While working with a humanitarian aid program in Africa at the beginning of the AIDS crisis, Marcus Schabacker, MD, PhD, experienced the kind of physician burnout that comes with having limited resources to treat extremely ill patients.
Clinicians face similar stress today as they battle the COVID-19 pandemic. However, senior finance leaders can help ease their burden, said Schabacker, now president and CEO of ECRI, a not-for-profit, independent organization focused on advancing evidence-based healthcare globally.
Schabacker, a board-certified anesthesiologist and intensive care specialist and former chief scientific officer at Baxter, discusses in this Q&A how CFOs and other finance leaders can support their clinical teams and patients in the challenging months ahead.
HFMA: What can finance leaders do now to help clinicians during the COVID-19 crisis?
Schabacker: If healthcare professionals feel like their administration and finance folks have their backs, that’s going to go a long way.
Addressing shortages of personal protective equipment is part of that because we want to do all we can to prevent healthcare professionals from getting sick like they did in China and Italy, and like we’re already seeing in some hotspots like New York [interview conducted March 30, 2020].
As a nation, we have enough supplies. It is a question of how we can distribute them to the areas where they are most needed. My guidance to CFOs would be to reach out to fellow healthcare CFOs in your region to pool supplies and equipment, and then shift them to where the largest needs are so you go about this collaboratively.
We certainly have a much better chance to fight COVID together rather than trying to hoard supplies, medication and equipment for ourselves. As a CFO, you don’t want to spend another $500,000 to buy 10 additional ventilators if you never need them. But you might be able to share ventilators and the necessary personnel between organizations, with the understanding that you would support your colleagues when they need it. That is definitely something I would explore at this point.
HFMA: What else can finance leaders do to address their organization’s staffing needs?
Schabacker: Deploying staff with relevant experience to the areas with the most severely ill patients will be critical. Ventilation therapy, for example, is very complex. You can’t train somebody on that overnight.
As a leader, you’ll want to think about how you can mobilize support staff and even retired physicians, nurses and other healthcare providers. You also might be able to redistribute staff who typically handle elective procedures so they can help with triaging. For example, an ophthalmologist or podiatrist may be able to help triage patients. You’ll want to put your emergency deployment plan on paper and make it executable in the short term.
HFMA: Let’s talk about testing. When a point-of-care test becomes widely available, will that alleviate some of the staffing and patient care issues?
Schabacker: Yes. For one thing, it will help identify the asymptomatic carriers. I think that’s the main reason why Germany has a low death rate, even though they have a very high number of infected people. They test almost everybody, and those who are positive go into quarantine for two weeks.
Testing also will help us better monitor staff and keep them out of the hospital if they are carriers. Right now, we’re flying blind. It shocks me that the richest country in the world with the highest healthcare spend per capita is way less sophisticated than countries like South Korea or even China in that regard.
HFMA: What can leaders do now if their organizations are not yet immersed in managing the crisis?
Schabacker: You can prepare by working with all the key stakeholders in your organization to develop clear, executable guidelines and checklists on what you are going to do if the situation worsens.
You’ll want to determine how you will direct the flow of patients who are COVID-infected and those who are not COVID-infected. You also can set up telemedicine to help reduce the patient load upfront. You’ll also want to determine if you have the right IT resources to keep non-essential workers at home to minimize their exposure. But it is important to realize that having more employees working from home poses increased security risks [detailed in this ECRI fact sheet].
In general, I would try to reduce patient volume and other traffic to the hospital right now. You also may want to postpone any projects that are not essential right now, such as renovations, construction, reorganizations and so on.
HFMA: What if your organization is already battling a high volume of COVID-infected patients?
Schabacker: Once you see increasing numbers of suspected COVID-19 patients in your institution, you need to cease all nonemergency activities to avoid contamination of non-COVID-19 carriers.
During this time, you’ll want to meet regularly with your clinical leaders to understand their immediate needs. For those who are already in crisis mode, what works well is having stand-up meetings with key personnel for a half hour every morning to discuss where the shortages are and where the critical issues stand. At the end of the day, you can meet again and course correct as you go.
HFMA: How can finance leaders support clinicians who may experience extreme stress and burnout as they care for patients during this time?
Schabacker: My thoughts go out to the frontline folks because I’ve been there. I personally experienced that when I spent two years in Africa as a physician. I spent the first 60 days there essentially working non-stop in the hospital. Luckily, I had a colleague and mentor who told me that I needed to take a break and take care of myself.
In times of crisis, healthcare professionals tend to overcommit because the need for their services outpaces the supply of available staff. CFOs should reinforce the importance of downtime to physicians, nurses and others. That is essential.
Many folks are now self-isolated as well, so if you can, try to create an online community for them and offer institutional resources that provide support. If they get burnout or severe fatigue, it doesn’t help anybody, especially patients.
Information on essential supplies for COVID-19
ECRI has developed a COVID-19 Resource Center that provides guidance on functional equivalents to the most needed supplies right now, including PPE: face masks, face shields, respirators, gowns, shoe covers, gloves and so on. Visit ECRI.org and click on COVID-19 Resource Center.