Description of a Multi-faceted COVID-19 Pandemic Physician Workforce Plan at a Multi-site Academic Health System

Abstract Background The evolving COVID-19 pandemic has and continues to present a threat to health system capacity. Rapidly expanding an existing acute care physician workforce is critical to pandemic response planning in large urban academic health systems. Intervention The Medical Emergency-Pandemic Operations Command (MEOC)—a multi-specialty team of physicians, operational leaders, and support staff within an academic Department of Medicine in Calgary, Canada—partnered with its provincial health system to rapidly develop a comprehensive, scalable pandemic physician workforce plan for non-ventilated inpatients with COVID-19 across multiple hospitals. The MEOC Pandemic Plan comprised seven components, each with unique structure and processes. Methods In this manuscript, we describe MEOC’s Pandemic Plan that was designed and implemented from March to May 2020 and re-escalated in October 2020. We report on the plan’s structure and process, early implementation outcomes, and unforeseen challenges. Data sources included MEOC documents, health system, public health, and physician engagement implementation data. Key Results From March 5 to October 26, 2020, 427 patients were admitted to COVID-19 units in Calgary hospitals. In the initial implementation period (March–May 2020), MEOC communications reached over 2500 physicians, leading to 1446 physicians volunteering to provide care on COVID-19 units. Of these, 234 physicians signed up for hospital shifts, and 227 physicians received in-person personal protective equipment simulation training. Ninety-three physicians were deployed on COVID-19 units at four large acute care hospitals. The resurgence of cases in September 2020 has prompted re-escalation including re-activation of COVID-19 units. Conclusions MEOC leveraged an academic health system partnership to rapidly design, implement, and refine a comprehensive, scalable COVID-19 acute care physician workforce plan whose components are readily applicable across jurisdictions or healthcare crises. This description may guide other institutions responding to COVID-19 and future health emergencies.

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Physician Workforce Response to the COVID-19 Pandemic at an Academic Medical Center

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2020.377 ◽

2020 ◽

pp. 1-4

Author(s):

Laurie G. Jacobs ◽

Jason A. Korcak ◽

Marygrace Zetkulic

Keyword(s):

Acute Care ◽

Medical Center ◽

Academic Medical Center ◽

Care Physician ◽

Physician Workforce ◽

Acute Hospital Care ◽

Face To Face ◽

Personal Risk ◽

Academic Medical ◽

Training Compensation

ABSTRACT Objectives: The aim of this study was to describe the planning, implementation, and outcome of an acute care physician supplemental workforce during the local coronavirus disease 2019 (COVID-19) surge at a 771-bed academic medical center, from March 25 to May 5, 2020, in New Jersey, United States. Methods: The Department of Medicine sought participation by “independent” and redeployed “employed” physicians to provide acute hospital care, as well as assistance with occupational health and family communication. Plans addressed training, compensation, clinical privileges, malpractice, and collaboration with the existing hospitalist service. Results: Redeployed employed physicians (81% internists) selected either acute care (n = 68; median age, 52 y [range, 32-72 y]; 28% female) or non-face-to-face supportive roles (n = 69; median age, 52 y [range, 32-84 y]; 28% female). The redeployed physician group totaled 474 twelve-h daytime shifts typically caring for 10 patients per day. Six employed physicians refused redeployment, and only 3 independent physicians participated (all acute care). Of note, COVID-19 infection occurred in 10 hospitalists and intensivists, and in several redeployed physicians. Conclusions: Successful physician workforce staffing for medical disasters, such as the COVID-19 pandemic, requires consideration of personal risk, as well as medicolegal, financial, and clinical competency issues.

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‘Let me move to another level’: career advancement desires and opportunities for community health nurses in Ghana

Global Health Promotion ◽

10.1177/17579759211027426 ◽

2021 ◽

pp. 175797592110274

Author(s):

Meghan Bellerose ◽

Koku Awoonor-Williams ◽

Soumya Alva ◽

Sophia Magalona ◽

Emma Sacks

Keyword(s):

Health System ◽

Community Health ◽

Work Experience ◽

Career Advancement ◽

Program Planning ◽

Sub Saharan Africa ◽

System Capacity ◽

Future Health ◽

Community Health Nurses ◽

Continued Education

Career advancement and continued education are critical components of health worker motivation and retention. Continuous advancement also builds health system capacity by ensuring that leaders are those with experience and strong performance records. To understand more about the satisfaction, desires, and career opportunities available to community health nurses (CHNs) in Ghana, we conducted 29 in-depth interviews and four focus group discussions across five predominantly rural districts. Interview transcripts and summary notes were coded in NVivo based on pre-defined and emergent codes using thematic content analysis. Frustration with existing opportunities for career advancement and continued education emerged as key themes. Overall, the CHNs desired greater opportunities for career development, as most aspired to return to school to pursue higher-level health positions. While workshops were available to improve CHNs knowledge and skills, they were infrequent and irregular. CHNs wanted greater recognition for their work experience in the form of respect from leaders within the Ghana Health System and credit towards future degree programs. CHNs are part of a rapidly expanding cadre of salaried community-based workers in sub-Saharan Africa, and information about their experiences and needs can be used to shape future health policy and program planning.

