Our VP of Partnerships Zak Pines recently sat down for a special edition of the Formstack Partner Interview Series with JoAnne King, Healthcare Advisory Services Director with Coastal Cloud, and Jim Stalder, Chief Technical Architect with Coastal Cloud. Both JoAnne and Jim are highly credentialed healthcare executives—JoAnne most recently as COO of AdventHealth Palm Coast and Jim as CTO of Cook Children’s. Zak spoke to JoAnne and Jim to get their perspectives on how COVID-19 is impacting our hospitals and to frame out the landscape we are all navigating. Here’s an abridged transcript of the chat.
Setting the Tone for What Hospitals are Facing
Zak: I’m very appreciative of you both being able to spend time with me today on these topics. I know how busy you are helping customers navigate through COVID-19 and the impact it’s having on their patients and organizations.
My hope today is to have you help me and our audience to frame out the impact of current events on our health organizations and what those organizations are going through. If I can get your help in navigating what healthcare organizations are facing in today’s new reality, I think that will be a huge accomplishment.
JoAnne: We’ll do our best.
Zak: I know we haven’t seen anything like this before. I don’t even know where to start with my questions. This is a truly one-of-a-kind situation, never before seen. Am I right, JoAnne?
JoAnne: You are right, Zak. What we are facing with COVID-19 is unprecedented. We’ve never seen a worldwide event like this in our lifetimes.
The only thing I can draw upon for some parallels—and it was far, far different than this—is working in a hospital system during hurricane season in Florida. Two years in a row, we faced the prospect of a Category 5 hurricane putting the hospital at risk. We were being forced to answer questions like: Do we need to evacuate? How do we keep the ER open for the community? How do we protect our staff and patients? How do we recover our operations? How do we get evacuated patients back afterwards?
There was a huge difference, though, in the hurricane situation: the crisis was imminent, but it was time-limited. A hurricane would come—and it could be bad—but then it would be over. And then you start the plan to recover.
Our situation with COVID-19 is unprecedented because we can’t clearly see what’s coming. We can’t see the virus. We don’t know when the peak will occur, and we don’t know what the impact will be in our communities and across the country.
Zak: That’s such a great point. With a hurricane, there is a finite time period to it. With an international pandemic like we’re facing now, we don’t know how the timing of this will play out.
JoAnne: There’s also an element of a dam that keeps leaking. We plug one hole, and another hole opens up. We have healthcare workers getting ill. We have nursing homes under crisis that may not be able to take new patients from the hospitals. Hospitals are cancelling elective surgeries, which impacts finances, employee schedules, and so many operational areas.
We haven’t seen a challenge of this magnitude in my career in healthcare.
Zak: You used the term “unprecedented,” JoAnne, and it truly is.
Jim, you’ve helped keep hospitals and health systems running for decades. Can you put us in their shoes right now? What are they going through in having to work through this never-before-experienced global pandemic?
Jim: The questions start with: How do we keep our healthcare professionals and nurses able to be on the front lines?
Hospitals need to manage staffing. How do we make sure staff are getting the right amount of rest? There are a lot of heroes out there who will work until they can’t work anymore. The hospitals need to manage their schedules. There is no pandemic mode to optimize your staff.
Then there is the question of supporting staff working more remotely. Traditionally in hospitals, all work is done on-premise. You might have a call center or IT center off-site. But you don’t have doctors or nurses or front desk staff working remotely. There are challenges like VPNs, access to applications, licensing, and Internet bandwidth that these teams are working through.
Zak: What are their call centers facing?
Jim: The call centers are getting bombarded with calls. There are calls related to COVID, but there are also all the day-to-day calls. A lot of those calls are going unanswered or getting dropped or going into a queue.
The volume of calls is a huge challenge right now. I’ve talked to past colleagues who are trying to figure out how to virtualize their call center environments to add capacity. The problem with many is that they are on traditional on-premise technology. Most of the on-premise solutions are constrained by the peak capacity designed into the system. Virtual call center solutions that can expand dynamically and instantly are in demand.
