COVID-19 Special Report: Lessons in combining compassion with technology

Of the many words used to describe COVID-19, one of the most common is to call it a "lonely" illness. 

Pam Guler (AdventHealth)

In hospitals across the country, seriously ill patients were allowed few or sometimes no visitors, even in the minutes before their deaths. Human interaction was largely limited to brief moments with staff gowned up in full personal protective equipment.

"We had to be very restrictive about who could be in the hospital and the policy really went to a no-visitors allowed for obvious reasons with COVID-19," Pam Guler, chief experience officer at Altamonte Springs, Fla.-based AdventHealth told Fierce Healthcare earlier this summer. "There could be one visitor for an end-of-life situation. There could be one visitor for an OB situation — mom having a baby could have the partner there with her — and then if the patient was a child, they could have a visitor. Other than that, visitors weren’t allowed to keep everyone safer really. This caused obviously this was very difficult for family and friends who have loved ones in our care." 

However, providers across the country mobilized quickly, sending nurses and doctors into patient rooms with devices to allow video calls with loved ones using technology as a crucial bridge for reconnecting with loved ones in their most stressful moments, Guler said. Here's a look at our conversation about lessons learned in the midst of the pandemic when it comes to using technology to bring more humanity into the patient experience. 

Fierce Healthcare: Where are hospitals experiencing in terms of COVID-19 surges?

Pam Guler: AdventHealth serves nearly a dozen states, each uniquely affected by the pandemic. In Florida, where our corporate headquarters and nearly 30 of our hospitals are located, we are experiencing an all-time high number of COVID-19 cases. Since the onset of the pandemic in March, we have had an active command center that has helped effectively organize our response through the fluctuations and developments of the pandemic.

At this point, we are proceeding with the expectation that COVID-19 will be an ongoing part of our business, much like our other service lines. We are carefully monitoring COVID-19 case data, hospital bed capacity, PPE supply levels, employee health statistics and work closely with public health officials to ensure our hospitals are equipped for any present and future surges.

FH: What are your visitation policies now?

PG: Currently, our visitation processes are specific to each hospital, based on their geographic region. Some of our hospitals’ visitation processes restrict visits for COVID-19-positive or [people under investigation] patients to video visits only, which is facilitated upon request by a team member with full PPE. We consider in-person accommodations for patients at end of life regardless of COVID-19 status. We are constantly reevaluating these practices to ensure they best balance the physical, mental and spiritual needs of our patients.

FH: How did providers at your facilities begin creating those video-chat connections in the early days of the pandemic? 

PG: One of our goals was to make that as bearable as possible by helping to connect families with their loved ones who are in our care. Just being on the telephone isn’t enough. One of the first things we really dove into was how do we rapidly scale up the ability to do virtual chats and virtual visits between patients and their families and keeping in mind that patients may or may not have their own devices with them. They may or may not be able to manage the virtual chat on their end. They may or may not be unconscious.

So how do we provide the availability of that? That was really the basis for our virtual visits platform that we rolled out via all of our patient experience leaders across the system. We have about 65 leaders across our hospitals and our campuses that focus every day on the experience that our patients and families and their caregivers are having. I network all of those leaders across our systems and worked closely with those in IT to deploy across our system about 1,000 Chrome-books that would enable — if the patient did not have their own device — the ability to do a virtual chat with family and loved ones who are outside of the hospitals.

There was a lot of IT work to make that as easy as possible when you think of the breadth that we were deploying this.

FH: Why did you go with consumer-facing tools like Google Hangout, FaceTime and Zoom rather than telehealth platforms specifically set up for healthcare settings? 

PG: Really our goal was to make this as easy for folks as possible.

Many people are used to these platforms and one of our goals, especially for our IT folks in setting this up, is to enable this in a way that wouldn’t require a lot of input of personal information on our end to establish the video chat. The families on the other end of the chat were either used to using Google Hangouts or some of these other means and were responsible for setting up their end of the connection. Our experience leaders were really engaged in working with the designated family member ahead of time so if it was identified the family and patient needed a virtual chat — and often we'd hear this from our bedside caregivers or our family members would reach out to our experience leaders directly — we would work with the family to make sure everything would go smoothly in that chat. That they would know exactly what to do and how to be ready to accept the call from us prior to the virtual visit actually happening.

Somtimes our experience leaders would help just before make the connection, and in some cases, would actually be in the patient’s room to hold the device. In the COVID-19 situation, one of the things we’re very careful about is the number of people in the room as well as the use of PPE and making sure that we’re being respectful of not overusing PPEs. So in a COVID-19 situation, typically we would enable the bedside caregiver to take the device in rather than having a different employee or team member bring in that device. There are different ways we ensure that we were very safely and effectively leveraging the virtual visit capability. 

