Supporting CHWs as they Support the Community
By Tanikka Price, Director of Education, Central Ohio Pathways HUB
Technical Assistance support may conjure images of someone walking through how to use a computer program, or how to input data entry. Technical Assistance (TA) with Community Health Workers (CHWs) and their Supervisors in the Central Ohio Pathways HUB is so much more than that. HUB Director of Education, I approach every TA session armed with the knowledge that CHWs have a huge turnover rate, and that the assistance I provide may make the difference between this CHW remaining employed or not. General issues that CHWs face include burnout, time management challenges, unclear expectations and overwhelming personal issues.
For most CHWs the opportunity to serve clients in their community is exciting. During Onboarding with the HUB, CHWs are warned of burnout in a session called “Self-care.” Meditation, exercise, a balanced diet, and boundaries with clients are explored as ways to manage the challenging work that is ahead of them as CHWs. They are trained to model and coach clients to a point of self-sufficiency, enabling the clients to advocate and do for themselves eventually as the relationship progresses. However, for some CHWs, they begin making appointments for clients, getting food for clients at the local food bank, picking up diapers and wipes from local agencies, and that gets taxing over time. So these CHWs are more likely to experience burnout. In our TA session, we work with setting boundaries and working smarter, not harder. We roll play talking directly to clients, not in a way that hurts their feelings, but in a way that garners respect and understanding.
Time Management Challenges
A calendar is a must for CHWs. Time must be managed. It is so easy to get derailed by an emergency call from a frantic client which takes up the entire day. In our TA session we discuss keeping a calendar which includes having time for breakfast, lunch and dinner (you’d be surprised how many CHWs don’t make time to eat during the workday). We also discuss building in time for time in Care Coordination Systems (CCS) our data system and time to reflect. For CHWs with a history of trauma or adverse childhood experiences, it is important to build in time to journal or, when necessary, therapy. Working with clients from similar backgrounds may be triggering, and it may be even more challenging to establish boundaries with a client who is struggling through something you can remember struggling through.
Sometimes there is nothing more than a caseload and a data system and CHWs have to figure out on their own how to prioritize the work. In this case, our TA session may incorporate finding out what the CHW is unclear on and then meeting with the Supervisor to make sure we are all on the same page. A good example of this is- a CHW may think that being efficient at work is checking all the emails in a day, while the Supervisor may have an expectation that she contacts clients every day. Communication and clear expectations are the key to making sure that the CHWs work is aligned with the expectations of the agency.
Overwhelming personal issues
Sometimes life situations come up that feels unmanageable. It happens to us all. In our TA sessions, sometimes the CHW just needs a trusting ear with which to vent. There is no therapy that happens during TA sessions, but there are suggestions made regarding time management, self-care, and communication with administration that are helpful to CHWs during a time when personal issues threaten their employment. CHWs are strong and resilient and that is what makes them so effective. Sometimes they just need to hear that everything is going to be okay, and to be reminded that they have made it through before and they will again. In those situations where personal issues are so overwhelming that they are not able to fulfill their responsibilities as a CHW, they are coached in a way that they can always come back to gainful employment when the time arises. When appropriate, they are referred to mental health agencies, or other social service agencies. During one TA session, I noticed the CHW squinting to read the notes on the computer and immediately referred him to Divine Family Eyecare where he was able to get an appointment and get new glasses to perform his job more effectively! In other words, sometimes we have to be a CHW to the CHW.
Reducing turnover with CHWs begins the day they decide to do the work of a CHW. At the Central Ohio Pathways HUB, we take our mission seriously: we cannot serve the community without ensuring that the needs of our CHWs are fulfilled. We do that by providing TA sessions that can empower and encourage CHWs to continue on their path.
HCGC Releases Latest Regional Quality Transparency Report
Innovations and Lessons Learned Amidst Pandemic
by Carrie Baker, President & CEO
Central Ohio providers continue to be open and transparent with one another about how they perform on specific quality measures with an eye on improving health and healthcare delivery across the region. HCGC is pleased to release our second Quality Transparency report of 2020 with data on nine clinical quality measures from 13 healthcare organizations representing over 223 primary care practice sites that are caring for more than 881,234 patients across Central Ohio. Our Quality Improvement Learning Group (QILG) has hosts quarterly work sessions for practices and quality improvement system leaders to evaluate regional performance, set goals, and align improvement activities at a system and practice level.
