health care workers during unprecedented crises: A

qualitative study of the COVID-19 pandemic in Connecticut, USA. PLOS One, 16(9), Article e0257423. https://doi.org/10.1371/journal.pone.0257423

Unit Lesson The COVID-19 pandemic resulted in unprecedented challenges in the health care sector. While the whole industry has very quickly learned a lot about how to manage the virus and the toll it takes, much remains to be understood. In this lesson, key areas of consideration will be presented in terms of where we are now and where we might need to go as future health care leaders. Specifically, the supply chain, facility design, visitor management, effects on patients, toll on staff and staffing, as well as some leadership strategies will be offered. However, it is vital for health care leaders to understand the rapid pace in which things are changing in terms of a global response to the pandemic in order to continue to contribute to the industry’s survival as well as a return to normalcy during these trying times.

Resources and the Supply Chain

The COVID-19 pandemic resulted in intermittent crises in the supply chain, and these issues contribute to fear and mistrust of key stakeholders. Mirchandani (2020) describes five major domains within the health care supply chain, including medicines, personal protective equipment (PPE), medical devices, blood, and other medical supplies. Medications are manufactured on a global scale, and the United States depends on other countries for the bulk of its supply. In fact, only 56% of brand name drugs and 62% of generic drugs are produced domestically (Mirchandani, 2020). Many shortages are felt by American hospitals and pharmacies, mostly related to regulatory constraints, the demands of virus-related pharmaceuticals overtaking normal production, and an overall depletion of U.S. stockpiles. In the beginning of the pandemic, supplies of PPE were so critically depleted that many health care workers were forced to reuse and recycle their one-time-use-

UNIT VIII STUDY GUIDE

COVID-19 and Health Care Delivery

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only equipment such as masks and gowns. Most experts blame the failure of U.S. government to have sufficient stockpiles of PPE and resulting pockets of price gouging that occurred as competition for PPE grew fierce. Mirchandani (2020) describes issues related to medical device procurement during the pandemic, mostly related to the extremely controlled nature of the industry. It is these restrictions and oversights that result in the high quality of the equipment to which American consumers are accustomed, but these also restrict competition and outside resources that would improve availability during the pandemic. Another area dramatically hit by the pandemic is laboratory supplies and other medical supplies such as intravenous and surgical supplies. Like above, the United States clearly was unprepared for a pandemic such as this and was slow to respond. Finally, blood supplies were critically low in some areas for a myriad of reasons such as normal donors being more reluctant to donate and difficulties with social distancing at collection sites. There are things the United States can do to weather the ongoing supply chain storm. Mirchandani (2020) suggests shifting pharmaceutical manufacturing to American soil to improve a domestic response to demands. To avert future PPE shortages, the country must have strictly enforced and monitored accumulations of emergency PPE with better coordination between federal, state, and local governments involved in overseeing this part of the health care industry. With regards to medical devices such as ventilators and other critical equipment, there must be an immediate call to action that balances improved design with more open trade brought about by less stringent rules that prevent such a process. In sum, it is clear the United States must quickly work toward a more coordinated, integrated storage and allocation of critical supplies as the industry continues to navigate the continued issues of the pandemic.

Health Care Design

COVID-19 catapulted health care design at a pace never seen before in history (Stichler, 2022). From surge plans, isolation requirements, and other clear demands of the virus response, the industry had to rapidly respond and adjust from a physical environment standpoint. Hospitals faced physical challenges, including the need for changes to mechanical systems; the need to rapidly produce more space for patients, staff, and visitors; and the critical need for increased patient care areas in emergency departments. Emergency departments not only continue to be overwhelmed with the sheer volume of patients but also the vital requirement to isolate potentially infected patients from those presenting with noninfectious complaints. Additionally, facilities faced a barrage of needs centered around changes required of heating, ventilation, and air conditioning (HVAC) mechanical systems, and a very real competition between the need for more patient care space and the need to store PPE and other supplies required by the pandemic. In response to these challenges, it has become common for hospitals to erect tents in parking lots to care for minor emergency department patients, increase telemedicine capabilities, rent off-site storage spaces, and convert office-type spaces such as conference rooms to makeshift ICUs and wards (Stichler, 2022). Facilities and leaders must be creative and agile to pivot and meet the demands of the population.

