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Dr. Mark Britnell | Global Head of Healthcare, Government and Infrastructure KPMG International

COVID-19 has vividly demonstrated that ‘no health system is an island’ and every country has something to teach and something to learn from the way it’s being managed.

Dr. Mark Britnell is the Global Head of KPMG’s Healthcare team that spans more than 40 countries. Below he offers ten insights of how health systems around the world are reacting to the pandemic and becoming more resilient as a result. In addition, a review of high-level considerations are also provided.

1. Digital front door

COVID-19 has caused health care systems and organizations around the world to rapidly adopt digital healthcare solutions. In many countries, the ‘digital front door’ has become the ‘only front door’ for patients to access clinical services. Hospital out-patient and general practitioner appointments across the world have been transformed with as much as three-quarters of all consultations now taking place virtually.

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Remote consultations

In the US, Florida’s Baptist Health swiftly managed an anticipated surge in demand at its 11 sites through the creation of a telephone hotline service that repurposed 60 staff to handle calls with scripts and protocols. Chat bots were also introduced to manage online inquires.

Remote monitoring

In Switzerland, the Canton of Basel-Stadt launched the country’s first app to provide care to people who have contracted COVID-19 and are in isolation. This app facilitates communication between patients and caregivers, in addition to supporting contact tracing efforts by the Canton’s Health Department.

Personal health records

In Canada, Alberta Health Services worked with telecommunications company, TELUS to rapidly roll out online personal health records that integrate primary and secondary care, empower patient editing rights and feature secure messaging functionality.

When the pandemic crisis abates, we do not foresee the digital front door closing because patients and providers have embraced the convenience and flexibility of this type of care. Now and when we enter into a post-COVID-19 new reality, a key concern for any health system will be scaling and sustaining these digital interactions.

2. Clean and dirty sites

In response to the pandemic, health systems across the globe such as China, Spain and the US have introduced strict infection control measures including the separation of COVID and non-COVID patients, to prevent spread in hospitals and care homes.

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  •  China was the first to introduce purpose built facilities for the treatment of COVID-positive patients. This measure helped prevent the spread of coronavirus through hospitals.
  •  South Korea was the first country to set up drive-through testing to avoid potential COVID-positive patients coming into contact with other areas of the health system.  
  •  Singapore established fever tents outside emergency departments to triage patients. These tents were equipped with portable x-rays and dedicated CT scanners.

While an effective infection control measure, a side effect of implementing clean and dirty sites has been reduced capacity, particularly for non-urgent procedures. Now and as we enter the post-pandemic new reality, meeting the backlog of elective cases will be a challenge and will require new patient flows through systems to manage this.

3. Hot and cold sites

In response to the pandemic, some countries are establishing hot and cold sites. Cold sites deliver non-COVID care in order to lower infection risk, operate efficiently without interrupting acute work and create capacity for elective procedures. Establishing hot and cold sites will be imperative to delivering the kind of new patient flows necessitated by COVID-19. Public Private Partnerships have been formed in some countries to help expand public sector capacity in this way.

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  •  In the UK, private sector capacity has been requisitioned and reimbursed at cost.
  • In Australia, Public Private Partnerships have been drawn up to ensure ongoing elective care at private facilities.

4. Scaled up primary and centralized specialty services

With COVID-19, we have seen that there has been a continued push by health systems towards delivering care in the right setting, especially in out-of-hospital care settings (e.g. primary care, home and community care, etc.). This rapid increase in demand has exposed the lack of scale and centralization of the primary care and specialty services, which will be necessary in facilitating any health system’s entry into the post-COVID-19 new reality.

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Acute care

Field hospitals to provide critical care for COVID-positive patients have been set up in many countries including the UK, the US and Spain, though China was the first. The Leishenshan Hospital in Wuhan treated more than 2,000 patients with around one quarter of its capacity dedicated to critical care.

Cancer Care

The National University Cancer Institute, Singapore (NCIS) discontinued all Community Cancer Services during the epidemic, and centralized delivery of treatments at only its main site.

Primary care

In the UK, a move to remote working in general practice left a gap in the capacity to carry out face-to-face consultations. In just three weeks, a centralized primary care hub was developed in Birmingham, with capacity to see up to 1,500 patients a day, who had been triaged first via remote consultation.

5. Aged care services

Elderly populations are particularly vulnerable to COVID-19 and managing the spread of the virus has been a challenge in long-term care facilities across the globe. Amidst this dark time in the sector, a few countries have stood out by taking quick action to protect the lives of their elderly.

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In Singapore:

  •  Aged care staff were housed in private accommodation
  • Staff were tested every shift
  • Residents were also tested before being admitted into aged care facilities

In South Korea:

  • Regular temperature checks were conducted for staff and residents
  • Visitor access to aged care facilities was restricted

COVID-19 has exposed flaws in how health and care systems are organized. Traditionally, aged care services have not been seen as a part of the health system, many governments have recognized this oversight and are taking action. Now and in the post-COVID-19 new reality there is an urgent and ever-increasing need to invest in and effectively integrate aged care services with the health system.

