We futureproofed healthcare.

Whew, that’s a strong statement. Strong, but true. Researcher Brian Rich (2014) described the concept of futureproofing as “the process of anticipating the future and developing methods of minimizing the effects of shocks and stresses of future events.” It’s a process of learning from the past and present and preparing for whatever is happening to repeat itself in the future, potentially on a grander level. Preparing for this is not a small task and the truth is we did it by accident. We futureproofed one organization and then stumbled into a futureproofed statewide health system just in time for the COVID pandemic to take over the state of Arizona and the world.

It began in 2018. A major health system and majority market owner situated in the Southwest was partaking in an unannounced Federal Emergency Management Agency (FEMA) drill. Our healthcare organization was tasked with evacuating our largest 750-bed academic medical center due to a hypothetical internal disaster. FEMA even made it easy for us by saying, “Don’t worry about physician capacity and credentialing and don’t worry about nurse staffing - just get your patients moved out of your facility and into surrounding hospitals. You have four hours. Ready, set, go.”  

Looking back and considering our current nurse staffing crisis today, that ease almost seems laughable. This ask, however, is not anywhere as easy as it seems and as the leader of the transfer center, it quickly became my unannounced Super Bowl. It was time for our team to shine, but boy did we fail. After four hours of phone calls, emails, text messages, and sticky notes covering a wall of my office, we had only placed about half of those patients. We did not have an efficient way to communicate and coordinate; we did not have an effective way to see where our beds were or were not available; we simply did not have a streamlined way to transfer patients. As you can imagine, we also did not receive the Vince Lombardi trophy or any awards by the end of the drill.

We were a major hospital system and clear market owner in one of the largest cities in the country. During the drill, it became clear that if there was ever a true natural disaster or mass casualty event, we were woefully underprepared. I consider myself incredibly lucky that these were only hypothetical patients, and we learned our inefficiencies not at the expense of real ones. But how do we even begin to resolve this major defeat?

We started digging. We dug so deep into data that not only did we learn we were logistically underprepared, we also found we were leaking patients out of our system at an alarming rate – to the tune of $40,000,000 per year. I purposefully wrote that out with the zeros instead of simply typing ‘million’ because of how much money that is. Forty million dollars per year we were letting walk out of our front door. That is an uncomfortable feeling and still makes me sick when I think of the number. To sit in your Chief Operating Officer's office and shamefully explain all of this to her was not the highlight of my career. To explain to her that your piece of this conglomerate business is likely costing the organization more money than any other single division, and probably by a lot, didn't make me proud. Not only were we at financial risk, but more importantly, our current and potential patients were at risk because we did not have the correct process, culture, and technology in place to be able to perform as needed or expected.

With that, we set out to improve our system’s operations. We partnered with vendors; we refined processes and operations; we left no stone unturned. While we still had a long way to go, after one year of operations under this new scope and authority, we grew our outreach by 14% and accepted more than 2,500 additional patients through our virtual front door, adding $14,000,000 dollars to the organization’s bottom line. Again, I purposefully wrote that out with the zeros instead of simply typing ‘million’ because of how much money that is. We improved the financial picture, and most importantly we improved the clinical medical support of our network of patients. In late January of 2020, I excitedly reported these numbers to our organization’s senior executive team, and I exclaimed that we improved operations and futureproofed our health system with this work. They ecstatically agreed.

Then COVID hit.

March of 2020, states like New York, New Jersey, and Washington were wildly overwhelmed with COVID infected patients. The Arizona Department of Health Services (ADHS) began to talk with those state departments of health and found that one of their biggest issues was that they didn’t know where their open beds were. They would have one hospital extremely overloaded with patients while another across the city or state had availability to care for more. The following is an excerpt from the notes of one of the ADHS leaders:

“I got back in the car and started thinking about the pandemic and the call line that could help organize the state. My stomach started to hurt. As I drove into work it hurt worse and worse until I felt like I needed to pull over to vomit. I avoided the vomit but sat in the department parking lot wondering how I could get out of the car. While I avoided actually getting sick, I was not feeling well at all and decided to go back home. I rolled around in bed, flopped about, played ‘Yesterday’ by The Beatles on the piano and then decided to call the major market owner hospital system – surely they know transfers. The nurse who answered the phone totally got it. I identified myself and what I was trying to do and she said ‘of course, I’ll send you on to my director.’ Within 10 minutes, Charley Larsen called me back and listened to my pitch and ideas of needing to load balance patients so that hospitals don’t get overwhelmed. Charley almost chuckled and said ‘I cannot believe we’re having this conversation – we have already organized a phone call with us and the other three major health systems in the state TODAY. You’re welcome to join if you’d like!’ Spontaneously, my abdominal pain was gone. I saw how it could work and we could get buy-in. I danced my way back to work and excitedly told everyone who would listen."

Over the course of the next month, we implemented, activated, and began to run the Arizona Surge Line, a statewide public-private partnership. This Surge Line was a centralized call center where any health system in the state could call to transfer a COVID infected patient to a higher level of care. Over the course of two years, through three distinct COVID surges, we transferred the care of over 13,000 patients between 230 different care locations. With this program, no single hospital became overwhelmed with patients if another hospital had availability. Of note, we did eventually get to a state of crisis due to the volumes, but we all entered crisis standards of care together. I like to use the analogy that the water rose evenly across the state. We replicated what we had already done at the futureproofed health system, and then we futureproofed the state. We built the Arizona Surge Line processes and protocols to not just be a COVID response tool but to be a SURGE response tool. The tough lessons learned during my Super Bowl led me and my team to successfully reform a transfer center and then apply that knowledge to help navigate the state of Arizona through an unexpected global pandemic.  

We futureproofed healthcare.