Valley hospitals have grappled with a global pandemic that triggered a litany of health care challenges, both operational and financial, including deferred care, staff burnout and financial losses.
But those challenges have created hospitals that, although bruised, are better prepared, more communicative and more aware of conditions that will persist long term as a result of the Covid-19 pandemic.
For example, during the pandemic patients avoided hospital visits for routine or preventive care. As a result, Kaiser Permanente’s local hospitals, according to Dr. Nancy Gin, regional medical director of quality for Kaiser Permanente Southern California, have seen an uptick in preventive care recently. She noted that a review by the nonprofit health system revealed preventive care and Covid surges operate conversely.
“What was really interesting, and probably not terribly surprising, was that every time there was a surge, the number of people coming in plummeted and then as soon as the (Covid) surge was over, there was a steep increase in the number of people seeking and getting their preventive care taken care of,” she said.
D.W. Donovan, chief mission integration officer at Providence Holy Cross Medical Center in Mission Hills, said that to bring employees to work, the hospital has had to pay much higher rates, putting a dent in its reserves. “Those people have deserved every penny as they (have been) working their tails off, but there is a question of sustainability,” he added.
Donovan also is concerned that Holy Cross and other Providence hospitals in the U.S. have lagged behind on infrastructure due to the time, energy and resources needed to take on the challenges of the pandemic. “To have that kind of work go on where you would have to take away beds for a few days, we just didn’t have that leeway,” he explained.
He added that Providence, which is financially strapped, has all but exhausted financial government aid.
According to its website, Providence Holy Cross is a 377-bed nonprofit facility that offers inpatient and outpatient health services. It serves the Santa Clarita and North San Fernando valleys.
An analysis by consulting firm Kaufman Hall found that California hospitals’ financial problems continued well into 2021, experiencing losses of nearly $6 billion on a volume-adjusted basis.
The Kaufman analysis also found that more California hospitals are experiencing negative or unsustainable margins compared to pre-pandemic levels. It also concluded that workforce shortages continue to drive labor costs increases while global supply chain challenges drive up other expenses.
Challenges will persist throughout 2022, according to the Kaufman analysis, which added that hospital profit margins may remain depressed for several months or for the remainder of this year even if hospital performance rebounds.
ICU and supplies
Preparation and equipment stockpiling has also become a priority to Donovan, who said that Holy Cross welcomed a 2021 law that required California hospitals to create and maintain a three-month stockpile of personal protective equipment, or PPE.
Preparation for periods of strained supplies and increased hospitalizations is also a factor that has become a point of confidence for Kaiser Permanente’s local hospitals, according to Gin.
The health system has 4.8 million members in Southern California, more than 2 million of which are located in L.A. County. The organization has medical centers in Woodland Hills and Panorama City and medical offices in Mission Hills, Santa Clarita and Antelope Valley.
Gin said that in addition to ICUs being well-supplied with all of the equipment needed to handle surges, Kaiser Southern California has become quicker and more efficient at converting rooms for sudden needs, such as an influx of Covid patients.
At Holy Cross, the ICU had only two Covid patients as of May 3, according to Donovan. However, the traffic in Holy Cross’ ICU is up significantly, even when compared to some stretches of the Covid-19 pandemic.
“What we’re getting is all those patients who held off getting care and now they’re coming in and they really are very sick,” Donovan said. “So, our average length of stay is up, and the complexity of care is up because (illnesses) that perhaps could have been caught earlier and treated much earlier – cancer is an obvious example – could be one to two years behind on a treatment plan. And sometimes it’s two years too late.”
Organizational bruises received at the start of the pandemic are persisting despite the ground gained by local hospitals. A common thread identified by Donovan and Gin was the matter of fatigue and burnout experienced by their employees.
“It has been two pretty long years and they are a tired bunch,” Gin said, referring to staffers. “They can take well-deserved pockets of time away, but they’re needed.”
Gin added that in the thick of the pandemic, employees from non-clinical environments took on responsibilities that freed up time for clinical employees.
Kaiser has been improving its staffing levels, but is still not up to the level it was pre-pandemic according to Gin.
Burnout is also impacting the health care providers at Holy Cross and will likely continue to do so, according to Donovan.
“You take care of the patient in front of you and then you almost have to put that experience in a box and put it up on a shelf and leave it there so you can take care of the next patient,” Donovan said. “It’s kind of a cardinal rule that you cannot process and experience trauma while you’re still being traumatized by it. So, we are still months away, if not closer to a year, from being able to really unpack these experiences and help people process them.”
Donovan said that in some ways, Providence Holy Cross has grown stronger from the pressure of the pandemic, allowing the organization to focus on improved collaboration.
“We probably are more hardwired now, not just in terms of processes but in terms of our relationships, with other Providence hospitals,” he said. “The collaboration amongst the Providence hospitals, 11 in our region, 51 throughout the system, increased exponentially because we needed to rely on each other, and we were all trying to learn together.”
Donovan said the heightened collaboration between hospitals has extended to Providence’s leadership team, which connects with both its own teams and Providence patients. “They have been through a trial by fire. … I would say that’s another thing that we did well before, but having been through something like (the pandemic), we’ve just taken it to a much higher level.”
Gin acknowledged that in spite of all of the challenges that hospitals continue to face, the pandemic has highlighted a need for health equity, a trend that will likely continue to permeate for years to come.
“From the Covid testing, to vaccines, to the newest treatments, we have put so much effort into ensuring that all members of the community that we serve have access to these modalities in the same way – and if they don’t, trying to figure out ways to ensure that they do get access to them.”