In recent months we have discovered that, despite our advances in information technology, we can not predict the future. Most health organizations have been consumed with planning to master the COVID curve; only to find that the reality was far different than predicted and the future continues to be elusive.
Although we anticipated a volume surge with COVID-19, except for a few well publicized locations, it did not happen. Most hospitals remained at unusually low occupancy, busy with planning and supply chain management as opposed to volume of patient care. With elective surgery cancelations and the fear of contamination from entering medical facilities, people needing healthcare for non-COVID related concerns stayed at home. Resources that could have provided this care sat idol.
The next few months are open for speculation. We need facts, not conjecture based on external data. Canada must base COVID analysis on empirical epidemiology data gathered within Canada through adequate testing across the population.
One representation of a possible outcome is illustrated in Image 1. Predictions include:
- New waves of demand as delayed surgical and non-COVID care cases return to the scene,
- Functional impairment from missed care opportunities,
- A mental health crisis exacerbated by economic hardship and social isolation, and
- Subsequent surges of COVID illness.
Considering our recent experiences around the accuracy of predictions, and an understanding that capacity management will be key, how can we best spend our time planning for the unknown? One thing is certain, we will need to be adaptable and prepared to surf whatever waves come our way.
Planning to be nimble begins with awareness of where you are, a vision of the desired future state and development of the tools and skills needed to get there. Prior to focusing on individual pieces of the puzzle, it is important to take the time to craft a strategic approach. Pull in the strategic planners, talk to frontline workers and survey best practices in the field. Identify the problems that need to be resolved and the opportunities for improvements. From this develop a strategic plan. Next move to tactical planning including the outcomes you want to target, innovative solutions required, changes in processes, resources, timing, etc.
The solution is likely to include a constellation of abilities that begins with accurate real-time data about supply and demand of physical, spatial, and human resources. Some organizations have developed tools to facilitate this. Command centres are popping up in many technology-enabled health organizations. These centres bring real-time data from health information systems into visually descriptive data tiles and apply predictive models to highlight areas of pressure. This information is presented to a team equipped with standardized action plans to manage the pain points. Having access to real-time data enables these organizations to act fluidly based on the reality of a situation from moment to moment. Command centres have been shown to improve efficiency and enhance patient safety and satisfaction.
AI can be a powerful tool in capacity planning. Reducing the time to value will be critical in deploying solutions. Cloud computing has provided organizations with the ability to deploy systems quickly. Some organizations have accelerated the implementation of electronic health records by leveraging evidence based clinical standards along with a streamlined user review process.
Agile resource procurement is another skill necessary to adequately respond to needs. As discussed in Angela Mondou and Colin Deacon’s article in the Globe and Mail, streamlined procurement processes have allowed our country’s entrepreneurs to pivot their businesses into making much needed products. Continued agility in procurement can be facilitated through innovative approaches that focus on problems, not solutions, thereby empowering the problem-solving capacity of the technology sector and liberating the health organizations to focus on patient care.
There is an opportunity for healthcare organizations and provincial/ territorial governments to stimulate the economy, ensure the recovery of Canada’s digital health technology sector, rapidly adopt technology solutions that are urgently needed, and create a “new normal” of nimble, agile healthcare procurement that integrates cutting-edge innovations into healthcare delivery while fueling economic growth.
For innovation to thrive in Canada we need “buy Canadian” policies and recognition that many innovative products and services will not meet the need 100% immediately. It needs to be accepted that innovation is “two steps forward and one back”. Most innovative solutions will need to be refined over time while others will fail. We need to be nimble in exploring and supporting multiple innovative solutions in parallel and share the results.
Improving patient access to care using innovative approaches is already well underway with the surge of virtual care options. Continuing to innovate in this area by optimizing and integrating virtual solutions with electronic medical records, aligning with homecare services, and focusing on pro-active chronic disease management will be critical to managing hospital capacity. Additionally, methods of resource and referral matching can help match patients needs with providers skills and availability to potentially reduce wait times. The use of wearable monitors, contact racing, robotics and surveillance systems are in the early stages of adoption but offer significant potential benefits in reducing staff time and patient risk.
These innovations, and many other pieces of the puzzle, are necessary to improve our agility for the tumultuous ride of capacity management that we anticipate in the next few years and beyond. If we expect to master the future, it will not be done by resisting what we do not want, but by adapting to what is.
 Mondou, A and Deacon, C. (2020) ‘Bold government procurement policies help companies recover from crisis’, The Globe and Mail, April 20, 2020.