Preparing for the Next Global Pandemic

Paul Anderson: Welcome to Smart Healthcare Safety from ECRI, the most trusted voice in healthcare, committed to advancing effective evidence- based care. I'm your host, Paul Anderson. And for more than 10 years, I've overseen our patient safety risk and quality membership programs here at ECRI. Tens of thousands of healthcare leaders rely on us as an independent, trusted authority to improve the safety, quality, and cost- effectiveness of care across all healthcare settings worldwide. You can learn more about our unique capabilities to improve outcomes at www. ecri. org. We're recording this podcast from our respective home offices as we practice and encourage all of you to practice good social distancing to help limit the spread of COVID. Today, more than a year into the COVID pandemic, we're talking about the process of disaster recovery. While much has been written over the past year about the ways in which the national and global healthcare system is prepared or could've prepared for the pandemic and should prepare for the next one, not as much attention has been paid to how individual providers and organizations will recover from the past year's trauma. Our guest reminds us that challenges like these can also be viewed as opportunities and we'll discuss how healthcare providers can turn that attitude into action. To get us started, I will ask our guest to introduce herself.

Brigitta Mueller: Thank you, Paul, and thank you for having me. I am Brigitta Mueller, a physician by background, and I currently serve as the executive director for patient safety, risk and quality here at ECRI. I have been with ECRI for about 18 months now.

Paul Anderson: So to get started, I think maybe it's important to acknowledge that even though we are not" after" the pandemic yet, I think maybe we feel like we can see after from here. Like we can sort of identify that it might be coming soon. How do we know when we've moved from the midst of a disaster to the recovery phase? And I'm just thinking, when there's an earthquake, when there's a hurricane, the event happens and then it's done. Pandemic, not quite the same way. How do we know... Where's that line?

Brigitta Mueller: That's a good question. And I actually would say even with a hurricane or with a tornado, yes, the event itself might be over, but there's still recovery and that might last for months, maybe even years afterwards. So similar to the pandemic, the pandemic probably will not have a clear date where we say it's over, but there will be lingering effects for a long time to come. Hopefully not just bad ones, but also good ones in that we will make changes to how we provide healthcare.

Paul Anderson: So it's safe to say that it's, the phrase that's coming to mind is almost it's a sliding scale. It's this idea of it's not I'm moving from phase A to phase B. It's a sort of a gradient transition from here to there. That would be a fair description?

Brigitta Mueller: Yeah. Not only that, but you also have to remember, yes, right now we're dealing with COVID-19. However, let's say this goes on through the summer. In the fall, we have to think about influenza again. There might be something else coming. There might be hurricanes, there might be tornadoes, fires, any other disasters. So this is just part of our world. And healthcare being so very much part of what we're doing will definitely be affected by all of them.

Paul Anderson: Sometimes I think about it, certainly, when I started at ECRI, my understanding was very much that we talked about emergency preparedness. And then after a certain amount of time, we talked about emergency response, which we thought of as, I think I thought of at the time as very administrative, kind of let's just get through it. We put in our incident command system and boom, boom, boom. But I think it's more than that now, sort of as I've grown to understand. And one of the things that I've seen you talk about is how an organization's patient safety culture actually feeds into that preparedness and response. So I want to talk a little bit about how does culture inform both response and then ultimately recovery.

Brigitta Mueller: That's a very good point that you make there, Paul. Because a safety culture in a hospital means that people are willing and able and encouraged to speak up about things that they see that one could do better. Maybe something went wrong, maybe not. Maybe it's just an opportunity to do something better. If you have a culture where people are really freely speaking up, you have so many more bright minds contributing to what you're dealing with and to finding solutions. So that helps definitely in a disaster in that people might be stepping up to the plate that don't have a defined role, but have good ideas. And they help you recover afterwards because they still believe in the organization as a whole, the culture as a whole. There was very much a focus on how do we deal with these very, very sick patients. How do we make they're safe. How do we make sure that we don't introduce new risks, for example, because we had to ventilate them in a different way. We had to put them on their belly to really get good ventilation. So we had to make sure that we don't create new problems for them. But a high reliability organization means that we're all the time looking to the experts, looking to the expertise. And that might not be the most senior attending. That might be the respiratory therapist, that might be the nurse in a hospital that really have the best expertise in how to do these new ways of treating patients. The same is true for resilience. Resilience doesn't just means being able to bounce back, but it means constantly learning from what has happened, learning from mistakes, learning from difficulties we encountered and incorporating them into the new way of doing things.

