Introduction

The Covid-19 pandemic has created a barrier to health care at a magnitude the likes of which our industry has never seen. Many patients are terrified to receive care in traditional health care settings. There are abundant anecdotal accounts of patients suffering from heart attacks, strokes and other severe illnesses due to fear of contracting Covid-19. This fear is exacerbated by the Covid-19 “infodemic,” defined by the World Health Organization as “an over-abundance of information – some accurate and some not – that make it hard for people to find trustworthy sources and reliable guidance when they need it.”¹ A Morning Consult poll revealed that a majority of voters said, “businesses and public spaces across the nation are opening too quickly.”² Economists say the way out of the recessions depends and the level of consumer fear.³ Ensuring patients can expect they are safe to receive care in traditional health care facilities will be almost as challenging as our nation’s response to the devastation, death and illness that coronavirus has reaped on our world.

These negative emotions go deeper and affect more of our population than we have seen in recent memory. They create a barrier to stabilizing patient care. Health care providers and organizations need to pivot from virtual shutdown to reopen and provide vital care to patients. To accomplish this, providers need to create and communicate that their “brick and mortar” settings are safe. Our health care heroes have gone above and beyond through this crisis. To make people feel safe to come back into our facilities, we will need to continue to go above and beyond. It is mission-critical that we make patients, their families, and their caregivers feel safe.

Six Things To Do:

1. Create a comprehensive plan

The first step to getting back on track is to create a reopening plan. Strategies should include intensifying communication with patients, redesigning physical layouts to prevent disease transmission, and ensuring enhancements to procedures, processes, and training to safely provide patient care while protecting everyone at the site. Plans must be thorough and rethink and establish the practice’s new care model. The standard of care that Covid-19 demands is designed not only keep everyone safe but also help everyone feel safe when receiving care. Your plan should outline how your organization will keep up with changing patient expectations. For example, virtual visits have quickly become routine. Under what conditions, when and how does your practice utilize virtual care?

As we emerge from the crisis, health care providers should take a fresh look at their operations; consider potential opportunities and new partners to increase revenue. What do you need to do to adapt to the market environment; are your partners able to change and grow with you? How is the care delivery model transforming, and how is your organization positioned to play a vital role? If services must be re-engineered, how does it affect your reimbursement, and will you need to adopt new payment models and new care models? Do you have a financial road map that guides you through a transition?

2. Follow the Centers for Disease Control and Preventions’ (CDC) guidance

Health care organizations need to follow the best practices and guidance issued by the CDC. Regulations from the CDC are detailed and comprehensive and include elements such as screening patients and visitors, protective equipment, social distancing, how to manage high-risk patients, staff training, cleaning and disinfecting and more. Providers should also monitor their local Department of Health (DOH) and professional organization guidance and recommendations. These organizations provide a useful starting point for creating a reopening plan.

3. Redesign ambulatory care delivery

Covid-19 has dramatically changed the way we deliver care. The pandemic has taught us that “It’s about patient care, not the where patients get their care.” The crisis has been a catalyst to expand virtual care, remote monitoring, drive-through testing, workflows restructure and our ability to continue shifting care to outpatient settings. Many providers gained experience in treating higher acuity patients, to which they were not accustomed to (e.g., nursing homes, hospital-at-home services, etc.)

Ambulatory providers are learning to provide “just-in-time patient care.” Long delays in a crowded waiting room are now more than a patient inconvenience; they can be hazardous. Changes to care delivery patient flow are needed. Patients now expect more care options. Here are our recommendations:

