What Hasn’t,
and What’s Next
he novel coronavirus pandemic has demanded that healthcare professionals worldwide take a long, hard look at the way their systems are facilitating or hindering their ability to deliver care. For Alaska’s Chief Medical Officer, this period has been an exercise in making the most of the state’s available resources.
When preparations were being made at the beginning of the year, Dr. Anne Zink was focused on two areas where Alaska appeared short-staffed.
“I was particularly concerned about our ICU capacity: nurses, respiratory therapists, ICU doctors, and technicians in that space,” says Zink. “Early on in the pandemic, there was a big emphasis on intubating people quickly. There was a lot of talk about ventilators and the amount of supplies, and that really requires a very subspecialized group of personnel to make sure you can run those machines well.”
Advanced technology requiring specialized care was the other area in which Zink felt Alaska was ill-equipped. Extracorporeal membrane oxygenation, or ECMO, is one example of a technology that has proved useful in combatting COVID-19 but which the state simply doesn’t possess the means to employ.
A process like ECMO requires the expertise of cardiothoracic surgeons, which Zink says have proved difficult to attract. “You just can’t recruit people to work in the state to do that, and you need a whole team to be able to pull that off. Something like that is a 5- to 10-year process to build up.”
“I think there was a lot of focus initially on hospital capacity and alternative care sites, but as we’ve been able to slow this pandemic, it has required a whole different skill set,” says Zink.
She points to the contact tracers, quarantine workers in rural communities, and other less celebrated positions that have played vital roles in the state’s response strategy.
And in many cases, new positions are being created entirely to cater to a world in which face coverings and social distancing are the norm.
Lisa Powell is Providence’s Director of HR for Alaska and Oregon.
One development in particular that Powell has noticed is the emergence of hospital monitors. “If you’ve been into a clinic or hospital, someone may have stopped you and taken your temperature and asked you a few questions,” she says, noting that, in some cases, the individuals assuming these new roles aren’t necessarily required to possess healthcare backgrounds.
“In some of our facilities, there are actually folks that monitor social distancing and folks that have to make sure we have enough PPE [personal protective equipment] on hand,” says Powell, adding that existing staff such as nurses and emergency coordinators have had to take on these additional duties.
As far as attracting applicants to some of the more specialized positions, Providence’s Talent Acquisition Director, Robert Dick, echoes Zink’s earlier sentiments on the difficulties associated with recruiting. “Overall, Alaska is a challenging market to get people from the Lower 48 to relocate to… and it has certainly been more challenging adding the pandemic to the equation.”
Doubling down on marketing campaigns has allowed Providence’s hiring efforts to remain steady, with sign-on bonuses also coming into play, Dick explains. “The psychology right now, with all the uncertainty in the market, makes people less compelled to leave a job.”
The State of Alaska is one of those partners. Acquiring the necessary professional licenses to work legally in the state takes time. And with both the demand and the immediate need for nurses at an all-time high, measures have been taken to fast-track some of these workers so that they are more readily available to serve on the frontlines.
Alaska Executive Search (AES) is one of the state’s leading staffing agencies, and its relationship with Visit Healthcare—an emergency response-focused testing company—is another example of companies taking a collaborative approach to problem solving. “We have worked closely with Visit Healthcare—they were able to set up testing sites for the municipality of Anchorage in record time with support from the CAN, CMA, data entry, and contact tracing candidates we provided them,” AES says.
In addition to partnerships within the state, Zink says that for certain situations, Alaska has had to maintain close contact with hospitals in the Pacific Northwest. While Alaska doesn’t possess certain specialized care like ECMO, Zink explains the state does possess the ability to fly someone on a portable ECMO until they’re able to arrive in Seattle. “We’ve had to work closely with Seattle and be like, ‘Hey, you know you are part of our healthcare infrastructure, right? We need to make sure that your beds are available,’” she laughs.
Others have not.
“There is a huge need for data—the untold story of this pandemic is the fact that we’re at over half a million tests now, and most of those were coming to us via fax when this first started,” Zink admits. “And we’re not the only state. Most states are really struggling with this.”
Zink says the healthcare community is spending a tremendous amount of time trying to make IT systems work together. “A lot of the time a community is focused on the positive of their contact tracing and they forgot to send it to us or fax it to us or call us—and we don’t have it, so we can’t put it up [on the dashboard].
“So, there’s all these bits and pieces of limitation that other countries who have a more unified healthcare system have not had to deal with.”
“And that is a good example of the fact that in most hospitals, inpatient can’t see what’s done in the emergency department, the emergency department can’t see what’s done in obstetrics, obstetrics can’t see what’s done in anesthesia—and that’s just within the hospital, let alone what was happening at the other hospitals or what happens in the clinic.”
Part of the reason hospitals are unable to provide a seamless flow of information is due to individual departments each operating their own unique IT systems—IT systems that are incentivized to be proprietary. Electronic medical records or EMRs can be hugely helpful in providing continuity of care as patients are moved through specialties or from facility to facility, but that’s assuming a level of interoperability between disparate EMRs that has yet to come to fruition for many healthcare providers. And while there has been an effort by the federal government to address this issue, Zink believes this is like trying to fit square pegs in round holes. “The Health Information Exchange [HIE] is supposed to connect those pieces, but it’s essentially an air traffic controller with a bunch of parts and pieces that don’t want to fit together… And it’s part of the reason our healthcare costs are so expensive.”
For Zink, the answer is surprisingly simple.
“I think healthcare has been structured around the place, such as the hospital, rather than around the patient. We need systems that put patients first—not systems that are meant for systems. What ways can we make this about patients and not about providers and places? If you’re in hospice, you could be at home and be able to have your doc FaceTime in and your doc doesn’t have to drive there—or you don’t have to die in the hospital.”
Expanding, she adds, “We need to invest in healthcare infrastructure that connects people and we need to invest in public health that’s community-focused. I think there’s been a movement in the healthcare realm for some time in Alaska about sharing information better and working more collaboratively, and I’m hoping we will take this moment to be able to really change the way that we do healthcare and have it be prevention-focused, patient-focused, and utilize the strengths of our communities to keep people healthy and well.”
As a roadmap for this approach, Zink points to the efforts of the Mat-Su community in tackling its opioid crisis.
“I was just really amazed at when the public really engaged in opioid addiction and overdose in combination with the providers, patients, policymakers, and the press. It made a difference: we saw decreased deaths, decreased addiction, and we see real change when that happens.”
Zink believes this approach would not only create a more resilient healthcare system but also a sturdier Alaska economy.
“We have really unique limitations in the state—we don’t have ECMO, we don’t have certain services up here, it’s really hard to recruit healthcare providers. But what we do have is a really strong sense of community. And I think if we invest in prevention, we invest in public health and community strength, it will decrease our healthcare costs, make our businesses more robust, and our communities healthy.”