Will collaboration become a new standard operating procedure?

In late March, as COVID-19 had taken hold of New York City and the surrounding area, New York Governor Andrew Cuomo called on hospitals across the state to operate not as individual organizations but as a single system united in the fight against COVID-19. Cuomo said he had met with the leaders of hospitals across the state and ordered them to share staff, patients and supplies under the direction of the state government. A few questioned whether the order was a step too far toward socializing healthcare, while most recognized the dire consequences of not combining forces to achieve a common purpose, especially in light of critical supply shortages. VOX News quoted the assistant chief medical officer at one New York City hospital as saying: “If hospital A has resources and hospital B doesn’t, it’s in the best interest of the patient that hospital A and B work together. Protective equipment should be available to all health care providers, not just those who work at a place with a better procurement officer.”

While some of the pushback was no doubt in response to a government mandate, there is no shortage of examples of voluntary collaboration within the private sector to address the threat of COVID-19.  

In late April, more than 51 hospitals in Florida announced that they had formed a collaborative to share data on how many patients they are treating for COVID-19 and their respective resources to meet the demand, from beds to ventilators. With access to such data, the hospitals can quickly and easily determine which hospitals have capacity for more patients. Tampa General Hospital noted on its website that the participating hospitals are also ones that typically compete with one another for market share. As the hospital’s vice president of care transitions noted, “It breaks down silos between competing hospitals for this collaborative community effort.” Less than a week later, seven states in the northeastern U.S. announced they were creating a purchasing consortium to avoid what Governor Cuomo called bidding wars between the private sector, states and the federal government that drive up prices for critical supplies.

One of the more successful (and intriguing) examples of collaboration brought together disparate sectors of an oft-fragmented healthcare system, including two competing manufacturers. At the same time that Governor Cuomo was enacting his “one system” order, global medical device manufacturers Boston Scientific and Medtronic joined forces with UnitedHealth Group (a major player in both insurance and health services), the University of Minnesota Medical Center (a healthcare delivery organization) and the Earl E. Bakken Medical Device Center (a research center within the Institute for Engineering in Medicine at the University of Minnesota) to build a lightweight version of a ventilator. In less than a month, the collaborative effort had yielded not only a design, but the first batch of 500 covetors, the name for the new device. The coveter, which is designed for emergency use during times of ventilator shortages, uses a robotic arm to compress an adult resuscitation bag that normally requires a person – often a paramedic – to do the manual compressions. The plan is to produce and distribute a total of 3,000 devices to where they are needed most, with the balance to be donated to the Strategic National Stockpile.  Those involved with the program said these kinds of collaborations are critical, not only due to the critical need for speed but also because individual entities, especially healthcare providers, are not able to solve these challenges alone.

Early in the COVID-19 crisis, I spoke with both hospital and supply chain leaders from several of the major health systems located in the St. Louis area.  They were already actively engaged with their peers at the other systems, swapping data on anticipated demand, their respective capacity, and how best to coordinate the response, including allocation of precious resources and supplies if needed.

The St. Louis healthcare community’s fast action on collaboration can likely be attributed to having worked together in the past on other matters of common and community interest. In 2018, several of these same hospital systems formed the regional St. Louis Area Hospital-based Violence Intervention program, the nation’s first collaborative between hospitals and academic institutions to combat the cycle of violence in the region. Six years earlier, the BJC Collaborative was formed, bringing together health systems from both Missouri and Illinois, and as far west as Kansas City. The participating systems entered into a mutual aid agreement to build out the infrastructure needed to support one another, including sharing of supplies, equipment and pharmaceuticals, in the event of a major disaster.

I first learned about the value of pre-established relationships in times of crisis many years ago, during the time I had left healthcare to work in the energy industry. One of my roles was crisis communications planning. We assembled representatives from government, emergency first responders, hospitals, not-for-profits and the private sector to conduct tabletop exercises to think through various scenarios and outline the roles and responsibilities of each party. Our hope had been to think through difficult decisions in advance in order to respond more effectively and swiftly. We discovered that the most important benefit was getting to know one another, learning to speak the same language, and building the trust that is the lifeforce of any collaborative effort.

From personal experience and the research I have conducted during this pandemic and past emergencies, it is clear that establishing collaborative working relationships in advance is a powerful tool. As we think through the challenges ahead: continuing to manage the virus while returning to some assemblance of normal operations, and preparing for future pandemics, it will be constructive to assess if and how the collaborative efforts forged during the COVID-19 crisis can facilitate our ongoing work to create a more affordable, accessible and high-quality health system.

I welcome hearing more about your collaborative experiences during COVID-19 and if you believe they will have lasting value beyond the current crisis. You can reach me at [email protected].