Hospitals are part of the early warning system in any emerging public health crisis, among the first to alert us to a growing problem. COVID-19 followed this pattern perfectly.
Although hospitals worldwide had warnings from China where the virus first emerged, its rapid spread through Europe, followed by the United States, proved challenging for the U.S. healthcare system. As a newly emerged pathogen, the novel coronavirus left healthcare with only blunt solutions to slow its spread, primarily requiring social distancing and high-levels of personal protective equipment, or PPE, for healthcare providers. The need to keep patients from mingling together and a scarcity of PPE have had continued effects on hospital and healthcare business operations throughout the pandemic response.
China's experience with COVID-19 taught U.S. planners to prepare for rapid growth in cases needing hospitalization and advanced respiratory support. China and Italy also showed that lockdowns and shelter-in-place orders were a useful tool for slowing the growth of cases, or "flattening the curve" as we quickly became accustomed to hearing. Because hospitals are large employers that also provide care to the public, they were affected by this strategy in two ways.
First, they had the same struggles as any employer, with much of the non-clinical workforce transitioning to remote work. Second, they started canceling elective procedures and outpatient appointments to free up space in facilities for potential COVID-19 use and to reduce the transmission among patients waiting for appointments. Either of these would be financially impactful operational disruptions, but together they were devastating. The American Hospital Association projected operating losses of up to $323.1 billion for the year across the hospital and health sector.
One of the first steps that most hospitals and other healthcare practices took was to move as many appointments as possible to virtual care. States and the federal government promulgated a series of declarations and waivers that removed many of the regulatory barriers to payment for virtual services.
The Department of Health and Human Services reported that within months, nearly half (43.5%) of Medicare primary care visits were being provided by telehealth, compared to only 1% prior to the pandemic. This rapid growth occurred across the healthcare spectrum. Private insurers saw similar telehealth usage growth, and even acute care patients began using virtual technology to interact with loved ones as hospitals barred most visitors. This incredible shift to virtual modalities coincided with shifting most white-collar work and most schools to online platforms.
The few short months at the beginning of 2020 marked a stunning sea change in how Americans used virtual technologies. Early evidence points to high patient satisfaction rates with remote visits, increasing the demand for telehealth and related technologies post-pandemic.
Hospitals and other healthcare organizations should prepare for changes to business driven by this shift, recognizing that competition from non-traditional players, such as direct-to-consumer telehealth services, constrains their ability to own and control these new delivery pathways fully. Those prioritizing investments as part of their healthcare business approach must account for this competition when structuring their digital offerings. Organizations should also rethink processes to allow for lower-cost digital delivery in the face of reduced margins driven by competition and consumer pricing pressures.
The pandemic immediately highlighted gaps in the U.S. public health surveillance system, and hospitals had to devote precious resources to fill them. The demand for state and federal reporting became insatiable as planners tried to understand how and where COVID-19 was growing.
A lack of national standards and leadership in aggregating information forced private organizations to begin aggregating and publishing data for the public. And important socio-ethnographic data was lacking in most reports, making it impossible to track how COVID-19 impacted different communities fully.
Nonetheless, the disparate impact of COVID-19 on minority populations has highlighted the need for more holistic approaches to public health and increased public awareness of social determinants of health. This new awareness requires a lasting change in clinical practices, with the U.S. Centers of Disease Control and Prevention promoting increased integration with community organizations as part of holistic COVID-19 treatment strategies, explicitly calling out, "Community- and faith-based organizations, employers, healthcare systems and providers, public health agencies, policymakers, and others all have a part in helping to promote fair access to health.”
Short-term impacts requiring more data entry of demographic information at the point of care are sure to become permanent. And governments may push for systemic improvements in the coming years as the public demands better responses to future diseases and continued surveillance of the long-term effects of COVID-19. Organizations will feel these impacts across all areas of healthcare business operations.
If the public learned nothing else during the early days of the pandemic, it began to understand just how fragile the healthcare supply chain could be and how global it had become. Shortages of personal protective equipment for healthcare and other essential workers lead news stories for weeks and persist even after leaving the headlines. In addition to ongoing PPE shortages, the emergence of several viable vaccine candidates, many requiring special handling, adds to the ongoing challenges facing the healthcare supply chain.
Government leaders and supply chain managers must address this fragility. Some analysts see an increased application of LEAN principles to supply chain management as an essential step for improving resiliency and responsiveness. With supply availability underpinning every part of COVID-19 treatment from hospital bed availability to vaccine distribution, investment and change in supply chain functions will impact healthcare business for years to come.
As we've seen during the pandemic, hoping that a disruptive surprise never arrives may seem an effective strategy. The approach saves time and resources that can be applied elsewhere. When disruption arrives, however, it is already much too late to mount an effective counter-initiative.
In the same way, building a future healthcare business strategy based upon today's trends is bound to create an environment where an organization is continually trying to catch up, never getting ahead, and reacting to the world instead of engaging with it. COVID-19 signals an opportunity to start thinking differently about how we plan for the future. While it is impossible for anyone to accurately predict the future, healthcare organizations can develop a credible view of possible future states that can be used to test and adjust near-term strategies and tactics.
A single organization concerns itself with its immediate needs: keeping the lights on, finding and developing its workforce, providing care, etc. The organizational micro-environment functions within a business sector, its meta-environment.
Here, providers and other types of organizations must also pay attention to legislation and regulation, collaborations, competition, etc. The healthcare sector is huge, both from the standpoint of the investment involved to provide care, and from the impact it has on the lives of all people. When strategic development is constrained to the trends and drivers within the micro- and meta-environments, the macro-environment is unfortunately ignored.
To futurists, the macro-environment is the most important of the three. The macro environment is where changes that will impact the healthcare begin and are first seen—if you know where to look. The first signs of change in societal values will define how our social, political, technological, economic and environmental domains adapt. It is within this rapidly changing world external to healthcare that the future begins to emerge. The healthcare sector (our meta-environment) must be prepared for changes that will emerge in the external landscape and that have yet to become identifiable "trends."
A futurist approach can yield possible scenarios that an organization can use in a couple of different ways.
First, scenarios serve as mental maps of the future; these inform thinking about the desired direction, and can be used as "tests" against which a proposed initiative can be measured. If the initiative, product, or service doesn't hold up against the desired future state, adjustments can be made early in the process. It's very similar to the concept of a failure mode effect analysis, or FMEA. While the scenario can reveal potential pitfalls, it also serves as the vision statement the new service aims to support.
Secondly, and somewhat ironically, scenarios can be used as a starting point, despite the fact that they are visions of possible futures. They act as starting points from which we can look backwards to identify the milestones along the way to the desired future. Milestones may include new technologies that must be developed, or changes in societal values, or anything in between. Some companies use scenarios as an enterprise-wide tool to future-proof projects. New initiatives must be measured against the enterprise scenarios to ensure alignment. How scenarios are constructed is a much deeper discussion, but this is the general idea.
Using COVID-19 as our example, and the year 2020 as our "future scenario," organizations and governments can learn about future planning by looking back at what could have been done differently in order to better manage from a position not of reaction, but one of preparedness.
More futures are on the way. This is a great time to think differently about them.
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