Visitors

The COVID-19 pandemic quickly taught health care systems that their buildings and facilities were vulnerable (Freidenfelds, 2021). From the need to screen visitors to the increased aggression of some, the way hospitals manage their front lobbies is likely forever changed. Technology is being leveraged, in addition to increased human resources and the security needed to manage visitors. Changes include the need for health screens, travel questionnaires, and an increased requirement to collect identifying information such as a driver’s license from all visitors. According to Freidenfelds, hospitals have an inherent duty to participate in strict contact tracing, including its visitors, to prevent the spread of the virus. Moreover, the entrance to the building is an important checkpoint within the system to ensure that all persons wear masks and adhere to social distancing. Finally, hospitals embraced all sorts of creative solutions for contactless visitation such as the use of smartphones and iPads.

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Patients

By now, you are probably well versed in the unpredictable and sometimes long-lasting effects of COVID-19 in a person infected with the virus. But, what about the toll on patients who are sick or admitted to the hospital for some other affliction not associated with the pandemic? According to Rosenbaum (2020), the pandemic wreaked havoc on the global health care system and gravely affected all patients. Specifically, overcrowding, a severe reluctance to seek medical attention, the need to protect noninfected patients from infection, and an overall lack of resources presents risks to patient lives. Further, the pandemic affects established standards of care. For example, changes in the management of oncology patients occur because of their immunocompromised state. Particularly, cases of moderate-risk cancers are increasing in patients foregoing chemotherapy or other investigative modalities due to risks and/or shortages caused by the pandemic. Further, many elective surgeries have been delayed or cancelled around the country. There are also rumors of more grave instances of rationing care occurring such as forbidding organ transplants because of patients declining the COVID vaccine or hospitals discouraging certain lifesaving procedures due to concerns of ICU capacity and ventilator availability.

Staffing Crisis

Undeniably, the U.S. health care system is experiencing an unprecedented staffing crisis. However, the response is likely contributing to the situation that is spiraling out of control. Bedside nurses and other health care workers (HCWs) are leaving the bedside in droves. The response has been for hospitals to urgently call on travelers and other contract labor to quickly fill the void at double or triple the salary or more in some cases (Hut, 2021). This lucrative situation is attracting more HCWs to leave the bedside, hence the spiraling situation. Here are some statistics from November 2021, according to the Healthcare Financial Management Association (as cited in Hut, 2021):

• 534,000 HCWs quit their jobs in August 2021.

• Predictions of shortages, including 37,800 to 124,000 fewer physicians than needed by 2034; 510,000 fewer nurses by 2030, and 3.2 million fewer support staff than required by 2026.

• Travel nurse rates have increased by 200% because of the pandemic.

• $40,000 is the cost of turnover of one bedside registered nurse (RN) position.

• 14 states reported critical staffing shortages from 50 to100% between October 2020 and November 2021.

While most disciplines are affected by staffing shortages, nursing is particularly impacted. Evidence suggests that nursing shortages increase untoward outcomes for patients and contribute to higher mortality (Samuel, 2022). According to the American Nurses Association (n.d.), the nursing shortage is fueled not only by the COVID-19 pandemic but also by

• the aging population,

• the aging workforce (The average age of an RN is 50.),

• burnout, and

• not enough new nurses entering the workforce. According to Hut (2021), some measures health care systems employ to respond to the above-alarming labor trends include payroll flexibility where skill mix is at the heart of staffing decisions instead of only focusing on productivity—as has been done historically. Hospitals are getting very creative to ensure nurses and other disciplines have the right influx of new graduates by creating partnerships with universities and building residency programs to ensure new hires’ success. Finally, acute care hospitals are highlighting paradigm shifts with programs that keep patients from receiving care in the hospital whenever possible by emphasizing telemedicine and community partnerships.

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Psychological Stress on Health Care Workers HCWs are experiencing high levels of psychological distress related to working during the COVID-19 pandemic (Gupta et al., 2021). The distress leads to burnout, which has been shown to contribute to medical errors, decreased productivity, higher turnover rates, and an overall lack of empathy for patients. HCWs experience increased difficulties with sleep and higher levels of stress, anxiety, and depression (Gupta et al., 2021). Frontline workers are at greater risk for drug use and addiction. d’Ettorre et al. (2021) found those at greatest risk for psychological distress related to the COVID-19 pandemic included HCWs who

• are younger in age,

• have fewer years’ experience,

• are female,

• have heavy workloads, and

• possessed an inadequate support system. Further, those HCWs who reported less medical training to respond to the COVID-19 pandemic also had greater risk for burnout and psychological effects. Simple Strategies to Ease the Staffing Burden According to The Ohio State University College of Nursing (Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare, 2020), there are strategies hospitals and health systems must consider for easing the staffing crisis and burnout HCWs experience. Suggestions include the following:

