The fractured federal response, a barrage of new coordinating responsibilities at the state level, and gaps in emergency response left the commonwealth underprepared for a crisis of this magnitude. To fill in the cracks, hospitals and health systems stepped in wherever needed to address critical public health needs, including COVID-19 testing and vaccination. Amid the chaos, healthcare organizations, the government, and communities came together to adapt and handle the problems in front of them in ways they hadn’t before.
President and CEO, health system: “We realized that, before the pandemic, we did not have the statewide system required to respond to a statewide problem. We appreciate that, with the help of MHA and the state, we made one.”
Perhaps the biggest takeaways from the pandemic experience are, first, that the interconnectedness of healthcare organizations, government, and community is critical, and second, that there is unparalleled value in good communication, collaboration, and joint planning before, during, and after a crisis.
The pandemic elevated care providers’ position as vital, trusted sources of information in their communities. Fulfillment of this responsibility was both proactive and reactive as healthcare organizations reaffirmed their leadership in this role, while also being directly sought after for guidance by other organizations, including restaurants, entertainment venues, and sports teams. At the same time, the pandemic brought longstanding and worsening healthcare inequities into sharp focus as the virus took a more severe toll on disenfranchised populations.
KEY FINDINGS
Effective statewide collaboration requires conveners.
Healthcare leaders report that their collaboration and the trust it built was foundational to the success of their pandemic response. MHA served as a nexus of the response, as a convener, and as an important source of truth and problem-solving for the healthcare system at large. It provided a safe, neutral place to ask questions, share information, coordinate, address issues, and advocate with a unified voice. To that end, MHA hosted frequent CEO calls; engaged in consistent dialogue with the Secretary of Health and Human Services and the state’s command center team; organized and led workgroups to address critical areas regarding post-acute care transitions, hospital capacity, vaccines, and clinical issues; quickly stood up a statewide data reporting platform for bed capacity and availability and behavioral health boarding; and helped secure critical flexibilities and waivers. Variations between regions, along with shifts in virus hotspots, made regional relationships and collaboration necessary to address local needs and develop solutions that worked within each community. This regional approach was also critical to bed capacity data sharing, collaboration, and problem-solving.
Government and health systems are interdependent during crises.
Strong relationships between health-care organizations, MHA, and the state prior to the pandemic translated to strong collaboration, coordination, and communication throughout the pandemic. State leadership was open and collaborative, and they responded to the needs of healthcare organizations based on both direct feedback and real-time data. These link ages were vital for information gathering and dissemination, policy changes and guidance, and funding and resource allocation. This was evidenced by the ability to secure significant and timely waivers and regulatory flexibilities when needed, including those for credentialing, surge spaces, staffing, prior authorization, and liability protections.
Community partnerships are critical to an equitable response.
As provider organizations witnessed the disproportionate effect the crisis was having on disenfranchised populations, they drew upon their ability to identify those populations and leave no one behind. To do so, they created and strengthened partnerships with community groups, churches, and other local organizations to better understand people’s needs, build trust, and identify barriers so they could tailor messages and solutions accordingly. In parallel, many healthcare organizations used their purchasing power to expand support to diverse businesses within the communities they serve.
External communication is not one-size-fits-all.
The pandemic compelled providers to reach out to the entire community frequently and expeditiously, with vital messages about care and visitation policy changes, testing and vaccination eligibility and access, and supplies and support needs. Hospitals partnered with MHA and the state to develop common messaging to ensure the healthcare system and its partners were all speaking with the same voice. However, different populations faced different obstacles to obtaining and acting on information and therefore require different approaches. Successful messaging campaigns used different channels such as print, radio, television, door-knocking, and outreach in gathering spaces (e.g., churches) by trusted leaders to target and engage underserved communities.
RECOMMENDATIONS
Define and understand the spectrum of public health emergencies.