Since 2014, the report has been released twice a year, providing benchmarking, trends and important insights to help as practices strive for continuous improvement. Over the years, HCGC has increased the number of practices from just over 80 reporting in 2014, to 223 in the most current iteration of the report. The number of quality measures has also increased as a result of the collaborative work of the QILG.
For the first time, and amidst a global pandemic, contributors reported data on telehealth services provided by their practices. While several preventative screening targets were predictably under target, this report demonstrates that central Ohio providers rose the challenge of using innovation to provide access to care at the height of the COVID-19 pandemic. On average, practices performed over 1,000 telehealth appointments with patients during this reporting period. This data demonstrates that providers in the region prioritize the safety and healthcare of their patients. Providing telehealth services to patients allows for a continuum of care, while ensuring the safety of central Ohio patients from preventable exposure to the coronavirus.
HCGC has decided not to include social determinant of health (SDOH) data as it has done in the past
two QT reports. Over the last year, HCGC has been working with a data analytics firm to combine our
SDOH and clinical quality data in a more comprehensive way that highlights regional trends and
improvement activities going forward. We look forward to sharing our progress with partners in 2021.
HCGC and the QILG are grateful to our contributing practices for their continued commitment to transparency and innovation to meet the needs of their patients. If you are interested in joining the QILG, or contributing data to the report please contact HCGC President & CEO, Carrie Baker at firstname.lastname@example.org.
HCGC Hosting Six Part Webinar Series with Patient Centered Outcomes Research Institute
by Heidi Christman, Director of Communications
The Patient Centered Outcomes Research Institute has funded HCGC to hold a series of webinars in late 2020 and into the first half of 2021. With an overall emphasis on health equity and eliminating disparities, the sessions will feature PCORI funded research, as well research and initiatives in Ohio. The planning committee for this series consists of key stakeholder representatives of the HCGC Board of Directors. Another important group working to inform the content and objectives for the webinars are a group of researchers from around Ohio that serve as PCORI Ambassadors. The PCORI Ambassador Program is a volunteer network of individuals dedicated to changing the culture of health research. In their communities and nationally, Ambassadors are shifting how research is being done by partnering with researchers, leading engagement initiatives, setting priorities, and spreading the word about the importance of stakeholder-engaged research. These two groups of diverse stakeholders have been instrumental in preparing and planning for what is sure to be a valuable learning experience for webinar attendees.
There will be three background-based pre-webinars in December and January. The first webinar is tentatively scheduled for Friday December 4th, and will provide an overview of PCORI, their research, and HCGC’s ongoing relationship with PCORI to disseminate and convene a diverse stakeholder group to learn about PCORI research. Two webinars will take place in January: Diversity and Inclusion Efforts in Ohio and Importance of Engaging Patients and their Families. Keynote webinars will begin in February and cover PCORI and other research based upon:
Registration for the series will begin in mid-November, and will be open to a statewide audience. For more information on programming or the planning process, contact Heidi Christman at email@example.com.
Columbus Metropolitan Housing Authority Partners with HCGC for Care Coordination Services
By Carrie Baker, President and CEO
HCGC is proud to announce a partnership with the Columbus Metropolitan Housing Authority (CMHA.) CMHA helps people access affordable housing through collaborative partnerships to develop, renovate, and maintain housing; promote neighborhood revitalization; and assist residents in accessing needed social services. The important work of CMHA led to a natural collaboration with HCGC and the Central Ohio Pathways HUB (the HUB.) The HUB, a care coordination system managed by HCGC deploys community health workers (CHWs) to connect vulnerable populations in Central Ohio with access to vital care and services.
The partnership creates a direct referral into the HUB for CMHA residents. While the access to affordable housing provided by CMHA is paramount to the wellbeing of vulnerable Central Ohioans, there is almost certainly other essential needs that have gone unmet for people who have sought housing through CMHA. The CMHA referral into the HUB allows for residents to be connected with a HUB CHW who will connect directly with that resident and work through an in-depth assessment of the spectrum of other care and services they may be experiencing. CMHA residents who become HUB clients have the opportunity to work with a CHW to apply for emergency rental assistance, utility bill payment plans, and understanding their lease agreement; signing up for health insurance, unemployment, food assistance; find employment, housing, and medical care, and education; manage their health and well-being including understanding illnesses and medications; understand and engage in family planning, pregnancy care, and care for you and your entire family.
