While children's hospitals have generally not provided care to significant numbers of COVID-19 positive patients, we have responded in a variety of ways. Like our colleagues in adult hospitals and health systems, we postponed elective surgical procedures, deferred clinic visits and delayed services. We asked our communities to stay away from our emergency departments if possible and implemented measures to minimize patient volume at our facilities.
Many children's hospitals have also taken steps to support adult hospitals in their communities by taking responsibility for their pediatric patients, providing care to young adults and redeploying staff members to work in adult hospital settings.
Children's hospitals have innovated to continue caring for children with chronic conditions and serving the core of our mission to improve the health status for children. In just a few short weeks, we developed novel ways to deliver patient education, changed our environments to allow for greater social distancing, advanced telemedicine capabilities, and developed innovative ways to support at-risk families in their homes, among other things.
These responses have been necessary during a crisis. However, the crisis phase of COVID-19 eventually will abate, and our communities will begin to function within the context of an uncertain “new normal.” We are in an interim period where we know our world has changed, but it is unclear what the ultimate results of that change will be.
Prepare for a new reality
As we look to the future and consider how children's hospitals should prepare for continuing success, we must consider a few key strategic realities.
Continued limited access to facilities. Screening at entrances will become a permanent fixture, and visitor restrictions will be the norm. Such restrictions are important for keeping staff and patients healthy, but also to give our community members the confidence to know that when they seek care, they will be safe and protected. This will also require children's hospitals to seek creative ways to continue supporting our commitment to delivering patient and family-centered care.
Families will define the scope of telehealth. Many children's hospitals have expanded their telehealth capabilities in response to COVID-19. This has been facilitated not so much by the technology, which has existed for years, but by the consent of payers to compensate appropriately for this service. In the new normal, families will be even more reluctant to drive to central locations, sit in crowded waiting rooms, and experience a clinic visit that they perceive could have been delivered virtually. If children's hospitals do not meet demand, families will seek other providers who will. Quality is important, but absent a clear way to compare quality, convenience wins.
A downturn in the economy will negatively affect children. Children are disproportionately affected by economic downturns. Downturns have historically caused more child abuse, homelessness and increases in teen suicides. It is likely that more children will find themselves on Medicaid, and access to health care may be threatened. These consequences will have long- term effects on children.
Children continue to need organizations that are 100% dedicated to their health care. Though we seek medical breakthroughs to eliminate childhood illness, we have not yet found a way to prevent cystic fibrosis, congenital heart anomalies, cerebral palsy or many other conditions affecting children. Regardless of how COVID-19 changes the landscape, children with complex medical issues will still need the expertise and experience of children's hospitals.
How children's hospitals can respond
If the previous observations provide some view into the new normal children's hospitals will operate in, how should we respond? Here are the strategic imperatives we must face.
Deliver high-quality, safe and effective services. The experience and expertise we bring to caring for children with complex medical issues is extraordinary. We must continue to expand these capabilities through technology and extend them through partnerships. During times of uncertainty in the external environment, we must strengthen our commitment to clinical excellence, research and education.
Deliver cost-effective care. Children's hospitals will be in a more stable position if we focus on delivering cost-effective care. We must use this time to create efficiencies, re-evaluate our overhead costs, and seek ways to reinvest those savings into our mission. Children's hospitals offer incredibly complex services that come at a cost. We must find ways to become even more efficient so we can expand the services we deliver.
Enhance advocacy activities. Given the potential consequences of an economic downturn, children need advocates to ensure they have access to health care, strong education opportunities, healthy housing and safe communities. Children's hospitals must be at the forefront of advocating for access to health care because health is a foundation for success. Children with access to high-quality health care have a better chance of receiving a good education, becoming productive members of society, and improving the communities in which they live. When children are healthy, their parents or other caregivers can remain in the workforce.
Finding success in the future
We cannot be certain what the new normal after the COVID-19 crisis will look like for children's hospitals. We must position ourselves to be successful no matter what the future holds. Focusing on delivering high-quality, safe and effective care in a cost-effective environment will position us for continued success and allow us to continue advocating on behalf of children. It is our responsibility as a children's hospital community. If we do not speak up for them, then who will? Children need us to help prepare them for a bright future. Now, more than ever.