Introduction

THE COVID-19 pandemic forced many health care providers to stop performing nonurgent procedures in response to state mandates, to ensure the safety of patients and staff, and to deploy resources towards COVID-19 treatment. Much lower volumes of these procedures have led to a considerable drop in income. As COVID-19 cases recede, how are hospitals and health systems going about resuming these procedures?

In May 2020, the Deloitte Center for Health Solutions surveyed clinical leaders to understand their concerns, approaches and steps towards resuming nonurgent procedures.

Key findings

The results suggest that resuming nonurgent procedures will be complex and clinical leaders are preparing for many uncertainties.

Top concerns include a potential second outbreak, low patient demand and supplies

While health systems have been at the frontline of caring for patients during the epidemic and have received some financial support from federal legislation, the loss of income has been a significant financial challenge for many. Surveyed clinical leaders estimate that the nonurgent procedure volume in April 2020 was just 16% of what it was during the same period last year.

When asked to list their top three concerns about resuming deferred procedures, clinical leaders cite the possibility of an outbreak or a second wave as their number one worry (82%), overshadowing all other concerns. Low patient demand due to safety concerns (54%) and adequate supply of materials, medications, equipment or testing (50%) are a distant second, followed by patients’ ability to pay due to loss of income or insurance (40%).

When it comes to supply chain, the top three concerns include testing capabilities (74%), personal protective equipment or PPE (68%) and the availability of medical and surgical supplies other than PPE (58%). These are all areas in which suppliers can support their customers.

Organisations probably have the least control over the possibility of another outbreak or wave. And a large outbreak can have cascading effects on other important variables: patient demand, availability of testing and supplies and staffing.

Lingering supply chain issues and the possibility of new outbreaks should compel organisations to rethink how they share, distribute, forecast and track supplies by site and service line. Providers may have a newfound desire for upstream visibility into the supply chain, whereas suppliers might want a detailed understanding of downstream utilisation. This would call for a much closer coordination among supply chain stakeholders: providers, group purchasing organisations (GPOs), distributors and medtech companies.

Adequate testing is the key capability organisations are looking for

In response to our question about what capabilities are still lacking, sufficient testing (for the virus and for antibodies) tops the list (figure 3).

While both clinical leaders at organisation/system level and leaders at the service line level agree about the lack of testing, their perspectives diverge on three other capabilities:

• Infection control for operating and procedure rooms: Only 7% of respondents at the service line level feel this capability still needs strengthening, but a much larger share at the organisation/system level (47%) feels this way.
• Understanding readiness and capacity of other community providers (e.g., referring physicians, diagnostic facilities, post-op rehab/follow-up): A much larger percentage of service line leaders (60%) than of organisation- or system-level leaders (18%) feel they need to strengthen their organisations’ capability in this area.
• Capabilities to monitor outbreaks: About 21% of organisation-level leaders versus 47% of service line leaders think this is lacking.

These differences may be due to different exposure to what is happening at various levels of the organisation or multiple locations, or due to the differences in tactical vs. strategic understanding of what is needed.

Organisations are trying to mitigate consumer concerns through virtual health practises and communication

To mitigate concerns associated with resuming deferred procedures, clinical leaders say their organisations are putting in place a number of measures (figure 4).

• Almost everybody (98%) in our survey says their organisations have implemented or plan to implement virtual health practises for some or all nonprocedure visits.

This represents a major shift in practice: the Deloitte 2020 Survey of US Physicians, conducted in January–February 2020 before the COVID-19 pandemic, showed that only 14% of surgical specialists had video visit capabilities and of those who had, a third (34%) were using them. This amounts to just 5% of all surgical specialists having experience with video visits before COVID-19.

• Nearly all respondents (96%) say their organisations have developed or plan to develop an external communication strategy.

However, measuring consumer sentiment is the least common activity being implemented (36%) according to our survey. Consumer perceptions are likely to affect demand for procedures, which 54% of our respondents noted (figure 1). Individuals who need nonurgent procedures tend to be older than the general population (57 vs. 38 years old, on average) and by some estimates more than three in five have at least one comorbidity,¹ putting them at a higher risk of severe illness from COVID-19. These consumers may be especially worried about getting their procedures done while the epidemic continues. Health systems should allay consumers’ concerns by tailoring their communications and showing they are able to minimise the spread of infection through adequate PPE for staff and patients and robust infection control.

We expect consumer attitudes and behaviours to be increasingly important for reopening. Organisations should establish market-sensing capabilities to monitor consumer sentiment by key psychographic segments and geographies. These efforts could focus on consumer confidence (including financial outlook, job security, capacity of the health care system), perceptions of safety and types of services consumers are cancelling or delaying. They could use multiple data inputs and analytical approaches for the purpose—from survey research to social media to internal information on appointment scheduling and testing.

Preplanning and extended hours are the top choices for dealing with potential demand surges

We explored measures being put in place to maximise patient throughput and utilisation of operating rooms should there be surges in procedure demand. Surgical preplanning and extending hours of operation are the most common approaches planned or implemented. A quarter of the respondents are not considering approaches to simplify and/or reduce provider preferences, though doing so could help streamline patient scheduling.

Changes to operating hours and scheduling could have implications for external stakeholders such as suppliers, community providers, or medical transport companies, who might need to adjust their practises to help health systems to maximise their capacity.

Even without demand surges, large expenses for treating COVID-19 patients, new and more time-consuming infection control measures and potential erosion in the payer mix are putting pressure on many organisations to seek efficiencies.

Surveyed clinical leaders expect the return to pre-COVID-19 productivity volumes to take two to six months, with three months being the typical (median) estimate. This relatively optimistic estimate may reflect respondents’ confidence in their organisations’ ability to prepare for reopening.

However, organisations will need to overcome significant operational challenges to reach pre-pandemic productivity. New protocols to minimise infection risk can create inefficiencies and constrain health care systems’ ability to operate at the same capacity as before. Patient scheduling can become more complicated and additional pre-operative testing for the virus and screening patients and staff for symptoms can increase same-day cancellations. Social distancing requirements could mean fewer patients and lower daily caseloads and additional cleaning and infection controls may slow down room turnover, impacting throughput. It could also mean minimal presence of medical device company representatives or other nonstaff services surgeons rely on to ensure efficiency in their operating rooms.²

Conclusion

Resuming nonurgent procedures may be more complicated and take longer than expected. While everybody is anxious to reopen, the approach should be methodical and allow for contingencies against possible risks to determine when to open, what services to resume and how to reboot income while building resiliency in the system and keeping the patient and the community at the centre. Such resiliency will likely require a real-time view of data on consumer sentiment and behaviour, the pace and progression of testing, readiness of the clinical and nonclinical workforce, having the operational procedures in place to compartmentalise COVID-19 and non-COVID-19 care and the financial resiliency to withstand the challenges that organisations may face as they ramp up operations again.

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