I’m Kate Dewhirst.

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The crisis phase is over – the emergency continues – how should health leaders move forward?

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I have noticed over the last month that the tone of conversations has changed and social critique has resurfaced. Individuals are rightly asking more questions. There is greater need in all aspects of life and public service for clarity and certainty.  There are more queries and complaints about the impact of decisions made in the early days of the pandemic.

This crisis phase is over.

Yet the emergency continues. We are moving into a stabilization phase. What does the future hold?

This shift means health care leaders need to move into due diligence, procedural fairness and proactive communication.

In short: we need to bring back process.

We have all been amazed and impressed by the innovation that has occurred in the health care sector over mere days and weeks. We have moved to virtual visits. We have shifted the kinds of services available at home.  We have created mobile clinics.  Organizations have worked together. Truly impressive progress is being made.

And …

We need to reinstate process into how health care is delivered and improved.

An example of this has to do with virtual visit platforms.

In the first few weeks of the pandemic there was a “low rules environment” for health care providers to reach out to their patients and caregivers.  Name a video platform and I can pretty much guarantee it was used by an Ontario health care provider to connect with patients who were vulnerable.  10 weeks later, I’m getting questions from administrators about the kind of technology they should use to connect with patients.  My advice has changed from the early days.

Now I tell my clients they have to carefully vet their video platform of choice. They have to ensure there are appropriate privacy safeguards in place. They need to know: (1) is video the best option for the service; (2) what their associations are recommending for the technology; and (3) whether the technology links to documentation and billing systems. They need to ensure there is more transparency in obtaining patient consent.

You see, in the crisis phase, as long as something mostly does what you need it to do and is not dangerous it might be #goodenough.  Historically in law, adjudicators and judges have acknowledged that for a temporary period of time during a crisis, the standard of care necessarily lowers. For a time the law acknowledges #goodenough activities. But #goodenough is contextual.  March 18, 2020 #goodenough is not the same as May 18, 2020 #goodenough.  The context has changed.

In a crisis, we must prioritize safety.   We must prioritize completing that which is the most important. That’s how we get into an evaluation of what is “essential” during a crisis and tough decisions have to be made and followed. But over time, and especially as the crisis passes, we must revisit early decisions and bring back evaluation criteria to ensure that decisions are:

  • fair
  • equitable
  • results-oriented
  • sustainable
  • informed by multiple perspectives
  • affordable
  • ethical
  • legal
  • mission, vision and values aligned

The criteria for what is essential have changed.

The idea of getting back to process in the form of meetings, patient engagement efforts, surveys, committees, professional/legal advice, consultations, discussions, hearings, newsletters, town halls, may make you want to give up.

I know you are tired.  You have been working overtime for 10-12 weeks or more under extreme pressure making life’s most important decisions without a road map, with imperfect data and with your personal life in upheaval.

But you know that expectations have returned. You already feel it. Concerns from patients.  Messages from caregivers.  Questions from staff. Queries from your board members. Posts on social media. You now have to justify and explain the decisions you made in the early part of the crisis and explain what you are going to choose to do going forward.

This is a necessary progression forward.  We don’t need process for the sake of process – and not just any process benefits us. But process and stakeholder engagement when done properly can ensure we make good and better decisions – not just decisions.

Let’s move together forward into process and stakeholder engagement so we can maintain the momentum offered in the crisis phase – albeit going forward at a slower pace so that progress brings actual progress.


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Kate Dewhirst Health Law

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