Overcoming bureaucratic hurdles to health care surge capacity

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The coronavirus pandemic (COVID-19) has put health care surge capacity to the test in almost every country.  Although many have already instituted measures to build surge capacity, it is worth revisiting them, since second and third waves of COVID-19 cases are expected, or are already manifesting themselves. What was improvised over the past weeks can be planned and organized for the coming months, to create more government and health sector resilience for the future. 

The legal side and organizational side of surge capacity

In the context of disaster surge capacity, people have been put to work in health care who would not legally be allowed to do so in normal times, including volunteers or retirees. This can lead to difficult liability issues when mistakes are made. But there are two ways that this can be prevented.

First, in a number of countries, volunteers are currently active in the health care sector (such as the United Kingdom and Cameroon). Both volunteers and hospitals could face liability claims for mistakes made while performing their duties. This can be a serious barrier for hospitals to recruit volunteers, and for volunteers to offer their services. Volunteer protection laws and Good Samaritan laws can grant immunity to such claims, as long as volunteers stay within their assigned duties, and there is no case of gross negligence or reckless misconduct. Another legal option would be to include a clause with more relaxed liability rules in existing law, which would automatically come into effect once the government declares a state of emergency.

Second, having a database of skilled health professionals can be a way to streamline verification of their credentials and give them permission to engage in certain clinical activities. In countries where all public sector health workers are mapped directly under the Ministry of Health, such an exercise should be feasible. This database would hold all individuals who are medically trained and indicate their diplomas and specific skills. This will make it much easier for hospitals to check if someone is able to carry out the necessary duties. The UK, for example, has introduced a digital passport for medical staff so that it could move those cleared to the front of the line and better meet surge capacity. At the very least, this might provide others with more time to complete paperwork, or to get necessary just-in-time training. 

Third, surge capacity in terms of supplies and locations needs to be a focus. Health system capacity can be further strained by increased absenteeism of staff, or a shortage of crucial resources such as person protective equipment.  In many cases, new health facilities may have to be built, new masks produced, and new staff recruited. National stockpiles of medical equipment are an obvious resource. Using the military’s medical capabilities to relieve civilian hospitals of their trauma injury patients is another option. Dedicating certain hospitals to pandemic-related cases, thereby concentrating knowledge, expertise and resources, and help manages contagion risks is a further possibility. Singapore used such an approach during the SARS epidemic. South Korea used primary health care facilities for moderately ill patients and kept hospitals for the critically.

Planning for a resilient health care sector

In cases where relocation of existing staff is not enough, new capacity needs to be created. Countries could tap into these types of individuals:

1.    Staff without traditional credentials such as pharmacists or psychiatrists, depending on their previous medical training.
2.    Private sector medical personnel, such as dermatologists, plastic surgeons, and their nursing staff.
3.    School nurses.
4.    Students in their final year of medical or nursing school, whom Spain and Luxembourg have tapped into.
5.    Retirees, as in Ghana and Barbados.
6.    Individuals with thorough medical training (policemen and firefighters, for example).
7.    People without medical training for support work, such as logistics, IT, customer service, etc.

Many countries have already deployed many of these individuals. The task of creating a database with contact and credentialing information of all medically trained individuals (outside of the public health care sector) should be commenced as soon as possible, given the likelihood of second or third waves of COVID-19. To help create a more resilient sector in the future, this exercise could lead to a Disaster Reserve Corps of continuously trained volunteers.

It’s also necessary to distinguish between surge capacity and surge capability. Surge capabilities do not just describe resources, but specialized resources. In Israel, for example, one hospital quadrupled its surge capability in burn victim treatment by training nurses. This created a large pool of specialized surge capabilities to be tapped into in times of disaster. The same is true for surge equipment and surge locations. 

The measures that are being taken during the current crisis are a good starting point to explore potential sources for surge capacity and to start planning more systematically.  Organizationally, the ideal outcome of this crisis is to emerge more resilient for what lies ahead.

Editor’s note: Read two related blogs about surge capacity in the public sector at large, and on the long-term development of nursing staff capacity.

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