This playbook provides guidelines for health care organizations in Greater Des Moines (DSM), such as hospitals, clinics, dentists, eye doctors and more.
Sample: Nurse Practitioner Risk Profile
The sample risk profile is relative risk to the professional carrying out their role as a nurse practitioner in DSM. The profile shows frequency, or how many people in a day; duration, or length of typical interaction; and variety, or the number of different people.*
The coronavirus outbreak has had direct and lasting impacts on health care organizations in the form of financial, operational and supply chain challenges. Hospitals and clinics saw sharp drops in regular doctor visits, emergency room arrivals and elective, non-essential surgeries that are vital to most organizations' bottom lines. It's not just the large, urban hospital systems that struggled. Doctors with their own independent practices in small to mid-size towns are suffering these same severe revenue cuts. Safety-net clinics, who serve the nation's poorest residents, were also hard hit. The pandemic put the health care sector front and center as development of therapies and vaccines to combat the virus got underway. As vaccines are more broadly distributed hospitals will safely be able to return to a more normal level of operations.
The rise of telehealth has brought about increased access to health care across the country, especially in rural areas. Telehealth will continue to be expected by some consumers, even in a post-pandemic environment. However, addressing cybersecurity concerns will be paramount in the future. Hospitals, health care systems, providers and payors will all have to accelerate digital transformation plans. These plans will likely be contingent on a resolution to the payment issue of telemedicine and telehealth.
Remote Patient Monitoring
Remote Patient Monitoring has been slowly gathering momentum for the past few years, with pilots and programs aimed at giving providers access to tools that monitor their patients at home, in between doctors’ visits or after they’ve been discharged from the hospital. COVID-19 has accelerated the trend. By taking a holistic approach to acute care, from monitoring patients before an admission through post-discharge, physicians can activate timely interventions, reduce readmissions and better allocate resources according to a patient’s risk.
Mental Health Effects
Demand for mental health services will increase substantially due to the pandemic, including the health care workforce and the general population. Hospitals and other organizations must prioritize the mental health of their employees, ensuring they have the proper resources and support to continue their work effectively and safely.
Leverage Culture to Build Resilience
An organization’s ability to thrive during COVID-19 is directly related to organizational culture. COVID-19 has threatened to introduce negative elements into the organizational culture across healthcare organizations due to strains on employee physical and psychological safety and its medium- to long-term financial impacts. Leaders must leverage culture to overcome COVID-19 impacts by understanding the unique needs of groups across the organization and adapting leadership styles where required.
Health & Sanitation
- Implement a pre-appointment phone screening process for patients.
- Establish a process to ensure everyone (patients, healthcare personnel and visitors) entering the facility is assessed for symptoms of COVID-19 or exposure to others with a suspected or confirmed COVID-19 infection and that they are practicing source control (using a well-fitting cloth mask, facemask or respirators).
- Properly manage anyone with suspected or confirmed COVID-19 infection or who has had contact with someone with suspected or confirmed COVID-19 infection.
- Employees who feel sick should stay home. Healthcare personnel who have had close contact with someone with COVID-19 should consult CDC guidance on when to self-quarantine.
- Patients and visitors should wear their own well-fitting form of source control upon arrival to and throughout their stay in the facility. If they do not bring their own, they should be offered an option that is equivalent to what is recommended for people in the community.
- In general, fully vaccinated healthcare personnel (HCP) should continue to wear source control while at work. However, fully vaccinated HCP could dine and socialize together in break rooms and conduct in-person meetings without source control or physical distancing. If unvaccinated HCP are present, everyone should wear source control and unvaccinated HCP should physically distance from others.
- To reduce the number of times HCP must touch their face and potential risk for self-contamination, when used for source control, HCP should consider continuing to wear the same respirator or well-fitting facemask (extended use) throughout their entire work shift.
- HCP should remove their respirator or facemask, perform hand hygiene and put on their community source control when leaving the facility at the end of their shift.
- Take steps to ensure that everyone adheres to source control measures and hand hygiene practices while in a healthcare facility.
- Provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand sanitizer (ABHS) with 60-95% alcohol, tissues and no-touch receptacles for disposal, at healthcare facility entrances, waiting rooms and patient check-ins.
- Ensure an adequate inventory of PPE and access to a reliable supply chain without relying on state or local government PPE stockpiles to support continued operations and respond to an unexpected surge in a timely manner.
- Have a plan to conserve PPE consistent with guidance from the CDC and Iowa Department of Public Health.
- Ensure there is an established plan for thorough cleaning and disinfection of spaces used for care and other high-touch surfaces.
Process & Space Modification
- Limit and monitor points of entry to the facility.
- Set up waiting rooms to allow patients to be at least six feet apart. If your facility does not have a waiting area, then use partitions or signs to create designated areas or waiting lines.
- Limit visitors to the facility to only those essential for the patient’s physical or emotional well-being and care.
- Post-acute care facilities and acute care facilities should follow CDC guidance regarding visitation policies.
- Reduce crowding in waiting rooms by asking patients to remain outside (e.g., stay in their vehicles or in a designated outdoor waiting area), if feasible, until they are called into the facility for their appointment. Another option is to set up triage booths to screen patients safely.