1. Implement a tiered-staffing strategy 2. Restrict routine services 3. Reduce administrative and teaching responsibilities 4. Reassign nonessential nurses back to the bedside (quality, education, etc.) 5. Limit staff vacations and leaves temporarily 6. Offer childcare options for staff 7. Make available onsite food options, resting areas, and other conveniences 8. Provide onsite or organization-supported housing 9. Vary length of shifts

10. Offer transportation to and from the hospital for staff 11. Utilize a runner nurse who is not assigned to a patient load but supports two to three bedside nurses 12. Increase the use of video monitoring 13. Use a team model to provide care 14. Provide adequate recognition to staff

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Leadership Strategies

In addition to the simple, targeted strategies listed above, there are overarching strategies health care managers must understand to navigate leading during a pandemic. Specifically, evidence supports six clear ways in which HCWs say their leadership can ease the burden of caring during the COVID-19 pandemic. According to Adeyemo et al. (2021):

Conclusion

It is clear the COVID-19 pandemic has touched every facet of the health care industry and has left global concerns that will likely forever change us all. From the way heath care facilities are designed, patients and visitors are managed, resources are obtained and allocated, and how we care for HCWs, clearly leaders need a strong grasp on how to manage during these unprecedented times. Even for those who believe the pandemic is nearing an end, it will certainly not be the last. At a minimum, it is evident that the staffing crisis will linger, and a major overhaul is necessary to fix staffing ratios, staff satisfaction, and labor costs in the United States. The foregoing barely scratched the surface of what it is like to lead during the pandemic. The

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best advice: be kind and empathetic; be transparent as often as possible; roll up your sleeves and help at the bedside whenever possible; and be creative with staffing, scheduling, resources, and recognition.

References

Adeyemo, O. O., Tu, S., & Keene, D. (2021). How to lead health care workers during unprecedented crises: A qualitative study of the COVID-19 pandemic in Connecticut, USA. PLOS One, 16(9), Article e0257423. https://doi.org/10.1371/journal.pone.0257423

American Nurses Association. (n.d.). Nurses in the workforce. https://www.nursingworld.org/practice-

policy/workforce/ d’Ettorre, G., Ceccarelli, G., Santinelli, L., Vassalini, P., Innocenti, G. P., Alessandri, F., Koukopoulos, A. E.,

Russo, A., d’Ettorre, G., & Tarsitani, L. (2021). Post-traumatic stress symptoms in healthcare workers dealing with the COVID-19 pandemic: A systematic review. International Journal of Environmental Research and Public Health, 18(2), 601. https://doi.org/10.3390/ijerph18020601

Freidenfelds, L. V. (2021). How COVID-19 has changed visitor management. Journal of Healthcare Protection

Management, 37(1), 22–26. https://www.telgian.com/content/uploads/2021/02/How-COVID-19-has- Changed-Visitor-Management.pdf

Gupta, N., Dhamija, S., Patil, J., & Chaudhari, B. (2021, October). Impact of COVID-19 pandemic on

healthcare workers. Industrial Psychiatry Journal, 30(Supp. 1), S282–S284. Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare. (2020,

April 14). Expert recommendations for staffing and surge preparation during pandemics, disasters and crises. The Ohio State University College of Nursing. https://fuld.nursing.osu.edu/sites/default/files/healthcare- expert_recommendations_for_staffing_and_surge_preparation_during_pandemics_disasters_and_cri ses.pdf

Hut, N. (2021, November 30). The COVID-19-induced surge in healthcare labor costs is testing hospitals and

health systems. Healthcare Financial Management Association. https://www.hfma.org/topics/hfm/2021/december/soaring-labor-costs-stemming-from-covid-19-test- hospitals-and- he.html#:~:text=Through%20September%202021%2C%20hospital%20employment%20had%20decr eased%20by,wages%20as%20hospitals%20scramble%20to%20fill%20essential%20positions

Mirchandani, P. (2020, August 18). Health care supply chains: COVID-19 challenges and pressing actions.

Annals of Internal Medicine, 173(4), 300–301. https://doi.org/10.7326/m20-1326 Rosenbaum, L. (2020, June 11). The untold toll—The pandemic’s effects on patients without COVID-19. The

New England Journal of Medicine, 382, 2368–2371. https://www.nejm.org/doi/full/10.1056/NEJMms2009984

Samuel. (2022, January 28). How short staffing affects patient care articles? Excel Medical.

https://www.excel-medical.com/how-short-staffing-affects-patient-care-articles/ Stichler, J. F. (2022, January 1). How the coronavirus pandemic has changed healthcare design. HERD:

Health Environments Research & Design Journal, 15(1), 12–21. https://doi.org/10.1177/19375867211060822