Traditionally, healthcare has been more high-touch and less about digital interactions. Some practices are modern— they’re incorporating portals, chatbots, forms, or digital interactions. Many have executive roles like VP of Digital Experience or VP of Patient Experience to help bring a high-tech approach to the already high-touch environment. The problem, though, is that high-touch doesn’t scale in times like this.
In many locations, the call volume is too great. At least hospitals generally have contact centers and are designed for volume. Your local primary care offices are generally not. Even a quickly implemented solution like a form on their website to request a call back later is going to help them minimize the peak call volume.
Another factor is based on the age of the patients—they have far different preferences and expectations. My kids want it to be digital. My 83-year old dad wants to talk to a person. So, ideally, providers need both high-tech and high-touch options.
Zak: That’s fascinating. So there’s the issue of dealing with volume. And then amongst that volume, how do you cater for preferences of different generations of patients? And how do you ensure that you, as a health provider, can deal with different types of inquiries of different levels of urgency at a time where volume is off the charts?
JoAnne: Coronavirus didn’t happen in a vacuum. Hospitals are still dealing with all of the routine health issues.
Cancer patients still need chemotherapy. Women are still having babies. Accidents are still happening. Hospitals need to handle all of that day-to-day traffic along with the crisis. They still need to communicate with that expectant mother who’s about to give birth. Will her family be able to be with her at the hospital if that hospital has had to place restrictions on visitation?
I’ve seen some really heartbreaking stories in the news around end-of-life situations. Some are related to the virus; some are not. Because of isolation requirements, visitors aren’t able to see their loved ones.
Life was happening before coronavirus. So now the hospitals are being asked to not only manage the virus outbreak but also keep the day-to-day activities going in parallel. It’s a huge challenge.
Zak: And volume is playing out in the hospitals’ physical locations and causing them to look for alternative solutions, right?
JoAnne: Yes, hospitals are looking at contingency plans to handle surges of COVID-related cases—other facilities, such as hotels or campuses, that wouldn’t traditionally be used for healthcare.
Jim: It could be a college dorm or hotel. When individuals move to these off-site locations, current guidelines are to have continual monitoring and have those quarantined or isolated perform twice-daily self-assessments so the environment can be closely monitored. They may be staying in a college dorm, and it’s critical that everyone is being kept safe.
Zak: There’s a lot of challenge in communicating during times like these, as information is constantly changing. Who has stood out for you as someone doing a good job in how they are communicating?
Jim: I’ve been impressed with scores of ISVs that are offering their solutions to help with COVID-19. The best minds of every solution provider have been coming together for a couple of weeks to help solve problems and provide some relief for those impacted. I’ve talked with dozens of companies and healthcare teams over the past two weeks, and the outpouring of support and desire to help in any capacity has been tremendous to witness. I’ve seen our teams at Coastal Cloud literally work around the clock to solve problems for clients that simply cannot wait to be done at a normal pace.
Tough Questions Ahead
Zak: I’m going to ask a short question, but it’s a really hard question: Where do we go from here?
JoAnne: We don’t know at this point what recovery will look like. It may be linear. It may be up and down. We know it won’t be a matter of flipping a switch and everything returning to normal.
Jim: It’s not like on May 1 everybody goes back to their workday just like before. How do things resume to normal? When will venues like movie theaters pick back up? Will people be scared to gather in large groups with strangers? When will people return to their offices? Will you need to get a doctor’s note? Will you have to show proof you are COVID-free?
JoAnne: And that gets us into privacy concerns. In all organizations, employee health issues are typically private in your HR files. How will we handle this in the brave new world?
Jim: Right. Where does privacy end and public safety begin? The lines will be blurred after this experience.
If I have a non-communicable disease, I can keep that private if I choose. It’s not anyone else’s right to know. That’s how we have operated as a country for a long time. Does what’s happened here change that? Do people have a right to know if I have COVID-19? How do we protect each other?