The CMHA referrals for HUB services are being directed to Physician CareConnection (PCC), one of the HUB’s twelve Care Coordination Agencies. Employing the Pathways Community HUB model of care coordination, CHWs that are employed by PCC have already began enthusiastically and efficiently receiving CMHA referrals. In just two weeks of operation through the partnership, HUB CHWs enrolled twelve CMHA residents and began connecting them to care and services. Another nine referrals were made through the system in that first two weeks that are in the process of becoming CMHA residents before they can begin to receive HUB services. That is a total of 21 referrals in just 14 days of the official beginning of the partnership. This data shows us the spectrum of needs associated with insecure housing that CMHA is addressing with their residents through partnering with HCGC and the HUB. This comes at the same time that the City of Columbus has made eviction reform a major priority amidst the COVID-19 pandemic, with funding for organizations like PCC that are known for their work in coordinating care and services for central Ohio's most vulnerable citizens.
Amidst the COVID-19 Pandemic, we know that the incidence of housing insecurity is rising at an alarming rate, and the work that CHMA has done since the onset of the pandemic is nothing short of inspiring. HCGC is honored to work to extend the access and relief that CMHA provides their residents by providing connections to the other social determinants of health affecting so many vulnerable central Ohioans in these trying times.
For more information on CMHA, visit their website.
Fore more information on PCC, visit their website.
For more information on the HUB, visit our website.
A Background and Update on Patient Family Advisory Councils
HCGC led project celebrates third year, announces virtual restart amidst pandemic
by Heidi Christman, Director of Communications, HCGC
Based on Presentation to COPC PFAC Leads by David Brackett, Vice President, Accounting and Special Projects, HCGC
HCGC has been managing, leading and facilitating Patient Family Advisory Councils (PFACs) in partnership with Central Ohio Primary Care (COPC) since 2017. A PFAC is a regular meeting with both staff and volunteer patients and families of a medical practice, in this case, within the COPC family of primary care practices. Members of the PFAC collaborate with employees (clinical, administrative and support) to provide guidance on how to improve patient and family experiences. At the meetings, councils work on a variety of practice and patient-and-family-centered care initiatives. The goal of a PFAC is to provide a collaborative environment that will enhance the experience for all patients and families at COPC through patient-and-family-centered care (PFCC) using constructive input that only patients and family members can provide.
The Four Guiding Principles of PFACS
Patients, families, healthcare practitioners, and health care leaders collaborate in policy and program development, implementation, and evaluation; in facility design; and in professional education, as well as in the delivery of care.
Dignity and Respect
Healthcare practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs, and cultural backgrounds are incorporated into the planning and delivery of care.
Healthcare practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely , complete, and accurate information in order to effectively participate in care and decision-making.
Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.
Celebrating Three Years of Impactful Engagement
In the three years since HCGC and COPC partnered to convene PFACs, there have been 2,000 patients engaged and 380 PFAC meetings held, with average quarterly attendance across all sites at 189 patients. PFACs have allowed for the implementation of qualitative and quantitative satisfaction surveys, creation of newsletters and informational displays to improve patient education and practice communication, as well as countless patient concerns and ideas being solicited and addressed. Over the lifetime of the project, there have been two major quality improvement outcomes that can be in part attributed to PFAC recommendations: there was a 21% increase in patients whose diabetes a1c measured as “in control”, and there was an 8% increase in patients whose blood pressure measured as “in control.”
Moving Forward Virtually
With safety in mind, HCGC and COPC made the decision to put PFACS on hold from March until August 2020. After time to plan and regroup, a plan was made to move forward with PFACs virtually. Starting with a participatory webinar in late August, PFAC leads, as well as HCGC and COPC staff came together to discuss convening PFACS via webinar for the third and fourth quarter of 2020. Participants discussed establishing goals for PFACs in these virtual meetings. Topics such as telehealth, COVID-19 education and information, as well as maneuvering in person office visits amidst COVID-19 were all discussed as potential topics for PFACs to address. Additionally, considerations for lack of access or knowledge of webinar platforms (Zoom in this case) were taken into account. HCGC committed to hosting all webinars on behalf of the COPC participating PFACs, as well as providing educational resources on how to use the platform for PFAC leads and members.
Now, more than ever, the voices of patient and family members are essential in improving patient experiences in primary care offices. While virtual, the team at HCGC and COPC look forward to hearing the patient perspective amidst these unique, unprecedented times. In the spirit of partnership and collaboration, HCGC and COPC look forward to moving forward to continue giving patients and families a seat at the table, whether it be virtually or in person down the road, to improve experience and outcomes for patients in Central Ohio.
