Health systems revamp vetting process during COVID-19

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Prior to the pandemic, Mayo would have to get the green light from up to 12 separate committees and departments to implement an idea.
While the Rochester, Minn.-based system set out to change that dynamic before disaster struck in March, the pandemic kick-started that effort.
COVID-19 revealed how clarity of focus expedited decisions, said Didehban, who serves alongside Dr. Amy Williams, executive dean of practice, in Mayo’s dyad leadership model. Keeping staff, patients and the community safe was of utmost importance, she said.
Mayo consolidated its separate committees into a single multidisciplinary team that operated on an hourly rather than monthly basis. It also delegated decision-making authority to lower levels of the corporate hierarchy and did away with the approval-to-initiate step, Didehban said, describing it as “approval to think about an idea.”
“We noticed this transformation in April and how powerful it was,” she said.
There are two types of governance, one that involves systemic changes in the bylaws and require the board’s guidance, and smaller, day-to-day operational changes, explained Victor Giovanetti, executive vice president of hospital operations at LifePoint Health.
For the former, the Brentwood, Tenn.-based system learned that they could still act quickly and maintain compliance, he said. “At times we got some relief from state and federal waivers, but overall the big governance decisions were easier to manage,” Giovanetti said. “We learned we could do the day-to-day governance and decision-making faster and with more decentralization, while still operating within the guardrails of our bylaws.”
Giovanetti headed up a COVID-19 task force comprising the various departments of the system. Under normal circumstances, it could take a month to secure more ventilators. In March and April, it only took a matter of hours, he said.
But, Giovanetti cautioned, there are certain matters they would not want to move quickly through after the national emergency subsides.
“Drug utilization and purchasing are things that need to have the level of filtration to meet our national quality program,” he said. “While we moved quicker around remdesivir and other therapies with the support of the government, under normal operations they would go through more of a filtering process.”
Still, not all healthcare organizations have streamlined their deliberation process, said Paul Keckley, an industry consultant.
“The existing committee structures have actually continued. If anything, outside of compensation, they’ve defaulted more to management on key issues around COVID,” he said, adding that is the case for larger health systems but things could be different at stand-alone hospitals.

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