Paul Anderson: So Brigitta, you touched on this earlier, not every change brought on by the pandemic will be temporary. And that's true really, I guess, of any kind of emergency or disaster. For example, the first thing that comes to my mind is it's hard for me to imagine that as rapidly as telemedicine and telehealth expanded, it's hard for me to imagine that it's going to contract back to where it was in 2019. What are some other changes, good, bad or indifferent, that you think are going to stick around after we really have moved mostly past this pandemic?

Brigitta Mueller: I think the biggest difference will be that certain things that clearly were in place before, all of a sudden became even more evident and the need for a new focus on them. So for example, any inequities in access to care, not having internet access, not having transportation to go to a hospital, all the issues with risk factors, the obesity epidemic. We knew that before it was a big problem. We've seen during COVID that patients who are obese are at higher risk to suffer from severe COVID disease. So we definitely have seen things that happened before become even more prominent. You mentioned telemedicine. That's a good thing that we now have expanded capabilities. Hospitals have incorporated it more into their workflow. But also, legislation has been passed to allow more freedom in regards to who provides these services, how are we billing for it. So this is very important going forward. And I agree, this will not go back to where we were. It probably will not be used as much as during the pandemic, because we also realized that certain encounters are just better done in person than via screen. But overall, there definitely will be more telemedicine than we had before.

Paul Anderson: You touched on issues around equity, especially, I mean, and certainly, as you say, that was something that existed and was exposed and emphasized by the pandemic. But even to the point where that became the number one item on our recent list of the top 10 patient safety hazards that we inaudible with this year. So I think that just sort of underscores your point of the prominence that these issues are now gaining, and you mentioned again, internet access. Well, if we're going to have telemedicine, that doesn't work if you don't have reliable, high- speed internet access.

Brigitta Mueller: And all these topics really show us a way to learn from disasters and take maybe a bigger step forward than what we would have done otherwise in our incremental progress. So we have made some giant leaps just because of awareness. We also, for example, we clearly saw that we're too dependent on certain supply chain mechanisms. We have to rethink that. We have to rethink how we stockpile materials, how we are able to work collaboratively to bring together providers from different systems, for example. It doesn't make sense to stay in our own silos and everybody looking out for themselves, especially in a pandemic. But even in relatively normal times, working together is so much more beneficial than all this competition. And I hope that we have learned from that and that we have put some mechanisms in place to take advantage of this.

Paul Anderson: I always like to wrap up our conversations by asking guests to describe something the listeners can do today to start to advance patient safety. So with this in mind, what's something that folks can do to start either preparing for that transition into a recovery phase, or starting to think about the next disaster. You mentioned, this fall, we're going to have influenza and hurricanes and wildfires, and what are sort of some steps we can take now to start getting ready for the next one, whatever the next one is?

Brigitta Mueller: Although most people are tired of thinking about the pandemic and all the things we went through over the last year or more, it is, however, very, very important to think through what went right, what went wrong, and to build on that, especially once we have a breather. You can think about, again, how would we do it differently, what have we learned. That is important from a patient safety perspective, just looking at the events that we have encountered, the constraints we had in regards to staffing issues, in regards to PPEs, other supply chain issues. But also in the bigger picture, looking at what kind of collaborations have we built that we really should sustain and continue to emphasize. So although we don't want to think about it, we're tired of COVID, there is a lot to learn and we do have to take the time to look at that and see whether we can do better the next time.

Paul Anderson: And I'm just thinking, as you're speaking to your point earlier about in a culture of safety and people feel comfortable speaking up, how important is it to get that feedback and those lessons from all levels of the organization?

Brigitta Mueller: Very important, because it is like that old picture of the elephant in the room and the blind man. Everybody has a different picture of what happened. And bringing it all together, letting everybody bring up their experience and their ideas is so helpful and is a really treasure trove of information that we should not let go.

Paul Anderson: Dr. Mueller, thank you so much for joining us today.

Brigitta Mueller: You're very welcome.

Paul Anderson: You can find publicly accessible tools, webinars, white papers, and more in ECRI's COVID- 19 Resource Center and ECRI members can access the Healthcare Recovery Center for COVID- 19 for even more. Be sure to subscribe to Smart Healthcare Safety on Spotify, iTunes, Google Play, or wherever you get your podcasts to get our latest episodes. We welcome your feedback. Visit us at ecri. org or email us at ecri- podcasts @ ecri. org.