For more information on PFACS, contact David Bracket at firstname.lastname@example.org.
Controlling the Uncontrollable
Dealing with Stress in The Most Stressful of Times
By Caroline Carter, CPC+ Practice Facilitator, HCGC
Uncertainty causes stress. We are living in uncertain times. We are stressed.
2020 has been a year of surprises – and not of the pleasant variety. Earlier in the year we experienced extreme natural disasters including floods, wildfires and earthquakes. In the last few months we have been forced to hastily adapt to the coronavirus pandemic which has already flaunted widespread colossal health and economic impact. More Americans are out of work than in the Great Depression, and more people are dying than in several of America’s wars combined. Simultaneously, we are experiencing political chaos. Social unrest exploded with fierce reaction to injustices such as the killing by police of George Floyd and countless other Black people.
Safe to say, we are experiencing circumstances that the majority of us did not have the sagacity to predict.
And so, here we are in the midst of a full blown, uncontrolled pandemic with all the anxiety and stress that accompanies that scenario. We have been unceremoniously coerced to adapt to a new sense of ‘normality’ that was until very recently beyond our comprehension. Millions of people did not anticipate losing their jobs. We did not anticipate thousands of adults having to home-school their children while simultaneously fulfilling their work responsibilities – from our homes. We did not expect the high level of confinement and restrictions imposed on our lives.
Many of these stress-inducing circumstances we have begun to contend with. However, we can expect further disruptions that will bring new, additional stressors such as the unknowns about the economy. Will businesses re-open? Will we retain our jobs, those of us that were fortunate enough not to have lost them already? When will we be expected to return to the physical workplace? Will schools re-open? Will our children be safe? Will working parents will be compelled to grapple with an untenable proposition of children being in their physical school building for only one week out of three? How does one coordinate childcare in a scenario that expects them to return to their physical workspace on a full-time basis? Deb Perelman eloquently grapples with this conundrum in her recent New York Times article In the Covid-19 Economy, You Can Have a Kid or a Job. You Can’t Have Both. https://www.nytimes.com/2020/07/02/business/covid-economy-parents-kids-career-homeschooling.html
First and foremost, we have to understand that stress is a normal and healthy emotion. Everybody experiences stress to some degree. It is a part of being human. We should also recognize that we are likely grappling with several types of stress including decision-making fatigue, daily hassles and chronic stress.
Decision-making fatigue is the result of having to make choices. Just a few months ago so many of our choices and decisions were routine. Consider your pre-pandemic morning routine, it is likely that it included a number of tasks that were so routine you didn’t even think about them. All of our standardized decision-making systems, our routines are gone. The beauty of routines is that they take away the need to make so many decisions. During these stressful times we are forced to make choices all the time that we didn’t have to make pre-pandemic.
So, what can we do?
They don’t have to be permanent. They don’t have to be perfect. They just need to reduce the number of decisions that you have to make so that you can experience less decision-making fatigue.
Next, let’s tackle the daily hassles. A major stressor, such as a pandemic creates a cascade of micro-stressors. These are basically small, little things that emerge that didn’t used to. The thing about hassles is that they can feel miniscule but those seemingly innocuous little things add up and cause stress.
So, what can we do?
First and foremost, don’t minimize the tax of daily hassles. Don’t give yourself a hard time when you find yourself getting upset about little things that, under normal circumstances you might not have even noticed or if you did you might have deemed them trivial.
Lastly, let’s consider chronic stress. This is a big one. We have no idea when our current, challenging conditions will be over. Living with uncertainty is a known force for causing stress.
So, what can we do?
Separate everything that is bothering you into 2 categories. One category contains things within your control, the other are things beyond your control.
For things within your control:
For things beyond your control:
General Coping Strategies:
While we cannot eliminate stress we can take some steps to minimize the effect that stress has on us. The good news is that we all have coping strategies.
Positive coping strategies include staying socially connected, engaging in happy distraction, engaging in self-care, and taking care of others.
The bottom line is that we are going to get through these challenging times. Stress and anxiety will be a part of it but we’ll get through it by focusing on positive coping strategies.
Thank you to Dr. Lisa Damour, Psychologist and best selling author for the strategies offered to manage stress.
