Responding to COVID-19: The Importance of ‘Value-Aligned Decisions’

Group of people around a table looking at graphs and maps as part of a decision-making session

Authors: Jiban Khuntia and Els van der Wilden

Taking decisions which count

Faced with the COVID-19 crisis, healthcare organisations and hospitals took two types of decisions: those which were short-term and mostly tactical, dealing with the urgency of the situation, and those which were taken with a longer-term view, involving plans beyond the pandemic. Which of these decision-making strategies will have a lasting impact as ‘value propositions’ after the coronavirus pandemic has subsided?

Health systems are also facing financial distress because of the pandemic. This is because of unexpected costs due to an increased demand for certain materials like PPE’s, high use of (expensive) intensive care units, and due to decreased revenues due to the lesser volume of regular care. Hospitals were stretched to their limits with care for COVID-19 patients and had to postpone treatments and interventions. Patients delay their regular visits to hospitals as well.

Health systems are grappling with how to find alternate funds to sustain.

Unless the decisions made during the pandemic are value-oriented to future viability, health systems will face another financial pandemic soon, the traces of which are already well-noticed across the globe.

Decision-making in a crisis

To inform and draw insights into the value-aligned decisions taken during the COVID-19 pandemic, as part of the IHF ‘Beyond COVID-19’ Task Force, we observed and interacted with more than 15 health systems in different countries. Our objective was to differentiate the value-aligned decisions, in contrast to the quick and immediate decisions to help mitigate the crisis. From our observations, the decisions by the health systems can be categorised broadly into three types:

Economizing decisions which involve cost-cutting, complexity reduction, and performance-reducing decisions. Examples , across almost all health systems, include:

  • Restricting elective and non-urgent procedures.
  • Furloughing for non-critical staff.
  • Deployment of non-intensive care trained staff to support in intensive care units.
  • Closing facilities and minimising patient visitor access.

Along with these short-term, economizing decisions, some healthcare organisations also adopted long-term decisions, such as:

  • Creating or activating command centre models to respond to future pandemic.
  • Building and developing in-house testing facilities for COVID-19 and similar infectious diseases.
  • Collaborating with local non-healthcare manufacturers to evolve as medical suppliers for critical PPEs and ventilators as a sustainable step to avoid critical issues associated with global supply chain disruptions.

The latter of these offer examples of decision more value-aligned in the long-term perspective than earlier tactical ones, while almost all health systems have taken the short-term tactical decisions.

Operational continuity decisions to sustain or ‘pause-plan-start’ some procedures and activities, aligned to a crisis and as it unfolds. Examples of this decision type include:

  • Maintaining facilities that are needed for care delivery.
  • Changing workflows in hospital wards to accommodate patients and avoid transmission of infections (e.g., relocation of IV pumps from patient rooms to department hallways to reduce the burn rate of PPE).
  • Reuse of PPEs and other materials wherever possible; infrastructural changes, such as hospitals placed tents on the campus for patient care or to replenish activities.

Healthcare organisations and hospitals, such as one in Taiwan and the public health system in Spain (supported by GS1 Spain), also took this opportunity to develop a better information infrastructure to coordinate supply chain activities. Two hospitals in the United States collaboratively identified and developed alternate supply chain routes that would help them in future similar situations.

New activities and process decisions that would lead to better solutions than existing ones. The examples of such decisions include:

  • Adoption of telehealth, remote critical care surveillance, and other continued care delivery models to earn revenue.
  • ‘Drive-through’ testing activities.
  • Improved types of personal protective face masks that can help in the immediate situation.

Long-term decisions, such as communication and coordination rules and procedures needed for crises, were established by several health systems. One hospital in the United States developed a set of reuse-and-recycle rules for gowns and wearables and informed all the employees about it.  Another hospital the Task Force engaged with had developed a chain of command structures to respond to future crises.

Thus, implementing appropriate decision-making strategies to secure protection equipment, immediately managing the demand and supply of PPE and ventilators, shutting down redundant or unproductive activities, and keeping up with testing demands, taking measures to identify and continue delivering crucial operations—all are aligned to alleviate the immediate pandemic situation.  However, as the coronavirus situation improves, only some of the short-term and tactical decisions will help hospitals and healthcare organisations to sustain their quality and care-oriented activities in the future.  On the contrary, well-considered and strategic value-oriented decisions, such as forming or investing in collaborative supply chain routes, managing the surge and subsequent continuation plans, and managing and integrating the move to remote and virtual care with their existing operations, are value-aligned decisions with long-term benefits.

