industry guide for
navigating the new normal
Healthcare providers can use best practices, technology and other creative tools to succeed in the the current and post-COVID-19 era.
For months, without ceasing for a moment, the healthcare industry has been laboring through a pandemic to provide critical patient care. After months of limited operations and heightened pressure, many healthcare providers are preparing to reinstate, or reinvigorate elective and other procedures as states ease restrictions. Whether your organization is a hospital, health system, ambulatory care network or physician practice, every healthcare provider is eager to restore additional patient services.
It is important to safely reinstate services not only for patient health, but also for maintaining solvency and providing job security for healthcare workers. The American Hospital Association estimates an aggregate loss of $202.6 billion among hospitals and healthcare systems between March 1 and June 30. This estimate includes cancelled and postponed elective services and procedures, the significant new expenses of treating COVID-19 patients, purchasing of personal protective equipment (PPE) and providing other support to hospital workers. Though they are largely insulated from the acute-care handled by hospital systems, ambulatory care networks and physician practices have also incurred dramatic losses from suspended standard procedures and, in some cases, overflow COVID-19 care.
Despite some relief from the Coronavirus Aid, Relief and Economic Security Act (CARES Act), healthcare providers will need to control costs while managing COVID-19 transmission risks and rebuilding patient volumes. Since real estate is a major expense for most healthcare organizations, adopting a strategic approach will be critical for long-term financial sustainability.
Many organizations are well into their journey toward reactivation, while others are only beginning to consider how to safely restore services. Along with the core challenges of providing patient care, your organization now must adopt and effectively communicate expanded protocols to mitigate the COVID-19 risk in your facilities. Social distancing, visitor screening, telemedicine and other steps will be essential to reduce risk and manage public concerns about healthcare facilities.
The following considerations, checklists and guidance will not only help healthcare organizations prepare facilities for safer operations, but also introduce methods to help strengthen your organization’s future.
(re)invigorate your facilities
Unlike a typical business, your organization already has expertise in infection control and patient safety. However, you will need to augment your standard infectious disease protocols with new COVID-19 risk mitigation practices as you rebuild your elective care volume. As a growing number of patients begin to enter and occupy your facilities, you’ll need to anticipate and manage every step of their progression through your lobbies, hallways, patient rooms and treatment areas.
The following are considerations for creating a safe facility experience for employees, patients and visitors alike.
- Assemble the right team to design and disseminate a facilities management plan for elective services.
Preparing your facilities to care for non-COVID-19 patients will require a coordinated effort. With a team comprising facilities, infection control and clinical staff, as well as your patient privacy officer and possibly human resources (HR), you’ll be better equipped to address all dimensions of non-emergency care—including regulatory compliance—to mitigate the risk of COVID-19 infections occurring during elective procedures. Your frontline staff will want to know how you are reducing risk and will undoubtedly have many practical ideas to contribute. And, the right mix of team members will help you balance safety and wellness ideals against achievable outcomes.
- Create a plan to ensure the health and safety of your patients and visitors—and publicize.
Before you increase your volume of non-emergency care, you must develop new standard operating procedures (SOPs) and playbooks to ensure the safety of patients and visitors in your facilities. And, if your organization operates a medical office building or ambulatory care network, consider exporting hospital-grade infection control standards to these lower-acuity settings.
While every facility will have different needs, these new practices will encompass a myriad of issues beyond social distancing, including greater use of PPE, additional cleaning and disinfecting protocols and visitor screening protocols. For each facility, you’ll need a plan for managing waiting rooms, overflows of inpatient procedure patients, elective procedures, COVID-19 versus non-COVID-19 patients and discharge procedures.
Proactive information and guidance for patients and visitors will be essential in soothing their concerns of exposure in a treatment setting, as these fears run deep within a large segment of the population. Since stay-at-home orders have been in effect, many potential patients have hesitated to seek non-COVID-19 healthcare services even when emergency rooms or other urgent care facilities are accessible. These concerns undoubtedly will linger, and you have the ability to change the conversation.
Concise, consistent, and reassuring communication is key to assuaging these fears. Through multiple channels, including signage around your facilities, you will need to communicate to the public the steps you have taken—and will continue to follow—to protect patients in need of elective procedures.
A custom approach to reinvigorating your lobby, reception and common areas
Prepare your buildings, space and people to provide the best patient care
- Take infection control to a new level
In addition to your traditional SOPs for cleaning and disinfection, additional measures will be needed to further reduce COVID-19 risks. One simple step, for instance, is to remove items such as plants, magazines, non-essential displays or excess furniture throughout your facilities to streamline cleaning and reduce the plethora of potentially infected surfaces. Where possible, utilize non-porous, easy-to-wipe surfaces (floors, wall coverings, furniture and screens) that can be thoroughly cleaned.
The following are additional emerging strategies for preparing and managing your facilities as non-emergency procedures are reinstated.
Thoughtful management of patient and visitor paths of travel will be critical for maintaining social distancing within your facilities.
To completely segregate patients and caregivers from patients displaying COVID-19 symptoms, the Centers for Medicare and Medicaid Services (CMS) has advised that organizations create non-COVID care (NCC) zones. A zone could be a separate building, designated rooms, or a separate floor or entrance, with minimum crossover with COVID-19 patient intake and treatment areas. Anyone entering the NCC—whether caregivers, housekeeping, patients or others—is screened via temperature check. They are given screenings for other measures of COVID-19 symptoms and required to wear their own mask. Similar policies have long been in effect at pediatric practices, which often feature separate sick and well waiting rooms.
Another solution is to manage patients by type of need or condition. A mother in labor, for instance, often would enter a hospital via the emergency room (ER). Since patients with COVID-19 symptoms also tend to arrive through the ER, a new SOP would direct non-COVID-19 patients to use the hospital main entrance.
