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Ambulatory Practice Creativity: A Necessary Response to COVID-19

By Graham Brown MPH

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Just as global events, world wars and plagues of the past have spurred waves of artistic creativity reflecting the reality and experience of those eras, so too are ambulatory practices now demonstrating operational creativity as a necessary response to COVID-19.  

A sampling of these creative actions is described below, based upon discussions the NextGen® Advisors team has held with healthcare leaders across the country through our outreach to try and understand the impact the COVID-19 pandemic has had on their practices, providers and patients. 

Practices have rapidly deployed and ramped up the use of telehealth and virtual visits.  Prior to the COVID-19 pandemic, there were significant regulatory requirements effectively limiting the use of virtual visits which have been temporarily waived during the period of the national emergency. This relaxing of the rules by Centers for Medicare & Medicaid Services (CMS), followed in most states by commercial payers, has enabled the rapid adoption of telehealth at an unprecedented scale. Providers have demonstrated their creativity by immediately shifting their operating model from face-to-face encounters, quickly developing new workflows, learning how to integrate telehealth tools into their interaction with patients, and developing the resources to teach patients how to use  the tools across a matrix of software platforms and hardware devices.

Many organizations have introduced creative protocols to enable providers to triage patients seeking care, screening them for influenza-like symptoms and directing patients accordingly. In the desire to create physical distance and minimize the risk of community transmission, in-vehicle waiting rooms have supplemented or replaced traditional clinic waiting rooms. In this model, patients call their practice to make an appointment, then at the appointed time phone the practice from their vehicle in the clinic’s parking lot to check-in.  Patients are asked to wait in the relative seclusion of their car until the provider is ready to see them, at which point they are escorted to an available examination room.

In a similar vein, other practices have implemented curb-side visits and drive through testing as a mechanism to refill prescriptions or other straightforward diagnostics for minor acuity care needs. Drive through testing has gained significant adoption, ensuring efficiency, contamination control and safety for clinicians performing COVID-19 tests.  Recognizing the necessity to separate COVID-19 positive patients from others, practices with multiple co-located sites, or site lay-outs with multiple entrances have designating “dirty” and “clean” buildings to serve patients.  Using “dirty” buildings means scarce personal protective equipment (N95 masks versus regular surgical masks) can be allocated to front-line staff interacting with COVID-19 positive patients; as well as limiting the number of staff potentially exposed to the virus.  “Dirty” buildings are then deep cleaned on a regular basis to mitigate against community spread. 

As a stark testament to the risk front-line staff face, some providers have shared that they anticipate that a majority of their clinicians might be infected at some point in time. Leaders have therefore allocated staff into care teams “A” and “B”; having a group of providers work on-site with patients while others work from home providing virtual visits, care coordination and other routine tasks that don’t require a face-to-face encounter in order to reduce the chances of staff contagion.  

Finally, in the true spirit of innovation and creativity, we learned of an organization who utilized the eight 3-D printers on hand to produce the head band component for face shields; pairing those with cut heavy duty plastic, they have been able to manufacture dozens of much needed pieces of protective equipment. During this unique time in our history, it is heartening to learn about and share stories of creativity, resilience and commitment by ambulatory healthcare providers across the country.


Graham Brown MPH

Senior Vice President, NextGen® Advisors

Graham Brown is a principal and senior vice president with NextGen® Advisors focused on transforming care with provider organizations. His practice centers on accountable and value-based care strategy, population health management programs, and technology solutions for providers enabling new models of care delivery across the United States…

Graham Brown is a principal and senior vice president with NextGen® Advisors focused on transforming care with provider organizations. His practice centers on accountable and value-based care strategy, population health management programs, and technology solutions for providers enabling new models of care delivery across the United States.

Mr. Brown is a former senior vice president and national practice leader for population health and clinical integration with GE Healthcare Partners (previously The Camden Group) where he led multidisciplinary client teams in strategy creation, program development, implementation, operations, and performance optimization engagements. He is an experienced leader in organizational development, managed care contracting, and change management initiatives.

Mr. Brown has over 25 years’ experience supporting provider groups, health and hospital systems, integrated delivery networks, and managed care payers to assess, design, contract, and implement systems and structures for population health management. He has worked nationally across the United States and Canada.

Graham completed his undergraduate studies at the University of Victoria, the Emily Carr University of Art and Design, and the Instituto Europeo di Design in Florence, Italy. He is certified in conflict resolution and negotiation by the Justice Institute of B.C. and received his Master of Public Health from the University of Rochester Medical Center.

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