Ramping up for Round II of COVID-19: 10 Key Lessons Providence Learned from Round I

Prior to January 21, 2020, “coronavirus” was another interesting infectious disease dynamic with very distant implications for the western United States. With very little warning, we received the first confirmed COVID-19 patient at our facility in Everett, Washington. A major outbreak was soon detected in a Kirkland, Washington nursing home.

The virus saw no boundaries as it spread. Neither my 43 years of nursing and leadership nor my lengthy public health and military service fully prepared me for what was to follow. With COVID-19 breaking down barriers at every turn, we experienced rapid, unprecedented transformation at Providence.

Looking back, our Pandemic Playbook paved the way for a successful systemic response, maximizing cross-team collaboration and “silo-busting.” It quickly became the working roadmap for our entire organization.

The Providence COVID-19 Pandemic Playbook: People, Places, and Products

Our immediate response was to organize around “3 Ps:” People, Places, and Products. We also launched a virtual COVID-19 Command Center. Local and regional centers that mirrored this enterprise-level command center were then stood up throughout the system. To better manage waves of this epidemic, we created this framework:

The Pandemic Playbook guided system, regional, and local response planning. We leveraged our size and scale to direct resources to impending “hot spots,” initially in Washington state and southern California.

Looking back, we not only learned fast, but we also became a much different and better health system.

Our Top Ten COVID-19 Lessons Learned from Round I 

1. Assemble your best experts and listen to them: Find your best epidemiology and infectious disease experts, data scientists, population health experts, informaticists, intensivists, infection preventionists, critical care nurses, pharmacists, laboratory leaders, etc. Put them in a (virtual) room routinely for consensus on best practices and do not hesitate to follow their collective guidance.
    
2. Remove organizational silos immediately. We quickly assembled a COVID-19 “Kitchen Cabinet” comprised of senior clinical leaders from acute care, ambulatory and long-term care, nursing, real estate, clinical programs, data science, and operations. This team huddled daily to steer organizational response and strategy.
    
3. Don’t let perfection be the enemy of good. We improved every step of the way by taking an iterative approach and sharing documents/plans and frameworks as they were being finalized to capture feedback.  We committed ourselves to resisting our natural longing for absolute certainty and absolute, confirmed evidence.
    
4. Be bold and proactive. It’s crucial to look around the corner, anticipate the worst, and build a plan.  We didn’t call it Doomsday Planning, but we did work backward from the imagined worst-case scenario at every step.
    
5. Look out for your people.  The recognition of caregivers as heroes has been touching and heartwarming. It put the focus on our people and their lived experiences. We celebrated and lifted all our front-line caregivers. We invested in a permanent, effective response network to help meet their behavioral and emotional health needs while combatting COVID-19.
    
6. Trust science as the source of truth.  Use data and science to make decisions and steer clear of hype, emotion, and passionate opinions.  Being grounded in a mission and strong values enabled us to focus on clinical care for those who needed it most.
    
7. Be open to changing your big, bureaucratic health system. We were able to turn around a 140,000+ staff ship and align nimbly. We knew speed would save lives. Continuous and concise communication supported it.
    
8. Connect with communities and nurture your partnerships. Dangerous epidemics cannot be managed by health systems alone. We collaborated with local public health infrastructures, government health authorities, advocacy groups, and other local health systems. Together, we organized around our states and communities, avoided duplication of efforts and competition, and managed precious cross-facility and system resources. Sharing data, and clinical, and technological resources was critical.
    
9. Feed the souls of the clinicians delivering care. Our weekly Grand Rounds brought together the brightest minds and most current evidence to create a culture of COVID-19 learning.
    
10.  Focus on the opportunity. The new culture of our health system today has resulted from coming together in response. We have become more innovative, nimble, and unified because of this crisis.

We have more hard work ahead of us and we must avoid returning to “life as we knew it.” As we enter Round II of this virus, with seven of our eight regions trending steeply in the wrong direction, we must accelerate this newfound cultural evolution in healthcare. It will save more lives from COVID-19.