For any patient or visitor arriving at your main entrance and registration desk, you’ll need to manage their pathways to and from the desk to their next destination. Using floor markers, rope barriers, signage or other means to enforce social distancing, you can direct the patient (and companion) to follow one-way directional indicators to and from the relevant treatment area. Be prepared to provide assistance to those who are visually impaired or unable to put on their own masks.
Clearly delineated social distancing pathways may be needed elsewhere in your facilities beyond the registration desk to help all occupants maintain social distancing. And, to control elevators, one emerging practice is to create designated standing marks, add clear signage regarding maximum capacity, and require passengers to face the wall.
You’ll need a strategy for managing waiting patients and patient overflow for elective procedures. Some healthcare providers have simply closed their waiting rooms, requiring patients to wait in their cars. An alternative solution is to use floor marketers or rope barriers to indicate safe distances and paths of travel. Additionally, remove chairs to limit room capacity. Consider closing public restrooms and if that’s not possible, establish new usage and cleaning and disinfecting protocols. Space planning and utilization metrics for exam rooms and other spaces is a valuable way of assessing capacity limits and minimizing patient overflow.
Inpatient and exam rooms.
Patients will be reassured by visibly available hand sanitizers and wipes in their rooms, and by seeing that all employees—beyond clinical staff—are wearing masks. You’ll need stepped-up protocols for cleaning and disinfecting patient, treatment and exam rooms in between patients, in coordination with clinical and housekeeping staff. Ensure each patient has one companion in their room at a maximum. Create rotational schedules for clinicians and facilities staff. Ensure minimal furniture and equipment, provide floor markers to show where clinicians, companions and staff should stand.
A custom approach to reinvigorating your patient and exam rooms
Prepare your buildings, space and people to provide the best patient care
For health systems that manage multi-tenant buildings or clinics in multi-tenant buildings, a smart screening strategy will be key. In these scenarios, it’s important to stay in line with HIPAA guidelines and ensure that patients aren’t turned away. Many physician groups are doing pre-screening virtually before a patient arrives for care and replacing a temperature check with other options. Other organizations have created screening areas in parking lots or larger areas near the facility. Regardless, communication and on-site signage is the most critical, up-front step. Communicate to patients what they should and shouldn’t do over the phone or virtually before they prepare for care.
- Adjust building systems to optimize air quality
Another important step as you begin to reinstate elective procedures and other services is to assess your HVAC and air-handling systems. The key element to this is to leverage evidence-based guidelines for preventative maintenance for HVAC units. In addition to compliance with healthcare regulatory standards for air exchange, humidity control and other indoor air quality factors, you may also need to make adjustments to reduce the risk of COVID-19 infection transmission. One approach is to assess facility areas on the basis of infection risk and adjust positive and negative pressure as appropriate. A major health system quickly converted a hospital wing into negative pressure to treat COVID-19 patients. Once the burden of COVID-19 care lessened in that facility, they were able to convert the necessary areas back to positive pressure while closely working with facilities and engineering teams.
(re)spect the health and wellness of employees
Even for those not on the frontlines of care, the COVID-19 pandemic has created doubt, uncertainty and anxiety about the risk of transmission. As you begin to reinstate or increase availability of elective procedures, you’ll need to ensure the safety and peace of mind for both clinical and administrative staff.
Also, you’ll need staff training and communications for adoption of social distancing behaviors and other new health and safety protocols.
Shared administrative and caregiver workspaces, including offices, onsite cafeterias and supply rooms, will require thoughtful management to create social distancing. Where possible, you can adjust room layouts to create more distance between desks, cubicles or workstations. Floor tape or other barriers can be used, for example, to indicate safe distances around individual workspaces. Another solution is to add desk panels or movable barriers. Instead of redesigning floor plans, some health systems have built creative assigned seating charts so there are no employees in front of, next to or behind other behind other employees.
During the stay-at-home period, some or all of your administrative staff may have been working from home. Where feasible, permanent adoption of telework policies will help reduce the number of people in your administrative offices, especially with the addition of virtual technologies for collaboration. Over time, teleworking also will shrink your administrative footprint and reduce your real estate costs, too.
As clinical staff consider care that can be delivered without patients on site, your facilities team will need to assess how and where telemedicine services can be delivered. Telemedicine workspaces must be private and HIPAA-compliant, for example, and designated spaces may require IT and power upgrades to support telemedicine technologies. Many organizations are considering adopting telemedicine as a permanent part of healthcare delivery, with its own real estate and social distancing requirements.
(re)balance your real estate portfolio
Since real estate is a major expense for most healthcare providers, a close look at your real estate portfolio may reveal opportunities to reduce costs and direct more funds toward patient care. As a starting point, you can continue to postpone transactions and construction projects until your operations have stabilized. Additionally, you can review and reprioritize your capital plan in the context of your current financial reality. Many health systems have shortened their capital project timeframe so as not to begin work on a project that might be obsolete due to developing protocols.
Also assess facilities that your organization leases. If you established alternate care sites to house COVID-19 patients, for instance, determine whether you need to retain all or some of these sites in the event of future patient surges — or if a vaccine emerges more quickly than anticipated. Given current real estate market conditions, you may have an opportunity to negotiate more favorable lease agreements for all spaces leased.
If your organization serves as a landlord to physician practices and medical services, the restoration of elective procedures will be an opportunity to resolve missed rental payments and default issues. However, it’s also important to monitor your compliance with the CMS’ evolving rules on Stark and Anti-Kickback statute compliance. As you seek to navigate short- and long-term considerations related to you owned and leased real estate, it’s important to stay abreast of the most recent regulatory guidance while also monitoring fundamental changes to the real estate markets that may affect valuations or warrant a change in your real estate strategy.