Responding to COVID-19: Lessons in Emergency Management for Healthcare Practices

Benjamin Higginbotham - COO - West Coast Retina, First Republic Bank
February 11, 2021

When the coronavirus pandemic hit, healthcare practices had to respond quickly, keeping both patient safety and operational effectiveness top of mind. For those organizations that engage in clinical services and research- or foundation-related work — such as West Coast Retina, my retinal surgical healthcare practice with five locations in the Bay Area — it was important to support not only staff and patients but also the larger healthcare community.

As COVID-19 continues to affect practices across the United States, many are still working out the kinks of their operational response. Worse, others are struggling to serve patients effectively — or see enough of them to stay open.

We at West Coast Retina wanted to share some lessons from our coronavirus response to help fellow organizations adapt and thrive in a challenging landscape. Here are some insights we’ve gained as we’ve navigated the pandemic.

Communication and clear information are key.

COVID-19 has been a notoriously unprecedented situation for healthcare practices, as it has for companies across all industries. Armed with no playbook at the start of the pandemic, practices like ours have learned the value of clear information and action plans.

To help our employees, patients, fellows and referring physicians get on the same page as soon as possible, we chose to craft an initial pandemic response on February 27, 2020. From there, we sought out more and better guidance as it was released and quickly incorporated that feedback into our policies and communications. This approach helped us put in place clear strategies from the earliest days of the pandemic through the end of April, at which point we’d reduced our patient load to 30% according to health and safety best practices.

Successfully communicating those strategies and best practices made all the difference to our COVID-19 response. Our efforts included sending weekly emails to staff on the changes being made to the practice, as well as maintaining ongoing email, social media and text communications with patients to let them know about changes in hours or service zones and keep them up to date on safety protocols.

Modernizing operations makes responding easier.

Moving fast when the unexpected occurs — or when new emergency guidance is released to address it — requires the right tool set. Practices need to embrace change in order to respond rapidly in a crisis, and thankfully West Coast Retina was already modernizing areas of our operations before the pandemic hit. My team had been working to collect email addresses, update phone numbers and obtain digital-communications consent from patients in the months leading up to late February 2020. Had we not, our communication efforts would’ve been much less effective — likely hurting our ability to stay open and support patients last year.

Since late 2019, another priority of ours has been automating rote areas of payroll and billing/administration to focus more resources on patient care and patient satisfaction, which ultimately supports our growth through patient-to-patient referrals and increased income. Streamlining our back- and front-office processes has significantly boosted our ability to innovate our day-to-day operations.

Since July 2020, for example, we’ve been able to increase our daily patient counts back to their pre-pandemic levels — sometimes even exceeding them — by restructuring our schedule and staffing resources and expanding our telehealth services, all while adhering to an improved infectious disease control policy. We’re also making it possible for West Coast Retina to serve more patients safely by streamlining check-ins and checkouts to be faster and more virtually enabled.

An effective response helps others.

Serving more patients safely helps West Coast Retina, or any healthcare practice, to better serve its community. In addition to driving up referrals from existing partners, increasing our practice’s partner referral base was an objective prior to the pandemic. Our efforts to network with peers and establish referral channels turned out to be mutually beneficial, as not all of those peers kept as much of their practices open as we did. During the worst months of the pandemic, many practices would offer only telehealth visits, for example, and send patients to West Coast Retina rather than scramble to put an office together for procedures only.

The ability to serve referring partners is a key part of our commitment to supporting our patient, clinical and research communities. We’ve actively participated within the retina and larger ophthalmic community to make sure that our knowledge spreads to other practices in our specialties and that our efforts create benefits that extend beyond our organization.

An important invoice-dating effort is one example. As soon as shutdowns began in March due to COVID-19, I reached out to the distributors of our anti-VEGF medications, which are very expensive and assist in the treatment of retinal diseases.

The manufacturers of our two main anti-VEGFs worked with us to extend the dating on invoices to twice their normal length, which we’ve extended out for three quarters in a row now. This has been beneficial to our retina practices as it ensures that they are able to flex their incoming revenue to support proper staffing. Working with the manufacturers and distributors to extend dating also helped ensure that other retina practices, even our competitors, are similarly able to better control their cash flow.

In addition, we passed our emergency response insights along to partners and competitors by contributing to the American Academy of Ophthalmology’s coronavirus response resources, outlining which services can be performed via telehealth.

Creative workarounds can have advantages.

Telehealth is just one virtual effort that has emerged as extremely useful for our organization amid the conditions of the pandemic. For us, a key pillar of our COVID-19 response was looking into new ways of doing things first, rather than choosing to postpone or eliminate traditional parts of our practice.

When it comes to our fellowship program, for example, we knew we’d need to determine a safe alternative to our traditional in-person interview process. Knowing that a simple Zoom interview wouldn’t be enough for a candidate to make a two-year commitment, my physician team and I coordinated to establish a guided facility tour, virtual lobby and Q&A with the existing fellows to emulate the normal in-person program. There were benefits to the all-digital approach: Even though we missed meeting the candidates in person and taking them out to dinner, the candidates appreciated the chance to do one end-to-end Zoom meeting instead of repeating themselves in multiple meetings with our doctors and other stakeholders.

Other projects we’ve implemented since last spring are delivering advantages that will stick around well past the pandemic. For example, we improved our PPE tracker so that we can not only verify that we have enough supplies to keep people safe, but also understand supply chain issues and vendor performance in new ways. This is enabling us to conduct better supply monitoring and make smarter decisions about inventory. In addition, we deployed a network of ultraviolet C (UVC) lamps that allow us to disinfect surfaces and the air within exam lanes between patient appointments. The initial site in our network was live within days of UC Berkeley releasing its report on the efficacy of UVC light sterilization against COVID-19.

Who you are is how you respond.

Continual improvement in our operations, staff relations and patient care are core commitments of West Coast Retina, regardless of the larger environment in which we work. Every effort we took during the pandemic followed suit with those commitments, especially when it comes to treating our staff well: We had no layoffs in 2020 and were able to get all employees back to their usual hours per week by April 2020, when our patient capacity was just 30%.

We’ve also included information on mental health, childcare and other support services in our frequent emails with employees throughout the pandemic, helping support their overall well-being, not just their ability to do their jobs. We recently launched a program to educate our employees on the importance of maximizing their benefits — such as their HSA, FSA, health insurance, discount programs and 401(k) — and containing their costs (initially via a reduced-rate cell phone service). The aim is to help employees control their earnings, reduce their tax burden and maximize the power of their dollar.

When it comes to patient care, we’re still innovating to see more patients safely — supporting our peers in the broader retinal disease and ophthalmic research communities who can help us with referrals, in turn.

It’s a cycle that shows that through collaboration and learning, emergencies can bring out the best in teams and partners, provided they already have a strong foundation. By moving fast in an emergency while keeping patient safety, operational effectiveness and community support top of mind, organizations can adapt and thrive in difficult conditions.

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