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May 14, 2020

Q&A: Inside Centura Health's plan to restart non-essential care

Daily Briefing

    Shauna Gulley, Chief Clinical Officer at Centura Health, a 17-hospital health system with providers in Colorado and Western Kansas, recently spoke with Steven Berkow, VP of Provider Research at Advisory Board, about how the health system is leveraging input from frontline workers and community members to address the Covid-19 epidemic and restart care for non-Covid patients.

    Starter list: How you can support frontline staff during the Covid-19 crisis

    Question: Thank you for making time to speak with me today, Shauna. How many Covid-19 patients is your system treating right now, and are you trending up or down?

    Shauna Gulley: Going back a few weeks, we had about 240 patients with Covid-19 in our hospitals across our system. I'm hopeful that was our peak. Since then, our Covid-19 caseload has decreased and stabilized.


    Question: Looking forward, how are you feeling about Centura's Covid-19 readiness, or more specifically about your capacity and supplies?

    Gulley: Like a number of other states, Colorado took dramatic steps to free up capacity for Covid-19 patients. There was an executive order to stop performing all non-essential procedures, which just expired in late April. Additionally, the rate of community spread of Covid-19 here seems lower than other places throughout the country, so things like PPE, medication utilization, ventilators, and ICU beds are not our limiting factors. On the whole, we are well equipped to take care of our community. In fact, I'm more worried about the readiness of all the non-Covid-19 patients we serve to again seek out care.

    Question: So at this point, it sounds like Centura is not only ready to restart non-essential care but is actively thinking through who most needs to come back in. Can you share more detail on your thinking here? Are their specific groups or types of patients you will be prioritizing as you restart non-essential care?

    Gulley: Most definitely. We've essentially prioritized three categories of patients outside of Covid-19 cases that we need to reach quickly. The first group we know well. It includes patients whose scheduled care was delayed and is now becoming urgent. The term "non-essential care" is an unfortunate misnomer for many of our patients, as the wiggle room on timing of care is very limited. For example, many of our patients who were scheduled for a procedure six weeks ago will face greater medical challenges if we don't get them back in quickly.

    The second group we don't know as clearly. It includes patients who've avoided seeking needed care for serious conditions due to fears about coming to a hospital treating Covid-19 patients. For instance, we've seen an alarming decrease in the number of people seeking care for cardiac episodes and stroke-like symptoms. Timing is essential for these patients. For many, time is literally tissue.

    The final category is patients who've delayed primary and preventive care because of Covid-19 fears. We think about simple things, like immunizations and wellness visits and things that you could argue are not time-sensitive. However, those visits often detect things that would become time-sensitive or life-threatening in the future.

    Securing the PPE and other resources we need here at Centura will be an ongoing priority for me and my leadership team. But we have the capacity, talent, and equipment necessary to care for our patients and larger communities. The bigger priority we all must now address is convincing those patients that it's safe to seek care.

    Question: I've talked with a number of your peers about rebuilding trust with frontline clinicians. That no doubt is a critical step in re-building trust with the larger community, but you seem to be pushing well beyond this one step. What other steps are you taking to ensure your larger community again sees Centura facilities as safe places to seek care?

    Gulley: We've been working on this for well over a month. As part of our initial response, we established clinician-led workgroups and community groups that have been advising us on how to ensure our communities get the right health care at the right time at the right place. One workgroup in particular is focusing on "return to normalcy." That group started in March and is thinking through questions like: "What will it look like if Covid-19 is our new normal? How do we make sure we provide excellent safe care to every patient? And what does safe look like post Covid-19 to our patients?"

    It's critical that the community perspective does not get lost in these discussions. You cannot top down making patients feel safe. We need to hear from them to understand what’s needed. So we're listening closely to the patient and family advisors we already have at each local facility, and centrally we've created a health care consumer think tank.

    Question: Zeroing in on the workgroups you've stood up, how do they function in practice? How do they plug into Centura's larger incident command structure?

    Gulley: Taking a step back, we activated our incident command plan for the epidemic at the very beginning of March. From the outset, we knew that input from clinicians on the ground was essential to address the many questions that would arise around Covid-19. So we started out with physician workgroups, and these quickly expanded into a multidisciplinary workgroup structure, including many voices from our larger community.

    Today, we have about 16 workgroups, though some have been retired or repurposed. For example, we had a laboratory and infection prevention group working on developing our platform for laboratory Covid-19 testing, as well as how to best deploy the platform in our hospitals locally. Now, that same group is trying to determine how to supply tier one, two, and three testing.

    Another example is our workgroup on convalescent plasma. Once we learned that convalescent plasma might be a treatment option, we set up a research workgroup with eight clinicians and some ad hoc members. By the end of the week, the group had developed a state-wide convalescent plasma system that allowed us to reach out to Covid-19-positive patients so they could donate plasma at a local blood donation site and have it processed and sent back to Centura.

    To be clear, these workgroups are not standing committees. They are temporary groups or taskforces that we bring together to solve well-defined challenges. And when you have these nimble clinician-driven workgroups with a focused purpose, you can get some pretty incredible things stood up quickly.

    Question: So who makes the call on when to stand up a workgroup and who should be on it?

    Gulley: Technically I, and my other incident commanders do, but in practice it's pretty organic. Someone suggests forming a workgroup, and my leadership team then talks through its purpose should and who should be on it, along with desired time to output.

    Each workgroup includes 6 to 12 people, and some have subgroups that can really dig in on niche subjects. We aim for each workgroup to have both geographical and functional representation, but exactly who is on each group depends on the work that needs to be done. Some workgroups have finance people or supply chain people, while others have nurses and IT specialists. The key has been to ensure each workgroup has the right people to look at a problem holistically.

    For example, we have an ED services workgroup that includes representatives from our hospital EDs and ICUs as well the primary care and the outpatient clinicians seeing patients outside of the ED, to make the group has a well-rounded view.

    Question: You mentioned you activated your incident command team about two months ago. How do the workgroups interface with that team?

    The workgroups mostly work independently and then report up through the incident command. We created a structure that enables them to work independently and report through incident command on Mondays, Wednesday, and Fridays to share updates on progress, needs, and barriers with incident command.

    The incident command then works to break down those barriers by providing new ideas or helping to move the projects forward. We also have those workgroup leaders attend the incident command's daily afternoon calls to answer any in the moment questions. 

    Question: Looking forward, what other guidance would you offer your health care peers, from your experience at Centura?

    Gulley: Right now we're all struggling to acknowledge that this isn't a crisis we're just going to get through in a couple of months, but rather our new normal. Wrapping one's head around this new reality is not easy. And yet we've all got to do this; there has to be some normalcy in terms of how we move forward.

    Reflecting on my team here at Centura, we have incredibly talented, devoted people in health care who, when organized around a common challenge, can create movement like no other. I think that our people have come together in ways that have surpassed anything I've seen before, for the wellbeing of our community. And, for me as a leader, that has been both inspirational and directional in how we will rise to the challenge of this new normal.

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