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Health Care Equity and COVID-19: Assessing the Relative Effectiveness of Egalitarian Governance and Health System Capacity on the COVID-19 Pandemic

SSRN Electronic Journal ◽

10.2139/ssrn.3628341 ◽

2020 ◽

Author(s):

Krishna Chaitanya Vadlamannati ◽

Arusha V. Cooray ◽

Indra De Soysa

Keyword(s):

Health Care ◽

Health System ◽

Relative Effectiveness ◽

System Capacity ◽

Health Care Equity

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Prioritising surgical cases deferred by the COVID-19 pandemic: an ethics-inspired algorithmic framework for health leaders

BMJ Leader ◽

10.1136/leader-2020-000343 ◽

2021 ◽

pp. leader-2020-000343

Author(s):

Amit Jain ◽

Tinglong Dai ◽

Christopher G Myers ◽

Punya Jain ◽

Shruti Aggarwal

Keyword(s):

Decision Analysis ◽

Health System ◽

System Capacity ◽

Surgical Case ◽

The World ◽

The Face ◽

Algorithmic Framework ◽

Limited Health ◽

Healthcare Leaders

Elective surgical suspension during the COVID-19 pandemic resulted in a sizeable surgical case backlog throughout the world. As we ramp back up, how do we decide which cases take priority? Potential future waves (or a future pandemic) may lead to additional surgical shutdown and subsequent reopening. Deciding which cases to prioritise in the face of limited health system capacity has emerged as a new challenge for healthcare leaders. Here we present an ethically grounded and operationally efficient surgical prioritisation framework for healthcare leaders and practitioners, drawing insights from decision analysis and organisational sciences.

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Legal needs of patients attending an urban family practice in Hamilton, Ontario, Canada: an observational study of a legal health clinic

BMC Family Practice ◽

10.1186/s12875-020-01339-y ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Gina Agarwal ◽

Melissa Pirrie ◽

Dan Edwards ◽

Bethany Delleman ◽

Sharon Crowe ◽

...

Keyword(s):

Observational Study ◽

Health Outcomes ◽

Family Practice ◽

Healthcare Setting ◽

Social Determinant ◽

Care Physician ◽

Health Clinic ◽

Legal Services ◽

Future Health ◽

Urban Family

Abstract Background Individuals living in poverty often visit their primary care physician for health problems resulting from unmet legal needs. Providing legal services for those in need may therefore improve health outcomes. Poverty is a social determinant of health. Impoverished areas tend to have poor health outcomes, with higher rates of mental illness, chronic disease, and comorbidity. This study reports on a medical-legal collaboration delivered in a healthcare setting between health professionals and lawyers as a novel way to approach the inaccessibility of legal services for those in need. Methods In this observational study, patients aged 18 or older were either approached or referred to complete a screening tool to identify areas of concern. Patients deemed to have a legal problem were offered an appointment at the Legal Health Clinic, where lawyers provided legal advice, referrals, and services for patients of the physicians. Fisher’s exact test was used to compare populations. Binary logistic regression was used to determine the factors predicting booking an appointment with the clinic. Results Eighty-four percent (n = 648) of the 770 patients screened had unmet legal needs and could benefit from the intervention, with an average of 3.44 (SD = 3.42) legal needs per patient screened. Patients with legal needs had significantly higher odds of attending the Legal Health Clinic if they were an ethnicity that was not white (OR = 2.48; 95% CI 1.14–5.39), did not have Canadian citizenship (OR = 4.40; 95% CI 1.48–13.07), had housing insecurity (OR = 3.33; 95% CI 1.53–7.24), and had difficulty performing their usual activities (OR = 2.83; 95% CI 1.08–7.43). As a result of the clinic consultations, 58.0% (n = 40) were referred to either Legal Aid Ontario or Hamilton Community Legal Clinic, 21.74% (n = 15) were referred to a private lawyer; one case was taken on by the clinic lawyer. Conclusion The Legal Health Clinic was found to fulfill unmet legal needs which were abundant in this urban family practice. This has important implications for the future health of patients and clinical practice. Utilizing a Legal Health Clinic could translate into improved health outcomes for patients by helping overcome barriers in accessing legal services and addressing social causes of adverse health outcomes.

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Patient Characteristics Associated with Telemedicine Use at a Large Academic Health System Before and After COVID-19

Journal of General Internal Medicine ◽

10.1007/s11606-020-06544-0 ◽

2021 ◽

Author(s):

Preeti Kakani ◽

Andrea Sorensen ◽

Jacob K. Quinton ◽

Maria Han ◽

Michael K. Ong ◽

...

Keyword(s):

Health System ◽

Patient Characteristics ◽

Academic Health ◽

Before And After

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Health system characteristics of quality care delivery: A comparative case study examination of palliative care for cancer patients in four regions in Ontario, Canada

Palliative Medicine ◽

10.1177/0269216311416697 ◽

2011 ◽

Vol 26 (4) ◽

pp. 322-335 ◽

Cited By ~ 17

Author(s):

Jonathan Sussman ◽

Lisa Barbera ◽

Daryl Bainbridge ◽

Doris Howell ◽

Jinghao Yang ◽

...

