• Sustain a central strategy with awareness of operations while keeping decision authority for operations at a level that is close to the point of care
It is crucial to build a safety culture featuring trust and an empowered network of teams .
• Build and sustain a framework for aligned decisions in the organization :
• Establish a common operating picture for the organization ’ s response through consolidation of diverse and timely data
• Review and update objectives throughout recovery as new information is collected from internal and external sources
• Establish a central , clear list of risks and priorities
• Build mitigation strategies tied to risk thresholds to align the organization ’ s approach to risk
• Anticipate and plan for future challenges
• Apply day-to-day leadership practices to build trust and sustain a sense of purpose :
• Build trust among staff and patients through actions aligned to principles of high reliability
• Demonstrate empathy through recognition , understanding , and respect for the feelings and opinions of staff and patients
• Be present , visible and available
• Maintain perspective in a crisis
• Reinforce intent and priorities frequently
For infection prevention and control specifically during an event such as a pandemic , the Deloitte / JCR whitepaper emphasizes the importance of a pipeline of clear communication : “ Designate a single source of truth within the infection prevention department or medical staff for interpreting , monitoring , and updating the latest scientific findings and most relevant guidelines and recommendations for screening and treatment . With novel viruses , such as COVID-19 , practitioners are constantly learning new things about the virus ’ s behavior , transmission routes , and pathology , and it is crucial to keep all staff up to date . Information must be accessible , and versioning must be apparent so that users know what is up to date .”
Healthcare Institution Preparedness
Ongoing lack of preparedness , despite experiences with the original SARS outbreak , H1N1 , and even potential Ebola cases coming to the U . S . for treatment , U . S . hospitals and other healthcare facilities remain largely unprepared for wide-scale events such as a pandemic . Facilities didn ’ t keep their emergency plans updated , they didn ’ t audit their supply chains , they didn ’ t assess their vulnerabilities , and they became complacent since the last outbreak scenario .
A University of Pittsburgh School of Medicine-led survey of dozens of surge capacity managers at hospitals nationwide captured the U . S . healthcare system ’ s pandemic preparedness status in the months before the first COVID-19 cases were identified in China . Published in March in the journal JAMA Network Open , the investigation details the strain experienced by U . S . hospitals during the 2017-18 influenza season , which was marked by severe illness and the highest infectious disease-related hospitalization rates in at least a decade . At the time , pandemic planning within hospitals was not reported as being a high priority .
“ The timing for our survey couldn ’ t have been better — ultimately it serves as a pre-COVID-19 time capsule of our preparedness to accommodate surges in patients needing hospitalization for acute illness ,” says senior author David Wallace , MD , MPH , associate professor in Pitt ’ s departments of Critical Care Medicine and Emergency Medicine . “ It was surprising to hear very detailed stories of the strain hospitals were under during the 2017-18 flu season , and yet have no pandemic planning come out of it .”
The 2017-18 flu season was associated with more than 27.7 million medical visits , nearly a million hospitalizations and almost 80,000 deaths , according to the CDC . That is more than double the deaths in a typical flu season and the highest hospitalization rate since seasonal influenza surveillance was instituted in 2005 .
Wallace and his team — which included specialists in health policy , medical anthropology and infectious diseases — interviewed surge capacity managers at a random sampling of 53 hospitals across the U . S . starting in April 2018 , at the tail end of the flu season . Using a structured
It was surprising to hear very detailed stories of the strain hospitals were under during the 2017-18 flu season , and yet have no pandemic planning come out of it .”
— David Wallace , MD , MPH
survey , they recorded detailed interviews about everything from ICU bed capacity and staffing ratios to the perceived effect of strain on quality of patient care and staff well-being . All those surveyed reported experiencing hospital strain during the 2017-18 flu season . Strain was generally described as the result of high patient occupancy causing demand to outstrip the supply of resources — in fact or in perception .
The 4 S ’ s — staff , stuff , space and systems — were reported as the widespread challenges that surge capacity managers consistently faced in continuing health care operations during the flu season . Staff was a particular concern , due to fatigue or staff being out sick with flu or caring for ill family .
“ This demonstrates that the perceptions of strain on staffing , patient care and capacity that we have seen during the COVID-19 pandemic were already present with prior epidemics ,” said lead author Gavin Harris , MD , an assistant professor in the Emory University School of Medicine , who conducted this research while at Pitt . “ Less than two years before COVID-19 took off in the U . S ., we were experiencing a preview of the strain that a fast-spreading , severe respiratory infection places on our health system .”
In fall 2013 , the U . S . Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response produced the Interim Healthcare Coalition Checklist for Pandemic Planning report , which identified eight categories hospitals should address when planning for crises , specifically surges in acute-care needs . None of the survey participants commented on all eight categories , nor did any specifically report using the checklist .
“ Hospitals have a tendency to deal with what ’ s right in front of them , the present ,” Wallace says . “ In doing that , we must also learn when certain levers — like a pandemic preparedness checklist — must be pulled . That is done through reflecting after a crisis subsides and looking for opportunities to improve before the next crisis hits . If the past year has taught us anything , it ’ s that infectious diseases aren ’ t going away , and we ’ ll always get a chance to put lessons learned to work .”
The supply chain continues to be one of the hardest-hit