With the above insights, we also identified the importance of having a ‘Plan B’ in supply, logistics, and infrastructure (SLI) for healthcare organisations and hospitals is a crucial value-aligned activity.  SLI is the backbone for ensuring a safe and reliable work environment for both staff and patients. Undoubtedly, healthcare systems who already had a ‘Plan B’ in place for their supply chains and logistics or who quickly implemented ‘Plan B’ were able to rise to the challenge of COVID-19 more effectively than their peers who were unprepared. For example, a leading healthcare system operating in Louisiana and Mississippi (United States) had a warehouse with a standardised and integrated supply chain infrastructure, with in-built surge and crisis management modules. This initiative helped the healthcare system better navigate the demand for equipment demand and supply

Key Takeaways that can be derived from the Value-Aligned Decision Making

Based on their observations, the IHF ‘Beyond COVID-19’ Task Force  presents three key learnings for healthcare systems to implement in their local settings:

First, hospitals and healthcare organisations are part of a broader health system that is interdependent on other parts. Collaboration and coordination with other partners are a must to ensure a robust healthcare supply chain. This also informs the necessity to form ‘information infrastructures’ around health systems in each country and across the globe, so that vested interests do not dominate or disrupt activities during a crisis.

Second, while most hospitals are following ‘legacy’ and ‘institutionalised’ models (that include supply chain logistics, information-infrastructure, reimbursement models, and operations), some organisations have built flexibility into their practices to accommodate any unforeseen disruptions.  For instance, the sudden surge in telehealth and virtual care necessitated by the COVID-19 crisis is creating enough additional pressure on them without built-in flexibility in work practices to allow integration of these models. At the same time, payor-driven legacy models may not support these innovations, although there are efforts to align reimbursement models to the new remote care models.

Third, a much-ignored supply chain issue has been exposed to health systems and is of a wide discussion in recent times. Plausible solutions may involve ensuring a responsive supply chain, following a using global supply chain standards and information infrastructure, while keeping a Plan B approach in view.

Moving beyond the COVID-19 pandemic

It is beyond doubt, all over the globe, that the COVID-19 pandemic heavily impacted healthcare delivery. The situation highlighted strengths and shortcomings. We are fascinated by some decisions and the flexibility of several health systems to manage the crisis, prepared or unprepared, but to adapt to the situation promptly. A safe and sound infrastructure (buildings, technical, IT) proved vital, as well as dependency on supply chain partners. The learnings will support strengthening the resilience of hospitals and the healthcare supply chain. The IHF ‘Beyond COVID-19’ Task Force will be discussing some of the issues highlighted in this blog at it is upcoming Virtual Forum in November.

 


About the Authors

Dr. Jiban Khuntia is an Associate Professor of Information Systems and the Ph.D. Program Director at the Business School of the University of Colorado Denver, USA. His research expertise is in the digital transformation of health systems. His work has appeared in leading premier journals such as Information Systems Research, Production and Operations Management, and the Journal of Management of Information Systems and Decision Support Systems, amongst others. He earned in Ph.D. from the University of Maryland. Prior to this, Jiban spent more than a decade, gaining experience in IT and supercomputing areas. He has consulted with other organizations of international repute.

 

Mrs. Els van der Wilden-van Lier is presently Director (Healthcare Providers) at GS1 AISBL. She is a medical doctor, trained in tropical medicine, governance and holds a degree in public health. She has worked in cross-cultural settings; in acute care; in public health; on the payers’ side (healthcare insurance company); in healthcare governance; in higher hospital management and as a Board member of a (merging) Teaching Hospital; and as Director of hospital-related healthcare in the Dutch Healthcare Inspectorate. She has a focus on the quality of care, patient safety, and efficiency of care.

The authors would like to acknowledge the following for their support :

      • Mr. Amit Pradhan and Ms. Lauren Duff, who provided research assistance to Dr. Jiban Khuntia to interview healthcare systems in the United States.
      • Dr. Rulon Stacey, the CEO Circle Chair at IHF, who helped to align the interviews with the health systems executives.

 

 

 

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