Keyword(s):

Palliative Care ◽

Health System ◽

Acute Care ◽

Pattern Analysis ◽

Care Delivery ◽

Quality Care ◽

Structural Features ◽

Comparative Case Study ◽

Care Utilization

Background: A number of palliative care delivery models have been proposed to address the structural and process gaps in this care. However, the specific elements required to form competent systems are often vaguely described. Aim: The purpose of this study was to explore whether a set of modifiable health system factors could be identified that are associated with population palliative care outcomes, including less acute care use and more home deaths. Design: A comparative case study evaluation was conducted of ‘palliative care’ in four health regions in Ontario, Canada. Regions were selected as exemplars of high and low acute care utilization patterns, representing both urban and rural settings. A theory-based approach to data collection was taken using the System Competency Model, comprised of structural features known to be essential indicators of palliative care system performance. Key informants in each region completed study instruments. Data were summarized using qualitative techniques and an exploratory factor pattern analysis was completed. Results: 43 participants (10+ from each region) were recruited, representing clinical and administrative perspectives. Pattern analysis revealed six factors that discriminated between regions: overall palliative care planning and needs assessment; a common chart; standardized patient assessments; 24/7 palliative care team access; advanced practice nursing presence; and designated roles for the provision of palliative care services. Conclusions: The four palliative care regional ‘systems’ examined using our model were found to be in different stages of development. This research further informs health system planners on important features to incorporate into evolving palliative care systems.

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Abstract T P259: What Should Really be Happening to Our Stroke Patients Post-Acute Care?: A System Best Practice Model for Inpatient Rehab

Stroke ◽

10.1161/str.45.suppl_1.tp259 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Shelley Sharp ◽

Elizabeth Linkewich ◽

Jacqueline Willems ◽

Nicola Tahair ◽

Charissa Levy ◽

...

Keyword(s):

Acute Care ◽

Stroke Unit ◽

Best Practice ◽

Patient Flow ◽

System Capacity ◽

Stroke Patients ◽

Practice Model ◽

Term Care ◽

Stroke Unit Care ◽

The Right

Background: A regional Stroke Report Card identified poor performance on system efficiency, effectiveness, and integration of stroke best practice. This engaged regional funders and 17 organizations (11 acute, 6 rehab) to collaborate in stroke system planning. The focus included stroke unit care and access to timely and appropriate rehabilitation, including increased access for severe stroke. Changes in acute care, including pre-hospital, have facilitated access to stroke unit care in the city. A model of patient flow from acute care was needed to understand other system capacity needs. Purpose: To use best practice and benchmarks to delineate post-acute patient flow and facilitate alignment of resources for inpatient rehabilitation. Methods: Administrative data from national reporting and local rehab referral system databases were used to review current system usage from acute care. A model of proportional distribution of cases from acute, specifically to inpatient rehab, was established using provincial benchmarks, evidence informed targets, and organization market share of total inpatient rehab system capacity. Iterative discussions were required to confirm the organizations’ commitment to stroke best practice. New volume and case mix changes were applied to determine capacity and resource planning needs across organizations. Results: The best practice model, approved by all stakeholders, proposes 40% of stroke patients discharged alive from acute care should access inpatient, 13% outpatient rehabilitation and 6% to Complex Continuing Care and Long Term Care. Current practice is 26%, <5% and 13% respectively. A projected volume increase of 278 patients is distributed across 5/6 rehab providers. This results in a total proportional system shift from 20% (n=160) to 41.5% (n =446) of severe patients receiving access to high intensity rehab. A reduction in the overall proportion of moderate and mild stroke patients from 65% (519) to 49.5% (n=534) and 15% (n=119) to 9% (n=96) respectively. Conclusion: Significant investment/redistribution of resources within the system is required to support patient flow and provide care in the right place at the right time. System funder support is critical to create a quality of care (best practice) system.

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HCFMUSP: Resilience in Response to the COVID-19 Pandemic

Revista de Administração Contemporânea ◽

10.1590/1982-7849rac2021200245.en ◽

2021 ◽

Vol 25 (spe) ◽

Author(s):

Marcelo Caldeira Pedroso ◽

João Teixeira Pires ◽

Ana Maria Malik ◽

Antonio José Rodrigues Pereira

Keyword(s):

Knowledge Management ◽

Health System ◽

Crisis Management ◽

System Capacity ◽

New Disease ◽

Healthcare Operations ◽

Teaching Case ◽

Health System Governance ◽

Emergency Actions ◽

The Impact

ABSTRACT The teaching case describes a set of emergency actions taken by HCFMUSP to manage the needs brought by the COVID-19 pandemic in Brazil. The case objective considers the issues related to the impact of the pandemic mostly in healthcare operations, emphasizing how to: (a) adapt health system governance in response to a crisis (crisis management); (b) manage the health system capacity, which traditionally is not so resilient; (c) deal with a new disease (knowledge management). Thus, it should allow gathering elements for the management of future crises.

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