FH: This seems like something you probably didn’t have a protocol for before.

PG: The virtual space is so prominent now that it was natural to think about that. We did not have that in place before all of this. It really made us stop and think, "What can we do to connect these loved ones with their families in a meaningful way?" One being: First, let's get the knowledge that we can help facilitate these virtual visits out there.

And immediately I also led a task force around end-of-life experience for COVID-19 patients and families. A part of that task force and that group’s effort was definitely how do we leverage our virtual visits to help families in that very desperate time. We have so many very powerful stories that are just almost indescribable. A story around having 15 family members on a Google Hangout visit along with their pastor having an opportunity to share words of love with their desperately ill loved one. Other opportunities where a mom and a dad had the opportunity to see and talk to their 20-year-old daughter who, blessedly, had been taken off the ventilator and was doing better. But the mom and dad hadn’t seen her in days. I have daughters. I just can’t imagine that.

There’s something about being able to see your loved one and talk with them or share words of love with them even if they are unconscious or at end of life. The stories are deep and the connections that we have been blessed to be able to make for families during this very difficult time are heart wrenching and at the same time really making a moment for that family that we never would have dreamed would’ve been necessary to do.

FH: You established universal guidelines for empathic language for employees to use, including phrases like "I can’t imagine what you’re feeling." Can you discuss why you did that?

PG: That was a key part of the end-of-life experience task force that worked hand in hand with this virtual visits process. One of the things we strive not to do is to over script this kind of thing. Our caregivers have such compassion for their patients and their families. We don’t want to turn anyone into a robot. But at the same time, there are ways of saying things that can be most helpful when a family is grieving and distressed. So we did provide some guidelines around what caregivers may wish to say or not wish to say without over scripting. This needs to come from the heart. 

FH: Can you share an example of a particular caregiver who went above and beyond? 

PG: There was a caregiver at one of our Tampa Bay Area hospitals who literally facilitated the call that I described with 15 family members and the family pastor on the call. They were able to pray with the patient, share words of love and caring with that patient. In that moment, what I learned of the story, the bedside caregiver got it all established, the experience worker was working with her, she got it established, and realized in that moment she didn’t need to provide any words. It was more, let this family have this time with their loved one and be there. Hearing what that meant for the family and also what it meant to the caregiver. This is one thing that we know this is providing such depth and meaning for our family and patients. It’s also providing a depth of meaning for our caregivers who are there caring for these patients day in and day out and having that opportunity to provide that connection has impacted them deeply. And those stories have been very powerful. 

Another mom was at the end of life and her son found out he was COVID-19 positive. Our experience leader in full PPE actually held a device outside of the hospital while a colleague held a device inside of the hospital an appropriate distance from this young man. He had a chance to tell his mom goodbye. Otherwise, he never would’ve had that opportunity and that moment is just so very difficult to even think about but something that our caregivers have been able to provide while respecting total infection control protocol.

FH: What are the biggest learnings in healthcare from this pandemic you think might stick?

PG: I’ve been talking about virtual visits and patients with visitation policies, but I think the virtual space in general. When you think about telemedicine, we already had an eCare platform where you can have a virtual visit with your doctor. It was a growing service.

And that whole virtual space and how our patients and families have been able o connect in various ways with their own doctors outside of the hospital has been very powerful. A lot more folks now understand the convenience and the benefit of being able to connect virtually with your provider. We see tremendous growth with that already as we’ve been through this cover situation and it continues. As we look to the future we see much potential in being able to expand how we continue to serve the community in that virtual space.

The speed with which we’ve needed to innovate and help our patients, our families and our communities has been unprecedented and its a speed we want to continue with as we look at innovations of the future. That’s a huge learning in all of this as well. A smaller component of all of this large space but the virtual visits for families connecting with their loved ones in the hospital, I see that continuing into the future.

We stood that up very quickly and across a very large system to help with the visitation restrictions. But we get patients every day who have family members across the country who would love to communicate with their loved ones, perhaps in other end-of-life situations where they couldn’t be there. As an experience leader, I really see carrying that capability forward to really continue to make it easy and love our patients and love our families into the future. The work we’ve done around end-of-life experience and bereavement, that work and how we can help our families and patients and caregivers, particularly in a COVID-19 situation like this, we’ve learned so much from that and carrying that forward into everyday application beyond COVID-19 will be very strong.

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