Governance in Healthcare: Best Practices after COVID-19

Just as healthcare organizations struggled with how to adapt to mergers and meet the evolving needs of their communities, COVID-19 struck with a vengeance forcing changes in governance in healthcare. Seemingly overnight, the healthcare industry was on the hot seat to save lives and create vaccines.    

As the coronavirus numbers continue to swell and recede repeatedly, healthcare boards and executives are having robust discussions by necessity about the impact of healthcare governance caused by COVID-19.  

As healthcare boards face an unknown future regarding the state of community health, the pandemic presents new opportunities to learn from this unparalleled experience. The current climate in healthcare governance begs further questions. How can healthcare boards use the knowledge gained through the pandemic to move forward better? What temporary changes in the healthcare industry due to the pandemic will remain and which will go by the wayside?    

COVID-19 Creates New Governance Challenges 

The idea behind establishing a healthcare board is to bring multiple perspectives together to make the best decisions possible. Good decision-making requires robust, thorough discussions and expediency —two things that many healthcare boards lacked as the pandemic went into full swing.  

The current times are especially challenging for community-based boards that lack experience in operating during a global crisis. Many boards had not yet set up rules and protocols for virtual meetings when news of the pandemic began to spread worldwide, leaving boards unequipped to meet virtually. Still, other boards lacked the benefit of videoconferencing software and equipment.  

Executives had to make timely decisions about purchasing PPE equipment, monitoring patients remotely, and allowing for virtual health assessments. Yet, they often lacked the authority to make responsible decisions without timely board approval.   

The current healthcare climate requires healthcare boards to review the changes they scrambled to make during this crisis, consider what changes they need to make now, and evaluate what changes will help better prepare them for a future crisis.    

7 Healthcare Governance Strategies to Take into the Future 

Healthcare boards need to consider what should change, if anything, once there’s no longer a need to social distance and take other sanitary precautions.   

We’ve put together 7 healthcare governance strategies to put on your board’s agenda:  

1. Focus on organization. Boards need to be organized and ensure they have the right tools and systems to allow them to communicate at a moment’s notice and keep them informed of updates. One solution is to form an emergency committee that is responsible for streamlining processes until the entire board has time to establish appropriate rules and protocols to prevent hasty, adverse decisions.   
2. Reevaluate the CEO’s spending authority. One of the issues that came to the helm during COVID-19 was the need for healthcare CEOs to make fast financial decisions to ensure their organizations could get the necessary PPE equipment and testing supplies without having to get board approval for the funds. The bidding wars over PPE equipment demonstrated that timeliness is of the essence in an emergency.   
3. Establish research and non-clinical partnerships now. As an example, Ohio State University struggled with the long wait times in getting COVID-19 test results. After partnering with Battelle Research Institute, they reduced COVID-19 test results from 14 days to 6 hours.   
4. Create a team to establish an emergency triage protocol. An excellent example of this is Atrium Health in North Carolina. They devised a tool that categorized patients into five designated risk strata to outline treatment strategies and protocols. This procedure allowed health professionals to quickly decide which patients could return home safely and which truly needed hospitalization. The tool helped reduce problems associated with hospital capacity.   
5. Set up a coordination center for healthcare. In the Netherlands, Dutch hospitals relied on the profiles developed by Integrating the Healthcare Enterprise to set up a nationwide coordination center to coordinate patient transfers and spread the burdensome patient load between hospitals.   
6. Set up a national system for sharing medical and healthcare data. The Dutch also established an integrated document sharing and mobile interface to ensure the safe sharing of patient data. They were able to get 95% of the hospitals connected to these systems with little delay.  
7. Minimize and streamline administrative procedures. Mary Greene, MD, director of the Office of Burden Reduction and Health Informatics at the Centers for Medicare and Medicaid Services, had this to say, “Sometimes increasing capacity means reducing administrative requirements, where possible, to focus on resources and patient care so people are not working on the administrative reporting requirements, but actually taking care of patients…” Dr. Greene advocates for flexibility and coverage related to prior authorization to expedite patients’ needs.  

To sum things up, Bill Horton, co-chair of the Healthcare Industry Team at Jones Walker law firm, said, “We’ve got to look at what kind of systems we need to have to respond as a board, and make sure we have taken appropriate action to empower the CEO, COO, and other leaders.”   

Taking Healthcare Governance into the Future 

While the future is still uncertain, what is certain is that healthcare boards have much work ahead of them as they consider which changes to make and which of them should become permanent.    

Historically, healthcare boards have followed the lead of the federal government in making significant changes. However, the federal government didn’t react with enough speed to the challenges arising from the pandemic. Forcing healthcare boards to quickly learn that they would have to rely on themselves and whatever resources they had available to tackle the pandemic.  

Given what we’ve learned about healthcare governance emergencies, the following questions should ignite some lively discussions at your upcoming board meetings:  

• How can you build flexibility into healthcare systems?  
• Which changes we’ve made should become permanent?   
• Which circumstances call for giving the CEO more authority overspending?   
• What role will telehealth play in the future, and what impact will it have on the budget?  
• How can your healthcare system respond better and faster during times of crisis?  
• What have you learned about your normal operations through this crisis?  
• Which types of health services are appropriate for telehealth services?  

Out of necessity, healthcare boards approved a host of temporary measures to help manage health crises and save lives. As difficult as the last couple of years have been, it’s provided multiple opportunities for boards to reground themselves in governance in healthcare that meets the needs of today’s populations. Overall, the greatest risk a healthcare board can make is repeating the same mistakes they made during the pandemic.