Using the Mirror to See One Another
By Tanikka C. Price, Data and Finance Director, Central Ohio Pathways HUB, HCGC
*Adapted from a presentation given to Dress for Success Columbus Volunteers in response to George Floyd’s murder and the protests that followed on 6/10/2020 Click here to view the presentation
The current climate of racial and political division has called many people to question the world around them, but I’m calling you to look within rather than outward to find the change we all need. Although many of us look around and outside of ourselves when the conversation starts to talk about bias, it may be that humans are inherently wired for bias. Bias is intended to help us. Think for a moment, would you sit on a three-legged chair? Think of the visual cues you used when choosing your partner or spouse. What attracted you? What repelled you? This is the way we use bias to survive.
Sometimes, biases are what Kelly Robsham in her blog entitled "Creating An Inclusive Company: Challenging Our Biases" calls “cognitive shortcuts” that are a result of human evolution. “We’ve evolved to have cognitive shortcuts (also known as heuristics) meaning we often survive by relying on unconscious assumptions in our lives.” Robsham highlights several occurrences of unintentional bias that affects decisions made in the workplace, including in hiring, retention and onboarding practices. These biases can be based on gender, race, age, and several other factors that are deep down in one’s subconscious.
Understanding key terminology
Before we can really delve into looking within, at our own biases, we must understand the following definitions.
Bias: prejudice in favor of or against one thing, person or group compared with another, usually in a way considered to be unfair. https://www.lexico.com/en/definition/bias.
Implicit Bias: refers to the attitudes or stereotypes that affect our understanding, actions and decision in an unconscious manner (Kirwan Institute). http://kirwaninstitute.osu.edu/research/understanding-implicit-bias/.
Prejudice: preconceived opinion that is not based on reason or actual experience. https://www.lexico.com/en/definition/prejudice.
Discrimination: the unjust or prejudicial treatment of different categories of people or things, especially on the grounds of race, age or sex. https://www.lexico.com/en/definition/discrimination.
Racism: prejudice, discrimination or antagonism directed against someone of a different race based on the belief that one’s own race is superior. https://www.lexico.com/en/definition/racism.
Anti-Black racism: policies and procedures rooted in institutions such as education, health care and justice that mirror or reinforce beliefs, attitudes, prejudice and stereotyping and/or discrimination towards people of Black-African descent. (Black Health Alliance) http://blackhealthalliance.ca/home/antiblack-racism/.
Understanding these terms and how they relate to one another will assist us in having robust and self-reflective conversations about the way anti-black racism is a part of every facet of American life. Making ourselves familiar with this terminology is key to understanding where we need to begin in a conversation and action in creating an anti-racist narrative in our everyday lives.
What does this have to do with you?
“To know the true reality of yourself, you must be aware of not only of your conscious thoughts, but also of your unconscious prejudices, bias and habits.” (Anonymous) https://www.al.com/opinion/2019/03/business-leaders-take-heed-we-all-have-unconscious-biases-which-must-be-confronted.html.
One must confront their own history with race, or lack thereof to being your journey of antiracism. What is your story about race? One’s beliefs about race are often defined by five factors: education, experience, history, “the talk” and your “five.”
Education- Who taught you what you know about US History and race? The story you were told is heavily influenced by whom you were taught. Did you have teachers of color growing up? Did you take classes in college about different cultures? Have you ever visited and learned from someone not-American?
Experience- What has been your experience with different races? When is the last time someone of another race came to your home? Does the place where you worship or gather socially reflect the world or is it a lot of people who look like you and have similar experiences as you?
History- What were you taught about US History. A seminal book, Lies My Teacher Told Me, by James W. Loewen, shows the fallacies and white-washed versions of history most of us were taught in US schools and how they affect how we see different cultures and the world. Keep in mind that tales of the hunt always glorify the hunter.
“The Talk”- have you ever had to have a talk with your children about how to survive in this country despite your race? Have you ever instructed your children how to act if they are pulled over by the cops? Have you ever had to tell your kids how to manage racial slurs hurled at them on the playground? If not, you have privilege. If so, you worry about your kids on a level that others cannot understand.
Your “Five”- Actor Will Smith says you are the five people that you spend the most time with. What are these people saying about race, gender, immigration, poverty and education? How are they affecting you? What is your Facebook thread reflecting? What side of history are you and your best friends going to be on?