Zak: I did say today was about asking questions. And these are great questions. You’re pointing out that people should have both the right to privacy and the right to not unknowingly be infected by a highly contagious virus. How do you balance those two rights?
Jim: It’s going to be an interesting next year or two working through the answers to these questions.
Examples of How Hospitals are Navigating COVID-19
Zak: Let’s shift to the Coastal Cloud Care4Covid program. Jim, can you share what type of work is being done with hospitals around COVID?
Jim: I’d bucket it into four categories: Inform, Deflect, Care, and Measure.
Zak: OK let’s step through each of those. Inform—sharing out information?
Jim: Correct. Everyone wants up-to-date information about what to do and where to turn. The problem is there’s a lot of conflicting information out there.
Many hospitals are the trusted source of truth in their communities, and they are all working hard to keep information current and relevant on their websites. Those that weren’t mobile-friendly are quickly realizing that they need to be. Information is changing quickly, and organizations need to be responsive to the changes.
Personally, I’m seeing already out-of-date information on some organizations’ websites. If people choose to duplicate content, then they have a duty to keep that information current. Referring back to the CDC or WHO is a good approach to avoid sharing stale information.
Zak: Deflect—that’s an interesting word choice because that sounds negative, but I have a feeling it’s actually something positive?
Jim: “Deflect,” or perhaps a softer term is “Stratify.” It goes back to our discussion on unprecedented call volume. Organizations are asking: How can I prioritize the unprecedented call center volumes my teams are receiving? I want to handle all the inquiries, but I need to do so in an organized manner.
What I’m hearing is: I don’t want to alienate my customers by putting them on hold for hours, but I can’t staff up to manage the calls. Organizations want to turn to forms and chatbots to move real-time callers to asynchronous communication channels for non-urgent issues. This is true not only for healthcare, but city and county governments, too.
Rules-driven forms and/or chatbot solutions can guide people to informed and clinically correct decisions. Every non-urgent case that is deflected from a call center or other human interaction means that a more urgent case gets taken care of more quickly.
Zak: I can see how if the problem is volume of inquiries, there is an urgent need to create ways for self-selection so you can get the right inquiries to the right resources with the right level of urgency.
Jim: That’s right. You want the result of that to be getting you to the right resource or person that you need to connect with based on your situation.
Zak: Your third topic is Care. Is that about what tools are available to help hospitals care for my patients when they can’t easily come to visit in person?
Jim: Self-service is the name of the game here. Providing online assessments and prioritizing patient responses, for example, and then letting patients self-schedule appointments. That can free up incredibly valuable provider and office personnel time.
Telemedicine also plays a role here. With testing kits still being scarce, most testing facilities are requiring a physician’s order to get a test. An order can’t happen without the physician seeing you. Telemedicine is a fast and expeditious way to see a patient—and help protect the employees and patients in the office that someone might otherwise visit.
Zak: And JoAnne, telehealth regulations have rapidly evolved to support this, is that right?
JoAnne: Telehealth can include anything from a phone call to a virtual visit. Historically, the areas of telehealth covered by insurance were limited. It’s now been opened up for more patients to get access to their healthcare providers.
I have a friend who is a nurse practitioner in family practice. A lot of her routine visits and screening visits have now moved from office to telehealth, so the patient doesn’t have to come out into the community. It’s for the safety of the patient and the safety of the office staff.
Zak: Jim, your fourth category is Measurement. Being in survival mode right now, is this something that hospitals even have a moment to think about?
Jim: It’s definitely a challenge, but you want to be asking questions like: How can I measure all of these activities and make sure I’ve got my scarce resources deployed in the right areas?
With so much happening online and not physically, it is hard to understand capacity and utilization. Management by walking around is not an option anymore.
Zak: This has been cathartic for me to hear both of you walk through the landscape and even touch on some of the measures hospitals are taking to deal with the adversity. I thank you both for sharing your observations and insights here today.
JoAnne: Anytime, Zak. Stay safe, my friend.
Jim: Yes, happy to do it, Zak. And yes, stay safe and stay home!