by Frank Otto
It’s from the most harrowing crises that the greatest lessons are often learned.
Plagues in the Middle Ages prompted the first organized instances of quarantining to control international disease spread. A yellow fever epidemic in Philadelphia following the American Revolution prompted a law that first established hospitals in port cities to keep sailors fit for service, which then evolved into the nation’s Public Health Service. And amid the magnitude of catastrophic head and facial injuries among combatants in the First World War, the field of plastic surgery emerged to restore form and function to the wounded’s bodies.
All of those responses arose directly from emergencies affecting certain times but have had immeasurable impacts in the years forward. To many in health care — including those in Penn Medicine’s Center for Health Care Innovation — the COVID-19 pandemic is a crisis from which we can find our next great learning opportunity.
Charged with fixing some of the biggest problems in health care, members of the Center for Health Care Innovation have been intimately involved in Penn Medicine’s efforts to combat COVID-19. Their work, in partnership with many teams across the health system, has ranged from developing drive-through testing sites and revamped emergency room entrances to address suddenly heightened infection control at the start of the pandemic to facilitating equitable vaccine roll-out efforts in communities that have been historically underserved by health care. All the while, Innovation team members have facilitated programs that took advantage of the new popularity – and emergently loosened regulations – of telemedicine. These programs included COVID Watch and the COVID Accelerated Care Pathway, which helped free up hospital capacity and buy time amid surges.
As we enter the third year since the pandemic surfaced in the Philadelphia region, the center’s personnel made sure to take lessons from each effort. Here, they share what they’ve learned in the course of two years of the pandemic and what they’re hoping to take forward into the future.
“The perception and reality of ‘risk’ was addressed differently when we needed to act fast. As a health system, we have a great responsibility to protect our patients and staff, as well as the information we hold. And with the pandemic, we had to re-evaluate our threshold for risk. I believe we realized that many processes too often place a minimal possibility of risk over the potential benefit of change, and don’t sufficiently consider the risk of staying with the status quo. For example, when we exhausted other means of reaching patients eligible for the COVID vaccine, we texted patients with a mobile number in their chart. In the past, the perceived risks were that patients would be annoyed or that we were jeopardizing privacy, but we recognized the benefit of reaching our most underserved population was worth the risk – and we demonstrated patients were actually fine with it. I think that we proved that our old systems for vetting change, as important as those structures are, are often less necessary than we once thought or at least can be faster, lighter weight, and more efficient.”
— Matt Van Der Tuyn, director of design and strategy, Center for Health Care Innovation.
Telemedicine the Lifeline… and the Future?
“I always believed telemedicine could become a significant way to deliver care and patients would want it. Even after it became inherently valuable during COVID, I’m still interested to see how we can maximize its potential as a tool to complement in-person visits. I also believed automating patient-facing processes could streamline care and make it more efficient. Moving forward, I’m excited to see how we carry forward lessons from programs like COVID Watch, where these two concepts were married and worked well together.”
— Krisda Chaiyachati, MD, assistant professor of Medicine; medical director, Penn Medicine OnDemand and PennOpen Pass; clinical innovation manager, Center for Health Care Innovation.
An Urgent, Central Goal Greases the Wheels
“Going into COVID, it wasn’t uncommon for good ideas to get stuck in bureaucracy, change control, and limited resources due to competing priorities. That’s changed during the pandemic. When you create an environment where all stakeholders are driving hard toward the same goal, you can implement effective programs in a short period of time. This was the case with COVID Watch. It was a true collaboration of thought leaders, clinicians, researchers, and tech folks with the same goal in mind – saving lives.”
— Christianne Sevinc, project owner, Way to Health.
Keeping Germs and the ‘Power Through’ Culture at Bay
“As we transition back to a hybrid in-person model of work, for people who are moderately unwell – like with a cold – but still want to get some things done, there’s now a strongly established norm for them to work from home. Before COVID, there was a broader societal expectation that people come in to work if they had mild symptoms of illness, like a cold. COVID has highlighted the importance of halting disease transmissibility, and the University’s accommodations to work from home — through measures like increased bandwidth to connect to a remote desktop and the provision of supplies like second monitors — has made doing so much easier. This has the dual benefit of reducing contagion and, more subtly, challenging an unhealthy culture of ‘powering through’ and coming to the office even when it has little benefit. This is a win-win for the person who has a cold and the colleagues who’d otherwise be exposed.”
— Kelly Zentgraf, senior project manager, Nudge Unit.
Mental Health Investment a Must
“We have known for a long time now that there is a global mental health crisis. Increases in suicide deaths and drug overdose deaths, have been occurring for some time — particularly in the United States — and we have been seeing especially troubling trends for young people. The pandemic has shone a light on how much we have underinvested in mental health care delivery. My hope is that the pandemic’s effect on mental health broadly destigmatizes mental health needs and galvanizes our world to double down on investing in mental health prevention and intervention. We and all of those whom we love will all need mental health prevention and intervention in our lifetime. We need to move forward with building a system with appropriate resources and infrastructure to meet that need.”
— Rinad Beidas, PhD, director, Nudge Unit; founding director, Penn Implementation Science Center; professor of Psychiatry and Medical Ethics and Health Policy.