For racial reconciliation to work we must confront our own biases. While we cannot control or change the education we received as children or the experiences that were provided or not provided by our parents, it is never too late to start educating ourselves and looking inward to confront our own biases. We cannot be afraid to confront the ways we were raised, how we were taught, and the experiences we have had. We must move forward taking a hard look in the mirror in order to see ourselves, and therefore each other clearly. It is only when we understand the foundations of our bias, that we can work with others to create real change.
Racism and its Impact on Health
A guest blog from The Columbus Medical Assocation by Anita Somani, MD, OB/GYN and current Past-President of the CMA
When African-American respondents were asked about their own personal experiences regarding discrimination:
A large and growing body of research shows that the day-to-day experiences of African-Americans create physiological responses that lead to premature aging (meaning that people are biologically older than their chronological age). Or, as described in the American Behavioral Scientist, “experiences of racial discrimination are an important type of psychosocial stressor that can lead to adverse changes in health status and altered behavioral patterns that increase health risks.”
As physicians we know the statistics-Dr. Sherita Golden, chief diversity officer at Johns Hopkins describes the increased incidence of Covid-19 in people of color and the disproportionate mortality rates.
African-Americans live sicker and die sooner than whites in America. Heart disease is the number one cause of death in the United States and middle-aged black males and females have death rates that are about twice as high as their white counterparts. Elevated death rates are also evident for cancer, stroke, diabetes, kidney disease, maternal death—the list goes on. In fact, every 7 minutes, a black person dies prematurely. That’s more than 200 black people a day who would not die if the health of blacks and whites were equal.
So, what are those day to day experiences that lead to premature aging? One of the biggest ones is chronic stress. I’ve never worried about my son going for a jog or playing music too loud or going to a store or church. But when I look at this list which is a list of wrongful deaths over several years, I wonder how have we failed so many for so long?
This is a list of the people we have heard about but what about the daily injustices and slights that others experience. It wouldn’t surprise me to hear that for every name on this list there are hundreds of others who suffered the same fate without anyone knowing or experienced a near miss or whose health has suffered as a result.
As physicians we need to set the bar higher. We can start by trying to understand the stresses that people of color deal with every day. White Fragility by Robin DiAngelo discusses why it’s so hard for white people to talk about racism.
The article I have shared here gives us 65 different things we can do for racial justice. Pick one or two or even all 65 and consider doing them. Think of the change we can bring in our community if we set the bar higher and start with evaluating our own biases. The COVID pandemic is bringing the disparities in health care to the forefront and we need to evaluate and create policy that will improve these differences.
65 THINGS WHITE PEOPLE CAN DO FOR RACIAL JUSTICE
Society Groundhog Day Amidst a Prolonged Pandemic
From Columbus Medical Association Blog:
HCGC is an affiliate of CMA
Dr. Sugat Patel’s thoughts are based on what is known as of 4/17/2020.
My aim is to start a discussion on the restart of our society considering the COVID-19 pandemic will endure until there is a significant treatment or vaccine. Understanding that we may have to wait for a year or possibly more, we will have to eventually emerge, risking exposure of ourselves and loved ones to the virus. I don’t want to be long-winded, so I am going to try and present this argument by given, assumed, then proposed.
Our practices of staying at home, social distancing, and using masks have helped to flatten the curve. We are below hospital capacity and need to stay there. Our top priorities are to not exceed hospital capacity and to have enough PPE to make healthcare as safe as possible. Circumstances, where the virus is aerosolized, require maximum grade PPE. Any plan that compromises those priorities is a failure. Spread is largely through asymptomatic carriers. Many asymptomatic carriers are children. The elderly and people with comorbid conditions are extremely susceptible to morbidity and mortality.
Measures implemented are all liquid, with the goal of keeping hospitals under capacity and with appropriate supplies. The original desire for widespread testing involved the goal of finding a carrier, then isolating the carrier and contacts to prevent spread. I think once the contagion has become widespread and the asymptomatic carrier rate is significant, the value of that measure decreases. Also, the psychology of testing value may become over perceived by the public giving a false sense of security. The best way to address the contagion spread is to assume everyone is a carrier. Keeping hands clean should now be a common and frequent practice, and is the simplest preventive measure. The second most valuable measure is to block one’s own respiratory or oral secretions. To implement this measure, people should wear homemade and other masks or mouth/nose shields in public. Masks to protect oneself from inhalation of the virus, especially homemade, may be less effective, but don’t hurt and should be used as a special precaution when risks are higher (comorbid patients, broken social distancing, etc.).
