Description of a Multi-faceted COVID-19 Pandemic Physician Workforce Plan at a Multi-site Academic Health System

Abstract

Background The evolving COVID-19 pandemic has and continues to present a threat to health system capacity. Rapidly expanding an existing acute care physician workforce is critical to pandemic response planning in large urban academic health systems. Intervention The Medical Emergency-Pandemic Operations Command (MEOC)—a multi-specialty team of physicians, operational leaders, and support staff within an academic Department of Medicine in Calgary, Canada—partnered with its provincial health system to rapidly develop a comprehensive, scalable pandemic physician workforce plan for non-ventilated inpatients with COVID-19 across multiple hospitals. The MEOC Pandemic Plan comprised seven components, each with unique structure and processes. Methods In this manuscript, we describe MEOC’s Pandemic Plan that was designed and implemented from March to May 2020 and re-escalated in October 2020. We report on the plan’s structure and process, early implementation outcomes, and unforeseen challenges. Data sources included MEOC documents, health system, public health, and physician engagement implementation data. Key Results From March 5 to October 26, 2020, 427 patients were admitted to COVID-19 units in Calgary hospitals. In the initial implementation period (March–May 2020), MEOC communications reached over 2500 physicians, leading to 1446 physicians volunteering to provide care on COVID-19 units. Of these, 234 physicians signed up for hospital shifts, and 227 physicians received in-person personal protective equipment simulation training. Ninety-three physicians were deployed on COVID-19 units at four large acute care hospitals. The resurgence of cases in September 2020 has prompted re-escalation including re-activation of COVID-19 units. Conclusions MEOC leveraged an academic health system partnership to rapidly design, implement, and refine a comprehensive, scalable COVID-19 acute care physician workforce plan whose components are readily applicable across jurisdictions or healthcare crises. This description may guide other institutions responding to COVID-19 and future health emergencies.

We need to work differently in a crisis: peer-professional leadership to redesign physicians’ work

“…Following this research, the new physician work model was successfully reimplemented during the second wave of COVID-19, 14 which further validates the peer-professional leadership model we report here.…”

“…The PHA coordinates healthcare delivery across the province. 14 The PHA had an existing emergency response plan; however, pandemic preparedness across its five zones varied. In the Calgary Zone, four physician colleagues recognised the existing approach to organising physicians' work risked being overwhelmed by the anticipated surge of COVID-19-related hospitalisations.…”

“…Although the PHA and the DOM collaborated closely to provide medical services at the Calgary Zone's sites, the physicians and organisational leaders recognised that there was no coordinated pandemic response plan to avoid overwhelming hospitals if COVID-19 cases increased as projected. 14 The four physician colleagues thought about solutions and discussed among themselves. Two volunteered the group's insights into their DOM division heads and were subsequently asked to develop a plan for their divisions.…”

“…Ultimately, MEOC designed, implemented and handed over (to the Calgary Zone and the PHA) a new, scalable acute-care pandemic workforce model to organise, staff, train and deploy physicians across four tertiary/quaternary care hospitals in the Calgary Zone. 14…”

“…An earlier paper reports the work model in more detail. 14 Our case study uncovered the actions and process that emerged as physicians and organisational leaders practised distributed 5 and peer-professional leadership to develop a new work model in response to a crisis.…”