Healthcare Management: Strategies for coping with COVID and the sector's recovery

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In the webinar held on June 2, 2020, we talked with healthcare experts about what we are learning from the COVID crisis, what changes have already been implemented and how we can organize ourselves for the sector's recovery and adaptation. In this article, see which topics were discussed and the lessons learned from the crisis. 

Taking part in this conversation were:

• Claudia Laselva, Director of Operations and Nursing at Einstein.
• Dr. Carlos Frederico, CEO of Grupo Instituto de Oncologia do Vale.
• Dr. Marcelo Alvarenga, CEO of ConectaExp.
• Flávio Battaglia, Director of Lean Institute Brasil.
• Paloma Rubinato, Head of Lean Healthcare at Lean Institute Brasil.

The main goal was to share our insights so that people would come away enriched with lean ideas and inspired by our most recent learnings. In this way, we believe we are contributing in some way to what is being built as the future of this sector.

The article is divided into three sections. We begin by putting into context some challenges at the institutional level, emphasizing the main changes needed to ensure preparation for and response to the pandemic. We also address  the impacts of these changes on care professionals and some improvements that will become permanently incorporated into the sector.

Next, we discuss how the pandemic may impact the future of the healthcare system, what we believe will remain and what is still part of an uncertain scenario given different sources of instability in the medium and long term.

We also sought to address how patients and families are seeing and experiencing this moment, how process changes have reduced waste, such as waiting times, for example, and created unprecedented expectations in the public and private sectors.

Finally, we discuss how lean can connect these three dimensions, acting to reshape organizations, increase the sector's performance and improve the experience of patients and families.

1. Institutional level – Facing the pandemic

Closely following what was happening in the rest of the world was one of the fundamental strategies for facing this pandemic in Brazil. Brazilian institutions that prepared in advance for COVID had important advantages, which resulted in shorter patient stays in ICUs and lower rates of mechanical ventilation use.

Being able to estimate the potential number of cases the hospital would receive on a daily basis, and how much material, equipment and staff would be needed to meet this new demand in advance, brought important benefits to the institutions that carried out this monitoring and acquired the necessary resources (PPE, ventilators, qualified staff) well before they became scarce.

Other important actions that helped in facing the pandemic were, for example, the creation of interdisciplinary crisis management committees and the establishment of differentiated protocols and flows for patients with suspected COVID. 

Another fundamental dimension was communication, since it is necessary to keep everyone properly informed to ensure employees' psychological safety and to guide the population. Claudia Laselva said in the webinar that “we tightened communication among the hospital team, leaders and their teams, through weekly live sessions, robust guidance documentation and the establishment of assertive communication with the population”. 

Even with all these measures and changes, patients are still afraid to return to hospitals, and we do not yet know what this recovery will look like. Trust needs to be worked on very carefully, and for that it is essential that we provide the best experience to patients.

2. Sector level – the main trends 

Although the healthcare system prepared to face this pandemic expecting to receive a very high demand of patients, there are some cities where the pandemic did not arrive with such force. One example is the city of São José dos Campos, which has empty hospital beds in both the public and private sectors. Analyzing this scenario, and what has been happening in Brazil's healthcare system, we highlight three trends for the sector in the medium to long term.

With the restructuring and redesign of operations, the closing of some services and other changes, we have experienced consultations in a “telehealth” format, which will possibly become consolidated as a post-pandemic reality, despite the initial resistance. However, one of the difficulties already identified that will need to be worked on in the future is digital integration between platforms and the standardization of interfaces.

A second trend seems to be the acceleration of the vertical integration process, since some healthcare institutions will face difficulties managing their businesses if demand levels continue to fall or take too long to recover. It will be necessary to redesign the care structure to level capacity with demand once again.