Healthcare leaders voiced concerns that prior public health emergency response planning, training, and readiness exercises with command center involvement were insufficient for a crisis of this magnitude and duration. The first step in addressing this problem is defining the true spectrum of possible public health emergencies to inform the scope of planning and resources required. Managing this endeavor requires clear ownership to avoid duplication of efforts, accelerate decision making, and ensure continuity. Stakeholders, both inside and outside the healthcare system, must be deeply involved in the entirety of the planning process, and they each need to understand their roles during health emergencies.
Notably, clinical and operational representatives with deep process and healthcare system expertise must be present in the design, exercise, and evaluation of plans to provide valid input on assumptions, response viability, and execution challenges. The Department of Public Health (DPH) should examine how it can eliminate silos and better integrate its plans and systems with those of the healthcare system. The state should convene representative groups of external experts during pre-event emergency planning and at the outset of any public health emergency.
Bolster emergency response training and regional readiness.
Emergency response exercises at the facility, system, regional, and state level are needed at regular intervals. Regional and state-level exercises require support and organization from the state, and these efforts should be enhanced to be more robust, predictable, and inclusive. Regional preparations among healthcare providers should cover common response protocols, load-balancing, supply chain contingencies, and crisis standards of care, as appropriate.
While the state’s six regional Health and Medical Coordinating Coalitions (HMCCs) have the potential to better support these functions regionally, they require additional expertise and responsibilities to do so effectively. Staffing and expertise within HMCCs should include individuals with healthcare operations and data expertise from across the care continuum, and be provided with access to the state’s emergency data infrastructure. As a vital organ of any effective regional capacity management, EMS and other transportation providers should also have a seat at the table.
Archive best practices, new workflows, and playbooks.
Healthcare organizations developed best practices and guides for many aspects of disaster response, including creating drive-through testing and vaccination sites, standing up field hospitals, designing new processes for care delivery and patient transfers, and updating workflows for operational disruptions and crisis standards of care contingencies. These lessons need to be codified, organized, and stored in an accessible manner so they can be quickly referenced, replicated, or adapted when the next emergency strikes. Likewise, having a directory of all waivers and flexibility enacted during the pandemic could be useful for reference in future emergencies.
Coordinate across the entire care continuum.
To maximize the state’s potential, collaboration between peer institutions, large and small organizations, and providers across the care continuum that arose during the pandemic must continue and deepen. Key players along the continuum include: primary care, tertiary care, long-term care, post-acute care, behavioral health, home health, senior care, and healthcare transportation. While much progress has been made, providers found it challenging, for example, to navigate differing guidance from DPH, the Department of Mental Health (DMH), and other state agencies. In addition, state and regional emergency response partnerships should be formalized.
Leverage the state’s renowned healthcare, research, and tech expertise in creative ways.
Massachusetts is uniquely positioned — perhaps in a category of one — as both a world-class healthcare destination and a renowned biotech hub with leading hospitals, researchers, and innovators. At the start of a public health emergency, a state-level “think tank” should be established, consisting of experts from across the state, to engineer a response and develop communications and recommendations on behalf of the commonwealth. MHA should continue its role in convening experts, much as it did with vaccines, testing, blood supply, and clinical guidance.
In parallel, public-private and cross-sector partnerships should be incentivized to innovate and respond to dynamic crisis situations. One example of such a partnership was the Massachusetts Manufacturing Emergency Response Team ecosystem, which addressed needs in personal protective equipment (PPE), testing, and essential supply chains that advanced manufacturing research, innovation, and technology validation. Another example is the collaboration between providers and the Broad Institute that facilitated quicker turnaround times for test results and enabled caregivers to get cleared for work.
Build on the HICS and EOC structures’ success.
Hospital incident command systems (HICS) and emergency operations center (EOC) structures were critical to the response. Provider organizations should identify and share success factors that enabled them to sustain prolonged incident command activity. HICS and EOC structures may also benefit from seeking additional health equity and communications representation at the table.