How the COVID-19 crucible can help fix the healthcare system


The COVID-19 pandemic has demonstrated the irreplaceability of doctors and other frontline health professionals. But it also revealed many of the chronic weaknesses and shortcomings of the U.S. healthcare system, and how those shortcomings push the workforce to the brink of collapse.

A National Academy of Medicine (NAM) discussion paper, “Clinicians and Professional Societies COVID-19 Impact Assessment: Lessons Learned and Compelling Needs,” identifies the greatest challenges for physicians and other clinicians during pandemic response and suggests priority actions to revitalize the health system to meet the health needs of the population, promote the well-being of health professionals and prevent future public health emergencies.

While physicians, nurses and other healthcare professionals “have been remarkably adaptive, innovative and resilient during the pandemic, verbal greetings alone are insufficient to address the systemic workforce challenges exacerbated by COVID -19 ”, indicates the NAM document. It was co-authored by James L. Madara, MD, CEO and Executive Vice President of WADA, the organization’s President-elect Jack Resneck, Jr., MD, and Mira Irons, MD, Chief Health Officer and AMA science, as well as with experts from the American Academy of Nursing, the National Black Nurses Association, Harvard, Johns Hopkins and Stanford.

“Tangible, long-term investments in training, operations and funding are needed to build the clinical capacity needed to care for future generations,” the NAM paper continues. “A particular focus on mental health, particularly efforts to reduce burnout and promote the well-being of the workforce, will be needed after the pandemic. “

The report sheds light on the systemic issues plaguing the healthcare industry in these four key areas.

Well-being and distress at work. Some 35% to 45% of clinicians had high levels of burnout before the pandemic, and COVID-19 has added many stressors, such as personal health risks, family separation due to the demands of isolation, the anguish of treating large numbers of critically ill patients, and fighting disinformation in their communities.

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Workforce and operations. Shortage of healthcare workers in intensive care units required both rapid geographic redeployment to COVID-19 hotspots and cross-training of different specialties. The lack of interoperability between data systems and EHRs has undermined admission and discharge decision making, as well as recruitment for clinical trials.

Education and formation. Interruptions in clinical training, research projects and laboratories have disrupted university finances, caused career delays and highlighted the unaffordable nature of medical education. Additionally, systemic racism and unequal access to distance learning has disproportionately affected students of color.

Financial and administrative implications. Visitation delays unrelated to COVID-19 and the cancellation of non-emerging procedures have disrupted revenue streams and threatened the sustainability of physician practices. The stress and workload of the pandemic has also made it more difficult for doctors and other healthcare professionals to comply with administrative requirements, such as reporting quality measures and the onerous prior authorization requirements implemented. by health plans.

The discussion paper also notes five ways that policymakers, regulators, employers, medical schools and professional societies should respond.

Invest in well-being. This includes: rebuilding trust with frontline workers; follow up on the recommendations of the 2019 NAM Clinician Well-Being Report; strengthen protections for healthcare professionals who report safety and ethics violations; train leaders in behaviors that promote well-being, equity and inclusion, and in recognizing distress and disabilities; and remove stigma and barriers to the use of mental health resources.

Advance innovations in clinical practice. The authors’ recommendations focus on data sharing infrastructure, workforce development, and protocol standardization. They also include the assessment of internal review and oversight processes to expedite necessary research efforts and the issuance of evidence-based practice guidelines during crises.

Promote financial resilience. It starts with developing and funding payment models that support high quality team care. It also means leveraging COVID-19 reporting flexibilities to reduce the administrative burdens associated with prior authorization, establishing ways to support patient access and continuity of care during crises, and creating coverage and payment policies that promote the continued availability of telehealth services.

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Transform education and training. In addition to addressing financial barriers to access, training for the health professions should: address factors of inequity in the resources and experiences of learners; expand competency-based education of varying duration; and advancing innovation in simulation for lifelong learning.

Develop policies and programs to address health inequalities. This essentially involves developing fair, equitable and transparent plans for the allocation of resources and access to care, with adjustments for systematically disadvantaged people. It should also include a full investigation of how racism might be at play in decisions or plans, as well as ongoing monitoring of the impacts of decisions and protocols on staff.

“A resilient health system begins with a resilient health workforce, and by addressing the systemic challenges exposed and exacerbated by the pandemic, policy makers can support and revitalize the clinical workforce to meet health needs. and caring for patients and communities across America for COVID -19 and beyond, ”the authors wrote.

The AMA COVID-19 Resource Center offers frequent updates on clinical information, AMA guides and resources, advocacy and medical ethics related to the pandemic.

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