What is the Purpose of Healthcare Administration During a Pandemic?

Katie Bieker
7 min readApr 23, 2020

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Personal Experiences in Management and Systems Thinking

I began a graduate course in healthcare administration in January of 2020 believing I had a solid grip on the subject based on prior knowledge and experience. By March, what I thought I knew was challenged as I became part of the team rapidly overhauling our hospital system in response to the Covid 19 pandemic. Knowledge Trail 5 in our course asks the question, “What is the Purpose of Healthcare Administration?” The practice of delivering medical care involves complex systems that require governing by leadership that understands the interconnectedness of the individual components, functions of teams, opportunities for innovation, and the constant reality of non-linear outcomes and dynamic circumstances. As the impact of the Covid-19 pandemic expands into the United States and the Midwest, healthcare administrators are rapidly calling upon their familiarity with the factors at play in a healthcare system to re-prioritize, set new goals, and redistribute the work of running a medical facility. To illustrate one aspect of that role, how healthcare administration plays a part in disaster response, I will take you through what I have been experiencing as a leader in a healthcare system as the coronavirus situation unfolds.

In mid-February, coronavirus had entered the United States in a few spots along the coast. Covid-19 began appearing on the meeting agendas of the many departments, units and teams within LMH Health — a healthcare system in Lawrence, Kansas that includes a hospital and several outpatient facilities and services. I am one of four Practice Managers in the Physician Division, the outpatient component of LMH Health. I oversee cardiovascular and pulmonary services. Although it is difficult to immediately see the link between pandemic impact and outpatient clinics, digging deeper and finding those connections is where systems thinking is critical, because the impact on those entities will be significant. In my second Module 2 blog, “The Function of Teams in Healthcare During a Pandemic”, I will go into detail about how the goals, purposes and organization of teams throughout LMH Health changed and adapted as a response to coronavirus.

One team I am a part of is that of the Practice Managers and Clinical Managers. There are about ten of us and we collaborate constantly and meet a couple times a week. I was the first to mention the need for Covid-19 preparations during a meeting in late February. As one of the purposes of a healthcare administrator is to anticipate the impact of external, environmental factors on the delivery of medical services, I brainstormed the potential consequences of the pandemic should it spread to Kansas and reported my ideas. I considered how it would impact our community, the hospital, and the trickle-down effect it would have on our clinics.

We were scheduled to go live with a major revenue cycle upgrade to our computer systems in late April. I mentioned that we should advocate for the postponement of that change. I anticipated staffing challenges because 1) schools might close forcing parents to stay home, 2) employees might become scared and want to avoid the workplace and 3) employees could start getting sick. I worried that we would begin seeing fewer patients, for similar reasons, and revenue would be greatly impacted. I knew we would need to explore ways to speed up implementation of telemedicine services, a process our IT department had been working on for at least a year but considered low-priority.

These thoughts were mentioned quickly as the last item on the agenda and no action was taken. Unfortunately, all of those challenges and more would be forced on us rapidly in coming weeks when we were truly under the gun. As with any complex system, outcomes are non-linear and dynamic. My thoughts listed above were not all entirely correct and were certainly incomplete. We are asked to define and discuss quantitative and qualitative indicators in healthcare. It was the monitoring of quantitative measures that finally led to action and qualitative assessments are being considered as we continue to adapt our plans. Quantitative indicators are those that can be evaluated numerically. They are less subjective than qualitative values and are collected as discrete data.

One of the purposes of a healthcare administrator is to monitor such data to keep tabs on the success of the organization or facility (in my case, my two practices) from the standpoint of quality of care, patient satisfaction, revenue and overall sustainability. An End of Month Report is expected from each of us, but we keep track of that information throughout the month. As we moved forward into the second week of March, a handful of cases began popping up in our region. We immediately saw an increase in patients not showing up to their appointments. It became difficult to get appointment slots filled as patients declined annual, routine exams, preferring to hold off until the crisis passed.

I am charged with reviewing our clinic RVU’s (relative value units). Every billable service performed in a medical setting has an RVU value assigned to it and adding those up is a relatively reliable way to gauge the productivity of a provider and their staff. RVU’s were already trending downward, meaning we were bringing in less revenue. Those numbers fluctuate routinely based on any numbers of factors including things as simple as snow storms keeping patients home to providers taking a vacation. Therefore, we watch trends or drops so far below expectation that we cannot rationalize staff and supplies. That first week generated concerning numbers, so I, along with the other managers and our directors, started paying closer attention.

By the third week, the situation was deteriorating rapidly. Schools had closed meaning we immediately lost two staff members. As a leader, I had to immediately adapt our staff schedules and begin considering what tasks are essential to run the clinic and which would have to be put aside. I also found myself playing the role of employee advocate, appealing to HR for ethical ways to assist these employees so that they could keep their lives afloat until they could return to work. As the number of cases in the neighboring county shot up, we were issued a stay home order. In cardiology and pulmonology, we were performing no more than half our typical number of visits.

Healthcare administrators are typically salaried employees. That comes with perks, but during times like these, it can be quite a burden. I had to start cutting staff which meant I and the clinical manager had to start covering the work normally completed by our employees and working before and after business hours and on weekends to keep up with management tasks. On that Wednesday evening, my director told me that, because I’d had healthcare IT experience, it was going to be my job to oversee the implementation of telemedicine throughout all 32 of the physician division clinics and it needed to be ready by Monday of the following week. I took people out of their usual roles and delegated them to telemedicine tasks, connected with the IT department, and worked 16 hours days. We got it done!

Again, I will discuss the system networks and team functions that evolved as I moved forward in orchestrating telemedicine implementation in my blog about teams in healthcare. For this account, I will just point out that the purpose of a healthcare administrator is to look beyond the more face-up functions of providing direct patient care and understand all the behind-the-scenes details that make treatment possible — the very definition of systems thinking. They also must understand that people are the most essential resource in an organization and must be prepared to utilize them to the best of their individual abilities and treat them with fairness and compassion during difficult times. For the first time in my career, I am having to tell people that their hours are being cut. Some are being told they’re going to have to work below their license to do what needs to be done, not necessarily what they want to be doing.

During a time of crisis, healthcare administrators have a unique purpose. They have to monitor healthcare indicators to a higher degree, adjust functions accordingly and creatively to solve problems, keep quality of care the number one priority, and be a steadfast, firm, but compassionate leader to scared patients and employees. This story is evolving and we have not even reached the anticipated peak of the crisis. My anxiety is increasing, ironically because the intensity of my workload is temporarily decreasing. We have had a week with telehealth in place and have reached a decent level of comfort with that process. We’re still seeing far fewer patients, experiencing less phone traffic, and to offset lost revenue, I have been asked to take a 25% reduction in hours starting next week along with all other staff and even senior leadership. No one is allowed in the hospital unless they have an appointment, no visitors are permitted, many employees have been furloughed or are working from home, cafeteria service is limited, and the coffee and gift shops are closed. Throughout the hospital and in our clinic, things have slowed to a creepy stillness. We’re all just waiting now. I am hoping to not have material, after the next few weeks, to write a new blog about my experiences in healthcare administration after transitioning from preparation to front-line response.

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