TY - JOUR
T1 - Adaptability on Shifting Ground
T2 - a Rapid Qualitative Assessment of Multi-institutional Inpatient Surge Planning and Workforce Deployment During the COVID-19 Pandemic
AU - Keniston, Angela
AU - Sakumoto, Matthew
AU - Astik, Gopi J.
AU - Auerbach, Andrew
AU - Eid, Shaker M.
AU - Kangelaris, Kirsten N.
AU - Kulkarni, Shradha A.
AU - Lee, Tiffany
AU - Leykum, Luci K.
AU - Linker, Anne S.
AU - Worster, Devin T.
AU - Burden, Marisha
N1 - Funding Information:
Thanks to members of the HOMERuN COVID-19 Collaborative Group: Brigham and Women’s Hospital—Stephanie Mueller, MD MPH and Jeffrey Schnipper, MD MPH; Elsevier Publishing—Jennifer Goldstein, MD MSc; Emory University School of Medicine—Khaalisha Ajala, MD MBA; Obsinet Tadesse Merid, MD; and TaRessa Wills, MD; Johns Hopkins University School of Medicine—Shaker M. Eid, MD MBA; Ifedayo Kuye, MD MBA; and Amit Pahwa, MD; Mount Sinai Hospital—Krishna Chokshi, MD; Horatio Holzer, MD; Chris Kellner, MD; Anne S. Linker, MD; and Vinh Nguyen, MD; Northwestern University Feinberg School of Medicine—Gopi Astik, MD MSc; Oregon Health and Science University—James Anstey, MD; James Clements, MD; and Anya Solotskaya, MD; Penn State University College of Medicine—Omrana Pasha, MD; Stanford University—Samantha Wang, MD; The Ohio State University College of Medicine—Jennifer Allen, MD and Kristen Lewis, MD; Thomas Jefferson University Hospital and Mayo Clinic—Alan A. Kubey, MD FACP; University of California, San Francisco—Andrew Auerbach, MD MPH; Amy Berger, MD PhD; Sneha Daya, MD; Archna Eniasivam, MD; Armond Esmaili, MD; Margaret Fang, MD MPH; Shubhra Gupta, MD; James Harrison, PhD; Emily Insetta, MD; Kirsten Kangelaris, MD; Kristen Kipps, MD; Zhenya Krapivinsky, MD; Shradha Kulkarni, MD; Rashmi Manjunath, MD; Sirisha Narayana, MD; Nishita Nigam, MD; Anna Parks, MD; Sumant Ranji, MD; Lekshmi Santhosh, MD, MAEd; Yalda Shahram, MD; Noa Simchoni, MD PhD; Matthew Sakumoto, MD; and Charlie M. Wray, DO; University of Chicago—Elizabeth Murphy, MD SFHM; Greg Ruhnke, MD; and Andrew Schram, MD MBA; University of Colorado School of Medicine—Marisha Burden, MD; Amira del Pino-Jones, MD; Angela Keniston, MSPH; Chris King, MD; and Katie E. Raffel, MD; University of Florida College of Medicine—Nila Radhakrishnan, MD and Nick Kattan, MD; University of Iowa Carver College of Medicine—Ethan Kuperman, MD MSc; University of Kentucky—John Romond, MD; Joe Sweigart, MD FHM FACP; and Sarah Vick, MD; University of Miami Health System—Chadwick Flowers, MD; Efren Manjarrez, MD; and Magdalena Murman, MD MAEd; University of New Mexico School of Medicine—Charles Pizanis and Kendall Rogers, MD CPE FACP SFHM; University of Pennsylvania—Ryan Greysen, MD MPH; Matthew Mitchell, PhD; and Todd Hecht, MD; University of Pittsburgh—Gena M. Walker, MD FHM; University of Texas, Austin Dell Medical School—W. Michael Brode, MD; Luci K. Leykum, MD MBA MSc; Kirsten Nieto, MD; and Sherine Salib, MD FACP; University of Virginia School of Medicine—Rachel Weiss, MD; University of Washington—Dan Cabrera, MD MPH and Naomi Shike, MD MSc; University of Wisconsin School of Medicine and Public Health—Blair P. Golden, MD MS; Sean O’Neill, MD; and David Sterken, MD; Virginia Commonwealth University School of Medicine—Sarah Hartigan, MD; Weill Cornell Medicine—Devin T. Worster, MD MPH; Yale School of Medicine—Rebecca Slotkin, MD; HOMERuN PFAC—Martie Carnie Catherine Hanson and Georgiann Ziegler. The views expressed do not represent the position of the Department of Veterans Affairs or other organizations affiliated with the authors.
