Role of hospital leadership teams to mitigate the operation & financial risk to the hospital during a pandemic

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 shares Dr George Noel Fernandes, Consultant Operations, AAA Healthcare

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

Structure of Functioning: The leadership team with advice from the ‘Hospital Medical Advisory Board’ (MAB) sets up a COVID-19 Pandemic War Room (PWR) that had key representation to analyse, strategise and implement the pandemic plan and work parallel on the business continuity plan. Two sub-committees are made that worked on the planning, execution and monitoring of the pandemic process (PP) and on the business continuity process (BCP). Both reported into the PWR who intern reported into the Core hospital Committee which consisted 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 sets few simple goals, and to achieve them, they redefined 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: The 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 will decide what they can afford to be:

• 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.

Network, Partnerships and Synergistic Relationships with Hospitals in the immediate Community: This plays a big role where leaders from all the local hospitals / nursing homes come together to work together by distributing the disease burden within the resourses available within the local area / community.

Service planning: Each basic facility needed a triage, diagnostics, in-patient services and clinical and non-clinical support services. The organisation then will need to address what more services can be added on and what 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 measure against infection protection, prevention and containment. This situation could be compounded by problems of closure of high revenue generation services, staff unable to come to work, 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.

The management will need to consider up-scaling or downs-scaling of services and increasing or decreasing COVID and non-COVID bed availability as the pandemic evolves.

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 had many hospitals and nursing homes and who had 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 organisations needs need to be certain on what service they can provide given their situation. Trying to do everything in such a scenario is disastrous to the organisation for its reputation, sustainability and existence.

Situations such as these bring out great leaders.

“To get what you want, deserve what you want. Trust, success and admiration are earned”- Charlie Munger