Navigating the COVID-19 pandemic

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Leaders at Stanford Medicine, located in one of the first U.S. communities to be affected by Covid-19, quickly realized that they were not prepared to meet the escalating needs of their clinical and operational workforce. The pandemic would require existing care-delivery structures across the academic medical system to be expanded and aligned to prioritize workforce protection. Leaders identified an approach driven by connection, collaboration, and caring. They created specialized teams to develop a systemwide Occupational Health service with practices and procedures to assess health care workers and begin robust Covid-19 polymerase chain reaction testing; to centralize operations to maximize utilization of essential clinical and nonclinical staffing resources; to make visible and address psychological safety concerns and basic needs for faculty and staff; to aggressively address personal protective equipment supply chain issues and effectively assess infection risk; and to plan for a safe return of elective procedures and visits.

For a health care organization to deliver high-quality care to patients, whether in normal times or in a crisis, the safety and well-being of health care workers (HCWs) is crucial. Although this may seem obvious, the care of HCWs is at times taken for granted by health care leaders rather than recognized as a priority requiring intentional actions and strategies. As the Covid-19 pandemic began to take hold in March 2020, the Centers for Disease Control and Prevention (CDC) identified Santa Clara County, California, as a community requiring elevated containment strategies.¹ Two at-risk populations were identified: elderly/immunocompromised persons and the health care workforce. At Stanford Medicine, we recognized that we were not prepared to meet the needs of our clinical and operational workforce within our current structures. An expanded and aligned approach to workforce protection across our system would be required. To coordinate system response efforts, we activated a hospital emergency incident control system (HEICS) and created a governance structure, chaired by physician executives, to oversee the clinical response and to coordinate operational priorities.

The Stanford Medicine system includes Stanford Health Care (SHC), the academic flagship hospital serving adult patients; Stanford Children’s Health/Lucile Packard Children’s Hospital (SCH/LPCH), an academic hospital serving pregnant women and pediatric populations; SHC ValleyCare (VC), a community hospital in the Tri-Valley located 40 miles from Palo Alto; and the Stanford University School of Medicine faculty and providers assigned to each of the hospitals and ambulatory sites. Stanford Medicine reported consolidated fiscal year 2019 net health care services revenue of $7 billion.² Upon HEICS activation, executive, operational, and clinical leaders from these three hospitals, each with quite different patient populations, volumes, acuity, and level of risk in the setting of Covid-19, came together to create shared strategies and one overarching response plan. Our common commitment to support our HCWs while ensuring the highest level of safety for them and our patients became our unifying call to action.

Following the emergence of the Covid-19 outbreak in Wuhan, China, in December 2019, caused by the novel human coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), infection rates reached pandemic proportions. By the end of March 2020, just as the surge was beginning in the United States, more than 77,000 cases a day were reported worldwide, with nearly 5,000 daily deaths.³ SARS-CoV-2 was causing a wide range of clinical outcomes, from a complete lack of symptoms to severe respiratory dysfunction requiring ICU-level care.⁴

As the pandemic accelerated, one of the most pressing issues facing HCWs was the risk of transmission in frontline clinical settings. Infection and subsequent removal of significant numbers of HCWs from the workforce because of quarantine and/or treatment when required amplified the strain on health care systems across the globe. In response, Stanford Medicine activated an incident command structure that included the Clinical Operations Resource Team (CORT), comprising senior-level leadership across the health system