The cancer community has been deeply impacted by Covid-19 constraints. Infusion centers across the country have reported significant declines in patient volume and infusion centers have yet to experience any kind of recovery.
There are several reasons behind the sudden drop in volume. The reduction of new cancer diagnoses due to delays or cancellations of surgeries and screenings and deferred or cancelled treatments because of immunosuppression risks have been major drivers. Other factors include social distancing requirements that influence the number of available chairs;, cleaning protocols that slow the turning of chairs; and the conversion of some treatments to home infusion or oral oncolytics. Each of these factors contributes to a complex recovery scenario.
The re-emergence of treatment
When reviewing a return to normal operations, there is much to consider.
For example, there will be unrecoverable loss — not every patient will return to the queue. Some existing patients that were not able to be seen may not come back because they moved to palliative care, or they simply turned elsewhere for treatment. The level of unrecoverable loss, though small, can be difficult to predict.
At the same time, there is considerable concern over integrating the remaining deferred volume. These appointments are expected to cause a substantial surge that must be incorporated on top of an already full schedule. The million -dollar question becomes “how do infusion centers accommodate deferred volume in addition to regularly scheduled appointments so that patients can be treated effectively in an unpredictable climate?”
A Deep-dive Into Specialty Pharma
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Here are four strategies aimed at establishing a healthy pathway back to something close to the norm.
Figure out your backlog
The first thing infusion centers need to do is to figure out their backlog. They have to know what’s missing in order to estimate when operations can return to “normal.” This will be something to map against.
There are a number of things to consider when determining estimated backlog and calculating recovery date. Look at the typical volume pre-Covid-19 as well as when volume started to drop (generally, a week before shelter-in-place guidelines went into effect). Centers need to estimate percentages of existing patients plus the new patients they need to include and consider assets and levers available to them that can affect their timeline — whether it is acquiring chairs from other departments or extending center hours.
This can require a lot of math and may seem overwhelming. Fortunately, free online tools and calculators are surfacing that can assist you.
Change the curve
Once centers have an idea of what they are dealing with in terms of backlog, there are several ways they can change their projections. These levers fall into three groups: staffing options, scheduling options, and physical setup.
In terms of staffing options, they should determine whether they can increase staff. Can they add more nurses, for example? If so, they need to get approval and start any kind of onboarding now so that they are ready to go at the appropriate time. They should also look at how they are utilizing existing staff. Can they be used more effectively? Are they available to work more hours?
For scheduling options, many centers will extend hours, both during the week and on weekends, to accommodate the surge. Another option is to use mornings and late afternoons more effectively in order to avoid that midday peak. Allowing patients to opt for their first-choice appointment slot may seem like the most patient-centric thing to do, but in reality, this is not always wise. Solving for the desires of a single patient when there is no slot available can increase the wait time for everyone. It can also prolong waits at a time when you want to limit exposure to others. If patients need to get their treatments back on schedule, they are more willing to accept appointments at suboptimal times; therefore, early mornings and late afternoons are great options for absorbing some additional volume.
There are also a few things they can try with regard to physical setup that can help as well. For example, in addition to borrowing beds or chairs from elsewhere, pooling patients across pods is another way to squeeze a little more efficiency out of what they already have.
Implement effective change management
One of the biggest challenges of change management in a Covid-19 and post Covid-19 world is that everyone within an organization is doing it at the same time. This ratchets up the potential for chaos if changes are not carefully planned and coordinated. This unprecedented time requires thinking about communication much more broadly than we have in the past. While centers certainly have to consider how they communicate with essential groups like nurses and pharmacy, there are additional peripheral groups they may need to consider as well — including some that wouldn’t normally be a part of change management. For example, if they change their operating hours, they may need to notify the Department of Health. They’ll also need to communicate with security to make sure doors are unlocked on time, have engineering available to activate heat and air at times that are usually “unoccupied hours,” and make sure interpreters are available during the new hours.
Additionally, it is important to think about who needs to include centers in their recovery plans. Centers should reach out proactively to ensure that they are involved in discussions with groups that might affect them, Change management to the extent health systems now face can involve coordination with up to 30 teams. Be sure that infusion is not adversely affected by a decision made within another group if at all possible.
And, recognize that within all of this change, real people are involved, including people who have been deeply affected by the virus. The path back to normal will likely be more difficult for some staff than others. Everyone has had a different experience; they may have lost friends or family members. It will be important to give grace as everyone does the best that they can.
Measure, iterate, innovate
Best practices that centers have developed, such as tracking weekly volumes over time, looking for trends, and making adjustments as necessary will be more important than ever in recovery. Yet, they need to make sure not to over-rotate on any single data point — there are going to be hiccups, and what happens on one odd day shouldn’t overly influence key decisions. Instead, think in terms of short, small movements rather than huge, wholescale changes.
Additionally, it is vital to share information with teams. Not everyone understands why certain changes are being made, and so much is happening so fast that they can’t keep up. If centers bring them into the loop and explain the “why” associated with each policy or practice change, operations will run much more smoothly within the center.
Also, remember that the best ideas can come from the least likely places. If they are using floaters or travelers, for example, they should ask what they’ve seen in the center that they like or where they could do better. They should also; ask about what they have seen in other locations that works well.
Finally, look for positive changes that were made because of Covid-19 and consider embracing them as permanent. Covid-19 has been the impetus for a lot of scrappy decision-making. One center representative told me that prior to Covid-19 they had a plan to implement telemedicine over the next four years. Once Covid-19 hit, however, they were able to get it up and running in just two weeks. There are countless other stories about how Covid-19 has enabled nimble implementation of initiatives that may be good to hold onto moving forward.
Covid-19 has also inspired some truly creative thinking, like centers that allow patients to check in via text from the car so they can come right into their room at the appropriate time. This kind of innovation may prompt you to ponder what the world would look like if they got rid of the waiting room. Finally, centers should not forget to take time to record the outstanding strategies the center creates (as well as those that were perhaps less outstanding and never need to be considered again). We’ve all heard that Covid-19 is likely to come in waves. By having successful strategies recorded, it is faster and easier to implement them again if needed. This has been a difficult period for infusion centers across the country. While they face an unprecedented health crisis, they are not alone. They need to learn and share with one another as they work to come through on the other side as a stronger organization.
Picture: anyaberkut, Getty Images
