Hospitals and healthcare organizations are often viewed as impenetrable, austere and consistently ahead of the mark. But despite the significant reliance on our healthcare systems, there continue to be gaps within the system that open the door for errors, including medical errors that can impact patients. Prior to COVID-19, the status quo had been for hospitals and healthcare organizations to put out fires without taking stock of the gaps in internal processes that lead to error. However, when patient cases started to rise, and health systems and workers became increasingly stressed, internal process gaps were more fully exposed and could no longer be ignored.
The pandemic created urgency among the healthcare system to rethink its current processes and identify ways to create a foundation for safe and reliable care. The following chronicles the gaps exposed by the pandemic and highlights major calls to action as much of the world is coming out on the other side and licking the wounds from a healthcare system turned upside down.
Recognition and Centralized Communication Mechanisms
During the pandemic, it was apparent that organizational communication mechanisms lacked the needed urgency to convey information in a timely manner. One of the first instances of reporting regarding the novel coronavirus came on December 31, 2019, when the World Health Organization’s (WHO) Country Office in the People’s Republic of China picked up a media statement by the Wuhan Municipal Health Commission via their website on cases of a “viral pneumonia” in Wuhan, People’s Republic of China. Yet, the severity of the virus and other imperative information remained unknown to many parts of the world.
On January 1, 2020, the WHO reported that Chinese authorities had determined that the outbreak was caused by a novel coronavirus. The next day, the WHO published a comprehensive package of guidance documents for countries addressing topics related to the management of an outbreak of a new disease. In the following two days, the Chinese media reported the first death from the novel coronavirus – implying its severity – and shared the genetic sequence of COVID-19. All reported information was vital in the pathway to addressing COVID-19 and its impact throughout the globe.
But it wasn’t until January 5, 2020 that the WHO issued its first “Disease Outbreak News Report” – a public, web-based platform for the publication of technical information addressed to the scientific and public health communities. The report included information regarding the number of cases, patients’ clinical status, details about the Wuhan National Authority’s response measures and the WHO’s risk assessments and advice for public health measures. With this reported information, many nations for the first time were able to comprehend the potential threat of the novel coronavirus, begin monitoring more closely and understand the measures China took to mitigate the disease. Still, the communication remained subpar to inform preparedness and successes in maintaining the virus.
Communicating vital information early on was essential for not only the regions in China, but throughout the globe to help mitigate the spread and impact of the disease. To expedite this information in the future, it will be imperative to establish a centralized method of communication and action plan for disaster to ensure that everyone understands their roles during a health crisis.
Initiating partnerships with other health organizations to establish networks, creating assessment processes to determine the severity of risk of new circumstances and establishing an emergency protocol to measure inventory, assigning new roles and effectively communicating could go a long way toward restoring reliability in the healthcare system – closing gaps in the present communication mechanisms.
Availability of Resources in Rural and Developing Regions
Looking at developed nations such as the United States and Europe, it was surprising to see such regions experience the strain that they did. Whether it was access to personal protective equipment (PPE), medical devices, COVID-19 testing or ventilators, many nations experienced sparsity in resources amid the pandemic.
On February 27, 2020, the WHO published guidance on the rational use of PPE while facing a global shortage. They provided recommendations on the type of PPE to use depending on the setting, personnel and type of activity. Still, many hospitals and clinics were in low supply, reusing equipment and requesting the public to donate resources. The same issue was apparent with medical devices, ventilators and testing. Regions throughout the globe struggled to expand manufacturing and testing to meet demand.
One action that took place to address the shortage of resources was the UN COVID-19 Supply Chain Task Force. The task force was launched on April 8, 2020 to coordinate and scale up the procurement and distribution of PPE, lab diagnostics and oxygen to the countries most in need. However, since it was apparent on January 5, 2020 that COVID-19 had the tendency to spread swiftly, waiting three months to enact measures to address a shortage in resources was unacceptable.
To better prepare, organizations should look into creating a coordinated, partnership-based emergency protocol to measure inventory, activate an equipment-sharing network, assign new roles and communicate effectively within each region. Regions could also evaluate methods of equipment distribution and preemptively devise methods for equipment management of crises to restore reliability in important facets of the healthcare system, closing gaps in the sufficiency and accessibility of vital resources.
Healthcare Worker Safety
When we think of healthcare, it isn’t uncommon to think about the treatment of patients. However, when the pandemic hit, and healthcare systems became stressed it highlighted the stress healthcare workers continually face. The pandemic underscored the broken culture and to truly have patient safety, you need to prioritize healthcare worker safety.
On September 17, 2020, the WHO released a Charter on World Patient Safety Day calling for steps to protect healthcare workers from violence, improve mental health, protect from physical and biological hazards, advance national programs for health worker safety and connect health worker safety policies. This charter allowed the WHO to address the abundant health concerns regarding frontline workers.
However, despite the efforts to improve resources, changing an organizational culture requires an immense amount of time and investment. To prioritize the safety and wellbeing of healthcare workers means ensuring they have proper PPE and supplies to care for patients, listening to their needs, establishing feedback mechanisms and showing them how the feedback has been taken into consideration.
It is apparent that the COVID-19 pandemic has placed a significant strain on global healthcare systems, pressing hospitals to stretch their resources thin and risk the health of staff. Hospitals are emerging from the pandemic with full knowledge of their vulnerabilities, and we hope that will turn into areas for improvement in preparation for the next major global event.
We should learn from these vulnerabilities and cannot wait until another health crisis to address the omnipresent gaps that are recognized with modern healthcare, otherwise similar barriers will be met again.
About the author
Anganette Cisneros is a third-year biomedical engineering-premedical student at the University of California, Irvine with a passion for innovation and healthcare. She currently serves as a clinical content intern at the Patient Safety Movement Foundation with the ultimate goal to apply to dental school and practice as an oral maxillofacial surgeon.
