Workforce Tactics to Manage the Surge of COVID-19 Patients

Between the COVID-19 hotspots and the geographies that are preparing for the surge, Premier members are implementing an array of workforce management strategies. While some have staff who are quarantined, others have staff on extended leave as they prepare for an influx of patients who haven't yet arrived.

Providers’ approaches range from task-shifting to enable clinicians to work to the top of their licenses to having quarantined staff take on remote research work.

As the workforce is reallocated, consider how to capture the financial impact of COVID-19 activities on the organization.

Three practices deployed by Premier members include:

1. Setting up a cost center to track COVID-19 activities to understand the downstream effect on operating expenses. A dedicated COVID-19 cost center is an optimal approach to assess the financial impact of COVID-19-related activities, as it will capture all associated costs, beyond simply labor. Consider a new cost center, as opposed to using an existing one, so COVID-19 data does not obscure figures associated with an existing department or initiative.
2. Identifying the cost of lost productivity to assess hidden costs of the crisis. As organizations assess the financial impact of COVID-19, they will not only want to evaluate labor in departments that had surge, but also productivity in departments that registered a material decrease in their volumes, such as units that historically manage elective procedures. For these departments that are recording lower volumes during the outbreak – like patient registration, food and nutrition, and the OR – providers should plan to compare the department’s worked hours per unit costs (WHpU) from before the outbreak, such as the Q4 2019 period, to the WHpU/costs the department incurs during COVID.
3. Considering new pay code(s) to capture additional sick time. Some organizations are developing a staff absence policy for sick staff, offering additional sick or leave time, and will need to track both the amount of staff who are out sick as well as the length of time they are out. As another mechanism for measuring labor expense associated with COVID, providers should consider implementing new pay codes to quantify additional sick time. Part of the staff absence policy may include guidelines to test employees and outline when it is safe for them to return to work. The CDC offers guidelines for healthcare workers returning to work.

Six workforce adjustments to help prepare for an influx of patients

These practices take into account task-shifting amongst clinical and non-clinical staff, as well as ways to fully leverage remote capabilities, credential professionals and care for staff.

For clinical staff: Identify who can be redeployed to support high-volume departments, and assign priority based on availability, certification and impact to the staff’s home (pre-crisis) department.

Critical care staff will be in highest demand, particularly critical care nurses and respiratory therapists. To allow intensivists to focus on the most severe critical care patients, including those on ventilators, providers can enlist advanced practitioners and physician assistants to help manage stable patients.

Nurses will also be called on by hospitalists and advanced practitioners to help manage stable patients, as well as complete respiratory therapy tasks as respiratory therapists’ availability becomes limited. Reference this practical guide to utilizing staff in crossover capacities for more ideas.

For furloughed clinicians, look for opportunities with trusted staffing agencies to efficiently reapportion them to geographies of high need and return them as the pandemic and fiscal situation allows. An ideal agency partnership will support credential sharing to fast-track temporary employment; track each employee's status and contract completion; and communicate key information to the employee's home healthcare system.

Develop a system to emergency-credential clinical staff who are not active and practicing.

As med schools offer early degrees to allow students to join the COVID-19 response, several states are waiving their normal guidelines to expedite access to clinicians who could take part in patient care. Processes focus on accelerating the credentialing of clinical staff who are not actively practicing so they can be quickly deployed. States are also loosening the specific parameters around how quickly clinicians must go through the credentialing process to enable quicker turnarounds.

• The Drug Enforcement Administration is allowing for emergency expedited registration of emergency or temporary off-site locations that still allow for use of controlled substances, to maintain patient access and sustain the drug supply chain.
• Some states that have declared a state of emergency have reciprocity with neighboring states, meaning clinicians in the non-emergency state can still write prescriptions for patients in the emergency state. Furthermore, doctors can treat patients in other states if there is an existing doctor-patient relationship.
• States are changing their requirements around state medical licenses. In California, for example medical facilities can bring in out-of-state personnel by submitting a form requesting to use out-of-state personnel in a state of emergency. The state medical board has offered to issue determinations in a matter of days, rather than weeks or months.
• Continuing medical education deadlines are being extended up to six months in some states.
• Many states are extending state license expirations if licenses are set to expire during the COVID crisis. In Massachusetts, for example, if a state license expired after the crisis picked up in mid-March, the state will not count it as expired until 90 days after the crisis is over.

For non-clinical staff: Identify who can assume other responsibilities and whether they can assist in patient care.

As clinicians focus on patients with the greatest needs, providers are asking employees in non-clinical roles such as supply chain, IT, marketing and quality about their willingness and ability to take on new roles or even provide basic patient care such as temperature checks. In hotspots, for example, suppliers are only delivering supplies to the loading dock, so staff responsibilities may include delivering supplies from the dock to a storage room or directly to the end users.

With staff taking on new or abated roles, providers can consider use of a workforce management solution to closely monitor flexing staff, particularly in departments with low volumes. Staff who are at higher risk for disease transmission due to preexisting conditions or other clinical risk factors may qualify to be quickly flexed or floated out.

Use telehealth for less-acute COVID cases to conserve beds for more severe patients.

As the CARES Act allocates dollars to support telehealth investments, health systems are exploring telehealth capabilities to support remote follow-ups for patients who may be suspected of having coronavirus. This may be an effective strategy for patients who are suspected or even confirmed, but with lower-grade symptoms. Remote monitoring eases capacity and conserves supplies by having the most severe patients coming into the facility for the treatment.

Even quarantined staff can be leveraged to maximize follow-up with telehealth patients. For some staff who are are self-isolating, providers have assigned journal research, EHR documentation, consults and other work that can be done remotely.

As COVID-19 case volume flattens: Bring together low-utilized clinical and operational staff to solve for inefficiencies around elective procedures and other non-essential areas.

As health systems begin to see a flattening of COVID-19 volume, some are deploying small, focused redesign teams of clinical and operational stakeholders to address pre-existing inefficiencies. The idea is to ensure a swift, structured return to normal operations post-crisis, particularly in areas such as outpatient surgical throughput that are critical for driving margin.

Elective procedures will be in high demand as the effects of COVID-19 settle, and providers will want to ensure these services come back online efficiently. Leverage the COVID-19 downtime and less critical staff to fix issues that may exacerbate financial and operational inefficiencies post-crisis.

Take note of staff wellbeing.

From nutritional needs to housing, providers are offering care for staff personally and professionally like never before. Some clinical professionals are distancing themselves from their families to limit the risk of disease transmission, thereby sleeping onsite or at a hotel, and there are increased efforts from providers and citizens alike to keep the morale up. Community members have instated regular hours to clap from their driveways for their local medical and frontline responders; send in handwritten cards, notes and coffee gift cards for staff and clinicians; and donate meals from local restaurants.

Especially in crisis mode, there’s a risk of physician, clinician and staff burnout, which increases the likelihood of medical errors and potentially disease transmission. Encourage caregivers to partake in mood-boosting activities, revel in the thank yous from the community and foster human connection. Every little bit helps.

Unwavering Support and Partnership

During COVID-19, Premier continues to act as a trusted connection point for healthcare providers, suppliers and the government. We are working 24/7 to address challenges as they occur and help our alliance of more than 4,000 hospitals and health systems and 175,000 non-acute providers access the supplies they need to serve their communities. We are also partnering with the Administration and private sector to create short-and long-term solutions.

Access our COVID-19 resources and tools.