• Gather as much information ahead of the appointment. Use the internet or telephone for pre-registration, medical history updates, completion of medication reconciliations and documentation of the need for care, all of which should be completed ahead of the visit, saving time and mitigating wait times.
• Expand use of telemedicine to increase both provider and patient engagement, and ease patient worries by eliminating the on-site risk of transmission.
• Reduce no-shows through the use of systems that send automated reminders to patients.
• Create drive-thru options for immunizations, phlebotomy or other services typically provided during a visit.
• Implement vital sign checkpoints at both entry and other needed locations within the health care setting to take temperatures for patients, caregivers and staff.
• Limit the numbers of patients and caregivers allowed on-site at any given time.
• Develop protocols that propose to patients a narrower window of arrival time such as having patients wait in their vehicles until called or providing an alternative waiting area to use, etc.
• Introduce staggered staffing plans that maximize staff on-site while others work remotely to allow for working social distancing.
• Change the facility’s structure to allow for best practices in reducing transmission among patients (e.g., entrances for sick vs. well, or area for patients with respiratory vs. gastroenterology needs, plexiglas separators, less waiting room seating spaced further apart.)
• Determine if every day spaces can be rapidly transformed and repurposed to support social distancing during a surge.
  For providers that are located in regions that experience expended periods of inclement weather, additional waiting room space may be needed to accommodate social distancing. Many businesses are shrinking their office footprints as they realize they can achieve productivity gains by having staff work from home. If reconfiguring or acquisition of more space is not an option, the provider will need to implement the strategies above with heightened proficiency.

4. Actively practice health and hygiene

The pandemic has increased patient attention to disinfection and necessary procedures to prevent transmission. Actively clean and disinfect in front of patients. Demonstrating that you are sanitizing helps to bolster patient confidence and increase feelings of trust and safety. Health care providers need to tap into the patients’ positive word-of-mouth communications to their family and friends to help validate that your facility is safe.

5. Be proactive with patient outreach

Patient communication should be a priority for providers to help overcome patient fears and increase patient trust. Providers must recognize the emotions patients are experiencing. Communication campaigns should be multifaceted, including telephone, email and social media forms of outreach. Speaking with patients/caregivers on the phone will be most effective because the caller may detect the patient’s fear and hesitancy and address concerns. In the absence of such outreach, patients will continue to avoid care in traditional settings. To catalyze the journey to normalcy, executing an effective marketing and communications campaign is essential.

• Select the patients most critical to call first. These are patients whose health is at most significant risk because of their condition or their need for diagnostic testing, procedures, or medication have lapsed or been deferred because of the crisis.
• Identify, prioritize and customize patient communications. The communications need to be expertly designed. They must be adaptable to each patient, their caregivers, their concerns and unique situations.
• To get back on track, the person calling the patients needs to be skilled at sensing apprehension. They need to be able to help patients through their fears, help them understand that they will be safe and realize the importance of the care. They need to motivate the patient to take action and get the care they need or have been sacrificing due to fear. Consider putting a team on the phone whose sole focus is conducting outreach calls, especially for high volume practices.

6. Train staff

Innovations incorporated to support reopening efforts should be integrated into standard practices and communications. The pandemic has presented an opportunity to invigorate the patient experience, expand patient choices and increase patient satisfaction. Health care professionals have always addressed patients’ fears and concerns. Covid-19 has significantly increased the number of patients who are experiencing apprehension. Physicians and staff need to be coached in the most effective techniques to calm anxiety and address Covid-19 concerns related to office visits. As virtual visits become routine, each practice needs to define under what circumstance virtual visits are appropriate and the protocols must be shared with staff.

Taking Immediate Action

The Covid-19 pandemic is continuing to require health care workers to go above and beyond. Patients and caregivers are inundated with information about the pandemic that heightens their fears. In the face of the crisis, the “infodemic,” and the anxiety provoked by both, proactive communication with patients has never been more vital. If there are no outreach campaigns, patients will continue to avoid seeking the care they need. In the face of these challenges, health care professionals are obligated to keep patients safe from the coronavirus and help them feel safe, so they can get the care they need. Health care providers must reach out to their patients now.

For more information on how to engage patients, please contact Tom Dougherty, FACHE, Principal, COPE Health Solutions at tdougherty@copehealthsolutions.com or 909-238-9898 or Elizabeth DuBois, DNP, MSN, FNP-BC, AAHIVS, Vice President, COPE Health Solutions at edubois@copehealthsolutions.com or 213-369-0571.

Endnotes

¹ https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200202-sitrep-13-ncov-v3.pdf
² https://morningconsult.com/2020/05/13/coronavirus-reopening-economy-health-impact-poll/
³ https://www.cnbc.com/2020/05/04/the-way-out-of-the-recession-depends-on-the-level-of-consumer-fear-economists-say.html