- Do not penalize patients for cancelling or missing appointments because they are ill.
- Explore options, in consultation with facility engineers, to improve indoor air quality in all shared spaces.
- Optimize air-handling systems (ensuring appropriate directionality, filtration, exchange rate, proper installation and up-to-date maintenance).
- Consider the addition of portable solutions (e.g., portable HEPA filtration units) to augment air quality in areas when permanent air-handling systems are not a feasible option.
- Prepare to cease non-essential procedures in case of another surge in COVID-19 cases.
- Utilize telehealth services when available and appropriate. The CDC considers that telehealth could be used to deliver the following services:
- Screen patients who may have symptoms of COVID-19 and refer as appropriate.
- Provide urgent care for non-COVID-19 conditions, identify higher acuity care needs and refer patients as appropriate.
- Access primary care providers and specialists, including mental and behavioral health care providers, for chronic health conditions and medication management.
- Participate in physical therapy, occupational therapy and other modalities as a hybrid approach to in-person care for optimal health
o Monitor clinical signs of certain medical conditions remotely (like blood pressure and blood glucose levels).
- Engage in case management for patients who have difficulty accessing care, including those who live in rural settings, older adults or those with limited mobility.
- Follow up with patients after they are discharged from the hospital.
- Deliver advance care planning and counseling to patients and caregivers to document preferences if a life-threatening event or medical crisis occurs.
- Provide non-emergent care to residents in long-term care facilities.
- Provide education and training for HCP through peer-to-peer professional medical consultations (inpatient or outpatient) that is not locally available, particularly in rural areas.
- Place visual alerts, such as signs and posters in appropriate languages, at entrances and in strategic places for hand hygiene, respiratory hygiene (including the use of cloth face coverings) and cough etiquette. Signs should be accessible for people with disabilities, easy to understand and available in multiple languages.
- Provide relevant instructions on a website for procedures inside the health care facility.
- Provide patients with communication devices to reach family members not allowed in due to visitor policy.
DSM has come together to provide support for the health care community. Organizations and groups such as St. Francis of Assisi, ChildServe and KinderCare began to offer child care services to families of essential workers; and hotels such as Country Inn of Ankeny and TownePlace Suites by Marriott also offered discounts to medical professionals.
Mental Health Support
The effects of states of emergency and operating in crisis mode induce stress, burnout and emotional burden — the effects of which are felt by medical professionals. MercyOne is offering free support groups for nurses, providers and other staff. Telehealth company ThriveTalk is also offering free mental health services for essential workers during COVID-19.
Additionally, UnityPoint Health has recently opened a behavioral health urgent care center in collaboration with Eyerly Ball and Orchard Place open daily 10 a.m. – 8 p.m. located at 1250 East 9th Street in Des Moines.
In early May, Delta Dental of Iowa Foundation announced $360,000 in grants to community health centers. To support Iowa dentists directly during the COVID-19 situation, Delta also introduced the Advance Claims Payment Program (ACPP). This program allowed dentists to receive up to 50% of their average weekly claims payment in an interest-free advance for four weeks with repayment beginning in July 2020.
MercyOne and Corteva Agriscience™ announced have joined forces to fill the urgent need for processing COVID-19 samples. MercyOne health care providers will collect the samples and deliver them to Corteva, where a small team of trained Corteva employees will assess them using the company’s sophisticated genetic screening capabilities.
Vulnerable & Minority Populations
Broadlawns Medical Center has developed outreach programming to ensure vulnerable and minority populations receive proper information and guidance. Broadlawns also recently partnered with the United Way of Central Iowa to expand this outreach programming for the current pandemic and are in ongoing communication with Central Iowa Shelter and Services and Food Bank of Iowa to provide reciprocity for the individuals they serve.
Equipment & Supplies to Those in Need
Running low in their supply of hand sanitizer and PPE equipment, Broadlawns Medical Center was seeking ways to replenish their inventory. Fareway Grocery Stores offered Broadlawns their hand sanitizer shipment while the Des Moines Quilters Guild provided thousands of handmade masks for non-clinical staff and patients to use. Broadlawns has also supported other community organizations, recently delivering an inventory of surgical masks and faces shields to Easterseals of Iowa so they could serve their patients.
The business function playbooks include takeaways that are specific to professional functions that could be present in any business, regardless of industry.
*We note that these assessments are qualitative and based on expert-led judgment (Johns Hopkins, 2020). Currently, there are not enough detailed data available to enable quantitative risk stratification. Businesses will need to make decisions about re-initiating business activities before there are validated data to know the precise levels of risk.
The Greater Des Moines Partnership's DSM Forward playbook is not intended to constitute legal advice or provide specific direction
. The preparation of a business continuity or preparations plan should be undertaken with the advice and direction of appropriate specialists and personnel, in consideration of the unique circumstances impacting each business. Third-party websites or material linked to or referenced in DSM Forward are for informational purposes only and do not constitute a recommendation of The Partnership of that material or its authors.
Last updated: 5/17/2021