Proposed (once the curve is flat and comfortable… hopefully within a month)
I am hoping most people become familiar with the practices of social distancing, frequent hand washing, and face mask or shield wearing, for these may continue for a very long time. Strict use of these practices will allow us to restart and reintegrate. A breakdown in these measures and we are back where we started. Current practices of telemedicine, teleconferencing, and tele-business should continue where practical. Most businesses should be able to restart with those constraints, along with frequent disinfecting. There will have to be enough hand washing stations and hand sanitizer for the business. These are already practiced and mandated at essential businesses. People should wear masks at work if they are not alone and 6 feet social distancing is not possible at all times. Nose and mouth shields are acceptable in low-risk environments with healthy young people.
Workplaces, where social distancing breaks down, becomes difficult. I think restaurants will have to wait a few more weeks to reopen after the lifting of the stay at home order if all goes well. When they reopen, servers and food preparers will have to wear masks. The restaurant can’t allow crowding. Bars are unique in that they depend on crowding, socializing and drinking, which make virus precautions almost impossible. They will be the last to open, which may be a long time, unfortunately. Schools are likely a hub for virus spread. I think they could restart a few weeks after the stay at home lifting. Masks or nose and mouth shields should be worn, and there should be hand sanitizer in every room. Social distancing practices should be in place. Lunchtime spacing must be created. To prevent a fail and complete pull back, high schools should start first, followed a couple weeks later by middle school, then lastly elementary school. Daycare for toddlers is a tough question. I can’t, practically, think of a way to control that environment. I would leave that to other experts, or they would have to suffer duration similar to bars and lounges.
Public transport should mandate masks or nose/ mouth shields. There should be signs to remind people to clean hands upon exit.
Gyms could also reopen as patrons could wear masks, and hand sanitizer and wipes should be aplenty. Cardio equipment should be appropriately spaced. Lap swimming at pools should be acceptable, but no “open pools” where distancing cannot be maintained.
Sports can resume if social distancing can be implemented. If not, then nose/mouth shields should be worn, by players and coaches. I can think of a simple design of a flexible over the nose fit with a firm plastic mouth shield that would leave plenty of room for breathing, but block almost all spit from talking or yelling. Hand sanitizer will, of course, need to be on the sideline. This may be difficult for wrestling to implement. Overcrowding at stadiums for spectators should not be allowed, and masks or shields should be required, along with hand sanitizer or wipes. Food and beverage should not be sold unless consumed in a private area with distancing (not at their seats).
There would have to be self-policing and social media should be helpful in whistleblowing. There will be a surge, but hopefully a very limited one. I think the under hit rural areas will especially feel a surge when the restart begins. Discipline and vigilance will be key.
What I have written here serves as my self-therapy to realize that we may be able to build a bridge to normalcy. Hopefully, it gives some hope
Sugat S. Patel, M.D.April 17, 2020
by Jack Stevens, PhD
Psychologist, Nationwide Children's Hospital
Associate Professor of Pediatrics, The Ohio State University
Dr. Stevens will be featured in HCGC's April and May Webinar Series on Behavioral Economics. Find registration information for the webinar series here.
What is behavioral economics?
Behavioral economics (BE) is an interdisciplinary field featuring concepts from psychology and economics to help people obtain their long-term goals. BE is often associated with the word “nudge,” a strategy that encourages people to make positive changes while preserving choice and freedom.
BE has often been utilized to help people make better financial decisions, such as saving more for retirement or decreasing their home energy bills. However, over the last decade, BE has been applied for health purposes in terms of assisting clinicians as well as patients.
Who are the leaders in behavioral economics across the United States?
The book Nudge was written by Richard Thaler (a University of Chicago Booth School of Business professor who won the 2017 Nobel Prize for Economics) and Cass Sunstein (a Harvard Law School and Harvard Kennedy School of Government professor).
In 2016, the University of Pennsylvania School of Medicine was the first health care system to establish its own formal behavioral economics team. BE work from this “Nudge Unit” has been featured in the New England Journal of Medicine as well as the Journal of the American Medical Association Network journals.
What are some of the success stories from behavioral economics?
BE strategies have led to positive health outcomes such as:
Why might behavioral economics appeal to clinicians, administrators, and health systems?
Past research has suggested that BE strategies often have a favorable benefit/cost ratio relative to alternative approaches. BE strategies are feasible to implement because they typically require a relatively low level of resource, such as rephrasing options for patients or altering screen displays in electronic medical record systems.