Global crisis changed the health care playing field

Over the course of the COVID-19 pandemic, health care workers were pushed to new limits. As the region nears two years since the first official positive coronavirus case, providers say the pandemic has reshaped individual and institutional approaches to care.

Changes for patient care

Over the pandemic, many patients who would have normally gotten treatment for chronic health conditions or regular checkups and screenings delayed care.

“We are moving forward with our focus on preventative wellness,” said Amy Larson, regional deputy medical director for CHAS Health at Lewiston. “Making sure that those patients who have missed out on their chronic care management are getting recaptured.”

As patients have started to return over the past few months, providers are working to treat progressive illness that normally would have been caught sooner.

For anyone who has put off screenings or appointments for chronic care, it’s important to schedule them as soon as possible, said Jonathan Boyd, a hospitalist at St. Joseph Regional Medical Center in Lewiston.

“We’re seeing sicker patients coming into the hospital,” Boyd said. “People whose chronic conditions have been exacerbated by lack of care. And it makes it more difficult to treat, makes it more difficult to get these chronic conditions back under control.”

In some cases, challenges during the pandemic led to more technological updates, improved communication among employees or stricter protocols for cleaning.

Hospitals introduced negative pressure rooms for COVID-19 patients, and Tri-State Memorial Hospital in Clarkston has committed to build a new inpatient wing with two additional intensive care unit rooms.

“Our patients who come here, (not even) COVID patients, they’re just sicker than what we would have typically seen in the past,” Tri-State CEO Kym Clift said. “So we’re setting ourselves up to be able to care for those patients appropriately.”

The demands of the pandemic also led to more options for telemedicine, which providers say will stay even as COVID-19 numbers drop.

“(We) transformed our model into a hybrid model where we see in-person patients and then also patients virtually for video visits,” Larson said. “Or currently, we’re even still doing some telephone visits as well as needed if they don’t have access to video. As far as that goes, I do believe that the hybrid version of care is going to continue for the long term.”

Stress and mental health among providers

During the pandemic, health care workers were regularly pushed to their limits, Boyd said.

St. Joe’s, CHAS and Tri-State all noted their employee assistance programs were available throughout the pandemic to staff members struggling with their mental health. For Boyd, much of the mental health support he’s seen for health care workers has been from others in the field.

“We were pushed to our limits so often, whenever you would reach that point where you felt like you couldn’t keep going, somebody always seemed to have their hand on your back, pushing you up,” he said.

Over time, he’s started to see a shift in how physicians view mental health care for themselves and their colleagues, Boyd said.

“You always do your best for these patients who are coming in, and you don’t really recognize your limits,” he said. “That’s just something that is kind of taught through residency. And I think that we lived so long, so close to the brink of our breaking point, to the edge of our capacity as health care providers, that we had to address that. That we do have limits, that our mental health is important.”

At Tri-State, Clift said, the organization tried to limit strain on staff members. However, unexpected stressors like changing guidelines and shortages of PPE took a toll.

“We really made it a priority for us to focus on the well-being of our employees, as well as the well-being of our patients and the community,” she said. “I think this organization did a really good job of helping to ease some of that burden with our staff, but you have unexpected things that come up.”

Rebuilding staff

Burnout among employees, coupled with staff getting sick or having to care for children who were out of school, all contributed to staffing issues throughout the pandemic at health care facilities.

At CHAS, student rotations were increased to fill the gap, with some getting offers for regular employment, wrote CHAS Chief Administrative Officer Kelley Charvet. CHAS has also been looking into more remote work, child care stipends, loan repayment benefits and signing and retention bonuses.

Both Tri-State and St. Joe’s said they offered pay incentives for staff members who wanted to pick up more shifts in addition to hiring traveling nurses.

St. Joe CEO Ed Freysinger said the hospital has primarily invested in helping to train new members of the workforce and working with employees to adjust schedules during times when services like child care were limited or unavailable.

“Some of those are going to continue into the future,” he said. “The profession of health care, though, is taking care of the patient. And so our approach is to continue to develop our current employees as well as (focusing on) how we are training more for the future.”

Rebuilding community trust

Over the past two years, health care professionals worked to combat misinformation and distrust of medical systems among the public.

One of the biggest challenges for physicians at the beginning of the pandemic was communicating the latest information to patients, Clift said. The hospital put a heavy emphasis on working with public health agencies and schools to keep the community informed on the latest updates to guidelines.

“We set up a hotline for the community to call and ask questions,” she said. “That hotline was used pretty extensively beyond our walls as well. Even the local department of health was referring community members to that hotline. And we did a lot of education with schools and with employers, specifically around (personal protective equipment), and how to wear PPE.

In addition to public information campaigns, providers are working to build trust with patients from the start in a way that wasn’t emphasized as much before the pandemic, Boyd said. As a provider, face-to-face conversations have been a key method to connecting with patients.

“It’s very easy to imagine that that big, faceless health care system does not have your best interests at heart,” Boyd said. “I think that one of the big parts of building trust is getting a face in front of them, somebody they can know, somebody that they interact with.”

Sun may be contacted at rsun@lmtribune.com or on Twitter at @Rachel_M_Sun. This report is made possible by the Lewis-Clark Valley Healthcare Foundation in partnership with Northwest Public Broadcasting, the Lewiston Tribune and the Moscow-Pullman Daily News.