The quality of healthcare and COVID-19

The COVID-19 pandemic has affected the delivery of quality healthcare in multiple ways. Beyond the virus itself, many people have lost health insurance coverage as they’ve lost their jobs and many are putting off care out of a fear of being exposed in the physician’s office or in a hospital. Independent practices are having to adjust to reduced income and to the new normal of virtual healthcare delivered via telehealth.

Researchers writing in the International Journal for Quality in Health Care have proposed several patient safety and quality improvement skills that the independent physician can deploy during COVID-19. Their five-step strategy and recommended actions will enable providers to meaningfully contribute during the pandemic by employing their core skills to support patients and staff.

1. Strengthen their system by assessing readiness, gathering evidence, setting up training, promoting staff safety, and bolstering peer support.
2. Engage with patients and their families so that solutions are jointly achieved and owned by both the healthcare providers and the people who receive care.
3. Work to improve care, through actions such as the separation of flows, workshops on teamwork, and the development of clinical decision support.
4. Reduce harm by proactively managing risk to both COVID-19 and non-COVID-19 patients.
5. Boost and expand their learning system, to capture improvement opportunities, adjust very rapidly, and develop resilience. This is crucial as little is known about COVID-19 and its impacts on patients, staff, and institutions.

In particular, in regard to supporting patients and families, the team of experts suggest that providers can:

• Communicate frequently and transparently with patients and their families.
• Help identify, develop, and disseminate patient self-management tools. This should be done for those with long-term conditions who now do not have access to care, such as education and management of diabetes and other chronic illnesses in the context of COVID-19.
• Focus on person-centeredness. Pay attention to the choice of language (e.g., “physical distancing” rather than “social distancing” and to ethical considerations.
• Assess equity in patient care and safety. Ensure decision-making is equitable in terms of gender, class, socio-economic status, and ethnicity, and redresses the negative consequences of social and economic inequity.
• Find ways to maximize the benefits of family support while complying with physical distancing. Assess the feasibility of providing electronic tablets for video calls.

Elation Health has developed a Telehealth Guide to help your practice continue to provide quality healthcare while successfully transitioning during the COVID-19 pandemic. Learn more here.

The World Health Organization (WHO) also provides operational guidance for maintaining quality healthcare and essential health services during the pandemic. WHO explains that while provider encounters should be limited where appropriate, in keeping with physical distancing recommendations, people should not delay seeking care for time-sensitive conditions and should maintain ongoing therapies for chronic conditions to avoid complications and acute exacerbations.

Clear messages about when and where to seek care, relevant policies about the suspension of user fees, and reassurance about the safety of care are essential and should be mainstreamed as part of the outbreak response communication strategy. This strategy should include guidance on safe care-seeking behavior and up-to-date information on changes in service delivery settings (e.g. changes in the location of specific health services, implementation of separate access points for people with and without symptoms of COVID-19 or when suspended services will be available again).

WHO also emphasizes that there are many relevant and practical examples of the use of digital technologies for maintaining and strengthening service delivery in the COVID-19 context. Telemedicine solutions include clinical consultations conducted via video chat or text message, staffed helplines, e-pharmacies and mobile clinics with remote connections to health facilities for timely access to patient data such as medication lists and diagnostic test results. Digital applications can be used as part of supportive supervision of health workers, and evidence-based digital tools can be used to support clinical decisions on diagnosis and treatment.

Messaging platforms that identify and communicate the location of dedicated facilities for specific services, such as routine vaccinations or maternal health services, can create transparency and increase appropriate care-seeking behavior in communities. In addition, digital health technologies can support medication adherence and empower patients to take more proactive measures to manage their own health. Evidence-based, high-quality self-care interventions can be delivered via digital technologies and can offer effective alternatives to some face-to-face interactions with providers.