By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
What will happen with health systems post-pandemic? It is a question that worried nurse leaders are more frequently asking me. These concerns fall into the category of what Donald Rumsfield describes as the unknown knowns. Unknown knowns are when we can look into the future and anticipate that there will be change but know there are some things we do not know that could present risks to the future. There are five key areas of unknown knowns in healthcare right now. They include the following questions:
What will the long-term impact of COVID-19 be on the nursing workforce? This question is top of mind for nurse leaders. Many have told me that they have never in their careers seen the workforce in such a fragile place. Staffing shortages have become widespread. Mental health issues are worsening. Anger and negativity toward leaders are palpable. Moving past what has happened will not be easy.
Will the healthcare consumer resume their pre-pandemic healthcare behaviors? The pandemic has led to fairly significant changes in consumer behavior in seeking care. The volume in some practices is as much as 40% below that seen in 2019. For the first time, many healthcare consumers don’t immediately run in to have diagnostic tests at the first sign of a health issue. With this behavior change, some have learned that many ailments go away on their own. Some health consumers have postponed elective surgeries such as joint replacements and are now reconsidering whether to have them at all. It is said that working from home has contributed to a decrease in cardiac problems with the elimination of commutes and workplace stress. More people are dying at home without seeking care at all. Behavioral researchers contend that new behaviors become hardwired, usually at the 60-day mark. Health systems and providers hope that their volumes will incrementally pick up, but this is not a given.
How will the impact of the pandemic change the financial picture for health systems in 2021 and 2022? Most Americans who watch overwhelmed health systems through the COVID crisis find it hard to believe that these systems are actually losing money – lots of money. The AHA reports that 90% of health systems lost 25% or more in revenue in 2020. 2021 might prove even more problematic because of the crushing costs of supplies and supplementary staffing in these first few months of 2021 to meet the care demands. It is uncertain at this point as to how much help health systems might receive from the federal government to offset their losses. The concerning part of this is that the last thing that an overworked, exhausted, and angry healthcare workforce will want to hear at the end of this crisis is their employers are in financial trouble and need to cut budgets.
How quickly will technology companies become disruptive innovators in the healthcare space? Healthcare today is a 3.6 trillion dollar business. In his book, Post-Corona: From Crisis to Opportunity, Scott Galloway discusses the real threat that the four major technology companies (Google, Apple, Amazon, Microsoft) pose to traditional healthcare systems and companies. They are all moving into the healthcare space in different ways. All four are exiting the pandemic with the ability to make deep pocket investments in disruptive change when their competitors are strapped for resources. His assessment is sobering.
Will we have health policy change due to the exposure of health system fragilities and lack of coordination in all aspects of the COVID-19 crisis (e.g., testing, patient care, health inequity, and vaccine distribution)? COVID-19 has exposed the fragility of health systems at many different levels. Consumer trust relative to the ability of health systems to provide consistent and reliable care has been shattered. For the first, many Americans now see the stark differences in healthcare between the haves and the have nots. Rebuilding consumer confidence will be important. It is uncertain at this time about what types of health policy changes might happen as an outcome of the COVID experience.
Nurse leaders need to be attentive to all five of these unknown knowns moving forward. Pay attention to both the noise and the signals. Even with herd immunity and a decrease in COVID cases, 2021 is likely to be a very challenging year.
© emergingrnleader.com 2021
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