COVID-19: Role of hospital leadership in mitigating operational & financial risks

Quick rational thinkers, skilled and swift implementers with servant leadership skills set the right culture, structure and tone with which the hospital functions during the pandemic.

In this article, we will go through some of the important areas that have a key role to play in the mitigation of risks. Listed here are the ways in which the hospital leadership team can function and move towards the desired outcomes.

Key skills

The hospital leadership team after careful planning should make the right decision at the right time, at the right place and for the right people. They should function with speed and accuracy and have in-depth knowledge of systems and processes. The leaders should adopt a science-based approach with clear recognition of and readiness for the need to immediately react to changing scenarios and rapidly-changing guidelines. They should be open to opinions and ready to listen. They should communicate freely on decisions taken to the team/staff and explain the rationale behind the same. They should have an acute clinical and business acumen that can work in the best interest of the country, community, organisation employees and most importantly the patients. They should be well networked with the state and municipal medical governance bodies and the neighborhood hospitals and medical fraternity.

Structure of functioning

The leadership team with advice from the Hospital Medical Advisory Board (MAB) should set up a COVID-19 Pandemic War Room (PWR) that has key representation to analyse, strategise and implement the pandemic plan and work parallel on the business continuity plan. Two sub-committees should be made to work on the planning, execution and monitoring of the pandemic process (PP) and on the business continuity process (BCP). Both should report into the PWR, who in turn can report into the core hospital committee, which can consist of the chairpersons of the MAB, PWR, BCP and hospital senior leadership and chairperson of the board member/trustee of the institution.

Redefining the goals, vision and mission of the hospital during the pandemic

The leadership team can set few simple goals, and to achieve them, they should redefine the vision and mission for the period of the pandemic.

For example: Goal: To treat COVID positive, suspect and negative patients through stringent infection control protocols in restraining environments such as building structure and maintenance (especially air circulation), hospital service locations, manpower, supply chain and many other that affect clinical excellence, patient care and quality, the three pillars of a hospital. Mission: To save lives by protecting our staff and facility. Vision: To sustain our hospitals and help our community.

Understanding the challenges

Hospital facilities have varied restrictions in terms of structure, maintenance issues, services, manpower skills and resources. It is important to know the strengths and limitations of the organisation, the facility, services, manpower and financials. These factors are critical to define the services and the timelines to achieve the operational efficiency and effectiveness of each service.

 Key decision making

The hospital leadership should decide the kind of facility they can afford to be, like:

• a quarantine facility; and/or;
• a treatment facility for COVID positive and/or suspect unit without intensive care; and/or;
• be able to add a COVID intensive care unit for COVID positive and/or suspect cases; and or;
• have COVID and/or non-COVID OTs or be able to deliver care to only non-COVID patients.

Synergistic relationships within immediate community

This plays a big role where leaders from all the local hospitals/nursing homes can come together to work together by distributing the disease burden within the recourses available within the local area/community.

Service planning

Each basic facility needs a triage of diagnostics, in-patient services and clinical and non-clinical support services.  The organisation then needs to address what more services can be added and which existing services can be scaled up. The new services could be emergency room services, ICUs and OTs. There will be an initial and sometimes substantial investment to put preventive and protective measures against infection protection, prevention and containment. This situation could be compounded by problems of closure of high revenue generation services, a smaller number of active staff, staff contacting the disease, shortage of supplies and many other operational issues. Organisations need to have a ready corpus to ensure that this critical funding does not affect normal operational expenses.

Consider up-scaling or down-scaling of services

Large planned facilities are better equipped to provide comprehensive services (with patient safety at high priority) such as treatments for COVID positive, suspect and negative areas with dedicated ICUs, hence zoning of red, orange and green zones with creation of infective and non-infective corridors. A workable time table can be created to help each facility with any support service requirements (laboratory; diagnostics, CSSD, pharmacy, stores, OTs) with standard operating procedures that supported infection control policies.

However, we have many hospitals and nursing homes and who have limited capabilities in terms of the building and maintenance (such as ventilation, air conditioning in particular), equipment, services, manpower and limited financial funds. This is where the organisation needs to be certain on their service panel given their individual organisation’s situation. Trying to do everything in such a scenario can prove disastrous for the organisation for its reputation, sustainability and existence.

About the author

Dr. George Noel Fernandes has over 24 years of healthcare experience in Asia including China and Japan, Europe, Africa, Middle-East and Americas. He has worked with organisations like Saudi German Hospitals, Apollo Hospitals, CK Birla Hospitals, Parkway Pantai Hospitals, Emirate Airlines, International SOS, Europe Assistance HIS. He has been also involved in various pandemics such as SARS, H1N1 and currently working with various organisations during the COVID-19 pandemic in helping to set up isolation centers and re-structuring and revamping hospitals to help sustain their operations.