6. Supply chain reliance and back office transformation

In addition to the health impact of COVID-19, there are considerable commercial impacts being felt globally particularly in the area of supply chain. The coronavirus has exposed the vulnerabilities of offshore and “just in time” supply chains that rely on lean manufacturing principles. Many governments have taken the lead on procuring Personal Protective Equipment (PPE), some like Russia, the US, Germany and Saudi Arabia have seen the relocation of critical supply production in-country. Furthermore, in some places local supply chains for PPE have cut through regulations and bureaucracy and forged new relationships between manufacturers, universities and procurement specialists.

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Domestic production

  • In Canada, Vancouver Coastal Health is repurposing local manufacturing capacity to produce PPE (gowns and hand sanitizer). 
  • In the US, the Food and Drug Administration issued guidance on safe use of PPE made with 3D printing.

As the ‘new reality’ steps in, health systems will need to digitally transform their supply chain models and other middle and back-office functions to be more resilient and responsive to changing clinical priorities. Greater resilience can be achieved through:

  •  Larger inventories
  •  Supplier diversification
  •  Nationalization or regionalization of supply chains

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Analytics and modelling

In Australia, a state government has created a command center for its PPE supply chain and is using sophisticated data and analytics to model demand and supply along with visualization outputs to support purchasing and operational decision-making.

Digital supply networks

IBM’s Rapid Supplier Connect is helping to relieve hospital PPE shortages by:

  • Rapidly verifying and on-boarding new suppliers, including smaller non-traditional ones
  • Using block chain and artificial intelligence to provide real-time insights into inventories and relieve supply chain bottlenecks.

7. Command centers

Health systems and organizations in some countries have realized the importance of data-driven insights in strategic and operational decision making. Command centers similar to air traffic control systems, are being developed to manage care in much more effective and efficient ways.

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National systems

The Helsinki and Uusimaa Hospital District (HUS, a Joint Authority formed by 24 municipalities) and Helsinki University Hospital, in collaboration with other Finnish hospital districts with academic hospitals share data to operate a “virtual hospital” – combining medical and digital healthcare. The university hospitals use a coordinated approach to the management of patients across a discrete number of clinical pathways. 

Regional systems

In Australia’s second most populous state, Ambulance Victoria uses a command center to manage their fleet of road and air ambulances over a 227,000 square kilometer area that includes seven regions – both metropolitan and rural. Combining real-time data from hospitals, GPS and traffic data, Ambulance Victoria has managed to significantly improve operational efficiency and patient flow for a population of five million, operating 840,000 responses a year. 

While some health systems are making progress in these areas, globally most lack a centralized, data-driven, smart system that can manage resources and assign patient volumes effectively and efficiently which will be helpful in navigating the post-COVID-19 new reality.

8. Agile workforce

Healthcare workers have been the heroic face of the pandemic. During the response phase, health systems and providers discovered that their workforce planning and deployment models had limitations. Below are examples of a few systems who were able to evolve their models to overcome some of these challenges:

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Remote working

Niagara Health, a large multi-site community hospital network in Canada used Microsoft Office 365 and Microsoft Teams to facilitate virtual patient communication and remote staff communication.

Flexible regulation

In the US, the Centers for Medicare and Medicaid Services introduced waivers to support increased use of telehealth and expanded scope of practice.

Multiple states have also changed legislation to permit cross-border consultations and to allow Nurse Practitioners and Physician Assistants to practice independently, without supervision from a physician.

Top of licenses

In the UK, NHS Nightingale Hospital in London developed a unique clinical model that defined roles by tasks and competencies. With this approach, the ratio of ICU nurses to patients increased from 1:1 to 1:6, with professions in less short supply supporting them. This included lay members of the public, who had received training as clinical support workers.

To prepare for a ‘staff slump’ due to physical, mental and emotional exhaustion and support operations in a post-COVID-19 new reality, workforce models will need to transform to become agile, employ data-driven insights, and empower their workers.

9. Institutional and health system governance

COVID-19 has exposed the need to work collaboratively to deal with the challenges it has placed on workforce, supply chains and infrastructure, amongst others. Through our global network, we have heard of widespread local, regional and national cooperation and this is a trend looks set to increase, as health systems move towards the post-pandemic ‘new reality’.

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  • In the US, a 2,000 bed field hospital was commissioned by the State of Colorado to provide extra treatment capacity for COVID-positive patients. Multiple providers cooperated on the project.
  • In the UK, the National Health Service integrated care systems across the country and have coordinated at a regional level to ensure adequate primary, critical and cancer care during the pandemic. 
  • In Canada, Ontario Health has implemented regional plans to restart elective surgery with sites varied according to local COVID prevalence and hospital preparedness.

10. Project management

Given the fast-paced nature of the changes being implemented in most health systems, an agile project management approach has been adopted by some countries. For instance, in the UK the NHS employed this approach when they converted an exhibition center into a temporary hospital (Nightingale London) in just nine days.

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This was a complex project, with multiple overlapping work streams ranging from infrastructure and procurement through to education and training. All told more than 160 contractors, along with 200 army engineers created a facility to service 4,000 patients, 16,000 staff and 750 volunteers were involved in the project. Additionally, thousands of furloughed air cabin crew members were also asked to redeploy into clinical support roles.

To support the post-COVID-19 new reality, providers and governments will need to adopt more agile approach to project management that allows them to implement rapid changes and performance improvement initiatives.