A third trend is the increasingly frequent use of the lean concept of “continuous flow”. Dr. Frederico shared how this concept works as applied at IOV: “with the pandemic, doctors no longer see patients as they arrive, leaving them together in a waiting room; now they schedule appointments at certain intervals so there is no crowding while waiting, and they set aside a specific period of time to handle spontaneous demand, creating a more continuous flow of care”.

3. Individual level: the experience of patients and their families

We have an excellent legacy being built in this pandemic: we have seen processes being revised, waits being eliminated and fast service, generating improvements in the experience of patients and families. As a result, we are dealing with unprecedented expectations from patients, families and employees, and this will be one of the great challenges for the sector after the pandemic.

With regard to patients, we need to pay attention to the experience we offer them as a healthcare institution and to the expectations patients bring based on their history and experiences.

The experience is influenced by people, processes and environments; expectations, on the other hand, can be divided into common elements, that is, what we all expect (such as a correct diagnosis and appropriate treatment), and matters of respect, dignity and appreciation, as well as differentiating elements, such as expectations that differ from person to person according to their experiences.

When it comes to COVID patients, the challenge is the uncertainty healthcare institutions face today regarding schedule preparation and resource management, due to the unpredictability of demand. And when we talk about non-COVID patients, we must be aware that the pandemic worsens the issue of access and the shortage of human, technological and treatment resources, beds, among others.

It also decreases the number of people seeking medical care, as we discussed above, which suggests that there may be an “overuse” of initial care in normal times. Hence the need to separate flows, to take care of people's safety and to raise awareness of continuity of care for chronic patients.

Patients will always have their specific needs. We need to focus on treating the disease, but we cannot fail to look at each person, deepening our understanding of each individual. “All the interactions the patient will have throughout their care […] generate an experience”, says Dr. Marcelo Alvarenga of ConectaExp.

4. Lean is the ingredient that can connect problems and solutions

Lean has been a fundamental ingredient in the management of certain healthcare organizations. In Brazil, there are hundreds of hospitals that have incorporated these techniques and concepts, in both the public and private sectors. We have noticed that the institutions that had mastered lean knowledge were able to react to the pressures generated by the pandemic in a much more agile and precise way.

Large health plan operators, such as Prevent Senior, for example, mention that part of the preparation to care for their COVID patients was only possible because the doctors in their network had mastered lean techniques. The São Paulo state health department has also mentioned several times the Ministry of Health's “Lean nas Emergências” (Lean in Emergency Departments) project as an important strategy to help in this scenario, as it brings flow and management benefits to institutions.

The lessons and experiences shared here reinforce the potential of lean, whether at the organizational level, having prepared in advance for the pandemic, at the system level, bringing the public and private sectors closer together, or even from the individual's perspective.

Healthcare is yet another sector in which lean is making a difference. We hope more and more people get to know it and learn how to apply it. Lean is a fundamental human technology that allows other technologies to fit in, including digital. “In the world we are living in, there is so much waste of time and resources, and we, as the Lean Institute, believe that our role in society is to help organizations and people with these challenges so that we think differently and make the right decisions”, says Flavio Battaglia, director of Lean Institute Brasil.

The healthcare field is undergoing profound transformations and needs, more than ever, to learn how to redefine processes, speed up care, absorb unplanned demand and manage unprecedented expectations from patients, families and employees. One way to begin implementing lean to facilitate this transformation is to identify a main opportunity, train the team and apply it in pursuit of results.

Lean has been making a difference in healthcare institutions in Brazil and around the world. This reinforces the potential of the philosophy, which can be applied at the organizational level, preparing it for rapid responses in crisis situations like the one we are experiencing; at the healthcare system level, enabling it for continuous improvement of processes and management; and at the individual level, truly placing the individual at the center of everything we do. Thinking and acting in a lean way remains fundamental for all these dimensions.

Lean healthcare consulting helps leaders and managers develop continuous improvement strategies, optimize resources and create more agile processes, ensuring a more efficient operation and more satisfied patients. Visit and check it out!