Publisher Copyright:
© 2022, The Author(s) under exclusive licence to Society of General Internal Medicine.
PY - 2022/11
Y1 - 2022/11
N2 - Background: During the initial wave of COVID-19 hospitalizations, care delivery and workforce adaptations were rapidly implemented. In response to subsequent surges of patients, institutions have deployed, modified, and/or discontinued their workforce plans. Objective: Using rapid qualitative methods, we sought to explore hospitalists’ experiences with workforce deployment, types of clinicians deployed, and challenges encountered with subsequent iterations of surge planning during the COVID-19 pandemic across a collaborative of hospital medicine groups. Approach: Using rapid qualitative methods, focus groups were conducted in partnership with the Hospital Medicine Reengineering Network (HOMERuN). We interviewed physicians, advanced practice providers (APP), and physician researchers about (1) ongoing adaptations to the workforce as a result of the COVID-19 pandemic, (2) current struggles with workforce planning, and (3) evolution of workforce planning. Key Results: We conducted five focus groups with 33 individuals from 24 institutions, representing 52% of HOMERuN sites. A variety of adaptations was described by participants, some common across institutions and others specific to the institution’s location and context. Adaptations implemented shifted from the first waves of COVID patients to subsequent waves. Three global themes also emerged: (1) adaptability and comfort with dynamic change, (2) the importance of the unique hospitalist skillset for effective surge planning and redeployment, and (3) the lack of universal solutions. Conclusions: Hospital workforce adaptations to the COVID pandemic continued to evolve. While few approaches were universally effective in managing surges of patients, and successful adaptations were highly context dependent, the ability to navigate a complex system, adaptability, and comfort in a chaotic, dynamic environment were themes considered most critical to successful surge management. However, resource constraints and sustained high workload levels raised issues of burnout.
AB - Background: During the initial wave of COVID-19 hospitalizations, care delivery and workforce adaptations were rapidly implemented. In response to subsequent surges of patients, institutions have deployed, modified, and/or discontinued their workforce plans. Objective: Using rapid qualitative methods, we sought to explore hospitalists’ experiences with workforce deployment, types of clinicians deployed, and challenges encountered with subsequent iterations of surge planning during the COVID-19 pandemic across a collaborative of hospital medicine groups. Approach: Using rapid qualitative methods, focus groups were conducted in partnership with the Hospital Medicine Reengineering Network (HOMERuN). We interviewed physicians, advanced practice providers (APP), and physician researchers about (1) ongoing adaptations to the workforce as a result of the COVID-19 pandemic, (2) current struggles with workforce planning, and (3) evolution of workforce planning. Key Results: We conducted five focus groups with 33 individuals from 24 institutions, representing 52% of HOMERuN sites. A variety of adaptations was described by participants, some common across institutions and others specific to the institution’s location and context. Adaptations implemented shifted from the first waves of COVID patients to subsequent waves. Three global themes also emerged: (1) adaptability and comfort with dynamic change, (2) the importance of the unique hospitalist skillset for effective surge planning and redeployment, and (3) the lack of universal solutions. Conclusions: Hospital workforce adaptations to the COVID pandemic continued to evolve. While few approaches were universally effective in managing surges of patients, and successful adaptations were highly context dependent, the ability to navigate a complex system, adaptability, and comfort in a chaotic, dynamic environment were themes considered most critical to successful surge management. However, resource constraints and sustained high workload levels raised issues of burnout.
KW - COVID-19
KW - focus groups
KW - hospital medicine
KW - qualitative
KW - surge planning
KW - workforce planning
UR - http://www.scopus.com/inward/record.url?scp=85126849414&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85126849414&partnerID=8YFLogxK
U2 - 10.1007/s11606-022-07480-x
DO - 10.1007/s11606-022-07480-x
M3 - Article
C2 - 35319085
AN - SCOPUS:85126849414
SN - 0884-8734
VL - 37
SP - 3956
EP - 3964
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
IS - 15
ER -