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Learn from a medical practice that reopened during COVID-19

Medical Economics JournalMedical Economics November 2020
Volume 97
Issue 15

COVID-19 has completely upended clinical operations, requiring a “new normal” going forward.

If resuming clinical operations during a pandemic were as simple as flipping a switch and welcoming patients back, health care providers across the country would be in a very different situation. COVID-19 has completely upended clinical operations, requiring a “new normal” going forward.

As you develop a plan for successfully resuming operations, you’ll need to answer many fundamental questions. How will I keep patients safe? How will I protect my staff? How many staff do I need? How can we leverage data to be nimbler and more responsive? Centers for Medicare & Medicaid Services and the American Medical Association have published helpful guides on restarting nonemergency clinical care.

The reopening experiences of a high-volume outpatient clinic can provide several valuable lessons. This clinic focused on three principal areas of importance: safely serving patients, ensuring staff safety and resuming operations.

Keeping patients safe

Patient safety was the top priority. The clinic quickly established a robust pre-screening process to keep individuals who may have been exposed to or were experiencing symptoms of COVID-19 away from the outpatient setting, and triaged them to a COVID-19 screening center. The pre-screening also incorporated scripting that allowed the clinic’s staff to communicate to patients any changes that had been implemented to keep them safe.

Initially this pre-screening process was entirely manual and involved the time of countless staff members. The clinic’s goal was to transition as much of this screening to digital as possible. A two-phased plan was developed to bring patient pre-screening online. After just six weeks, more than half of the clinic’s patient pre-screening was being done electronically. This enabled staff to do additional work with patients in the clinic and spend more time on the phone with patients who reported positive symptoms during the pre-screening process.

Understanding the importance of rapid communication to patients, the team quickly revamped an existing website and repurposed it to provide critical updates for patients. This included information on visitor restrictions, changed hours of operation and facility changes to maintain social distancing, as well as the clinic’s enhanced cleaning protocols.

Most critical in terms of patient safety were the changes the clinic made to scheduling, which ensured patient appointments did not overlap and that there would be ample time between appointments to clean equipment and shared spaces. The clinic’s prior scheduling templates were modified and reduced by 30%, subsequently extending the clinic’s hours to accommodate a volume comparable to pre-COVID-19.

Ensuring staff safety

Ramping up clinical capacity also meant thinking differently about keeping staff safe while also providing care. The same safety measures for patients were also applied to staff, such as requiring wearing of masks and social distancing. For clinic staff, physical distancing proved the most challenging, as staff had previously worked in close proximity. To counteract this, the clinic began staggering staff schedules and placed limits, based on office square footage, on the number of staff members.

The clinic also established an all-staff screening program for exposure to COVID-19 and symptoms of COVID-19, similar to the one used for patients. The clinic is investigating the feasibility of t testing for all of its frontline workers.

Reviving operations

While patient and staff safety were the clinic’s priorities, there was still a need to provide clinical care and resume revenue-generating activities. After severely minimizing its clinical activity to only the most urgent of patient cases, the department faced a significant backlog of outpatient appointments that had been canceled. The combination of rescheduled appointments and new volume could not fit within the newly reduced capacity. The clinic began using patient visit data to determine appropriate staffing levels and created dashboards to project volumes and hours of operation to match demand and revenue requirements.

With daily operational changes in the clinic a new norm, daily huddles enabled staff members to assess what was working well and what needed to be changed. These daily huddles allowed staff members to respond more swiftly to quickly changing operational dynamics.

Liz Aron is a consultant with Freed Associates, a California-based health care management consulting firm. Send your practice management questions to

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© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health