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Table 2 The workgroup foci of activity

From: Adapting to change: Clalit's response to the COVID-19 pandemic

Workgroup I—An appropriate response for COVID patients: The focus of this workgroup’s activity was split between the hospitals and the community
  Hospitals Community
Areas of focus The preparedness of the hospitals to provide an appropriate medical response to COVID patients, according to the scope of hospitalization expected in the national scenario Planning of an appropriate medical response for mild COVID patients and the quarantined who would be cared for at home or in hotels, according to the national reference scenario and including:
- Establishment of routines for tracking and continuous communication
- Defining of remote/personal monitoring and communication
- Planning of a structured response to non-COVID medical problems among the quarantined and among COVID patients
  Hospital infrastructurepreparation of designated care stations; electricity, oxygen, monitoring and care infrastructure  
- Defining a quantitative target for the number of staff required (based on the assumption that some of them would be under quarantine or would become infected with COVID): physicians and nurses; and identification of critical staff, such as intensive care nurses and respiration technicians
- Setting of a target for training of hospital staff in ventilation and appropriate use of protective equipment
  EquipmentDefining optimal inventory levels for protection equipment, respirators, monitors, and ECMO machines (according to consumption estimates based on the national scenario)  
  Definition of designated care paths in the hospitals  
  Adoption of professional care guidelines – uniform care protocols for all of the Clalit centers  
Workgroup II—An appropriate response for non-COVID patients: The focus of the workgroup’s activity was split between hospitals, the community and organization-level capabilities
  Hospitals Community Pan-organizational
Areas of focus Preserving pan-organizational capabilities in order to provide an appropriate medical solution to non-COVID patients in the ERs/wards/operating rooms/intensive care: Defining a structured, proactive and hybrid (virtual and in-person) response in primary and consultative care for defined groups:
- Chronic patients
- Elderly patients at home under quarantine
- Homecare patients
- Seriously ill patients
Preparations will include the creation of "smart lists":
Identifying defined beneficiary groups based on Clalit's big-data models, which will make it possible to proactively contact them for the purpose of conveying information and offering services (both physical and virtual) that are suited to their needs
For each group of patients, the planning of a response in the following areas:
- Medical needs, such as the system of medical monitoring and tracking, the distribution of pharmaceuticals to the patient’s home, etc
- Social, mental and logistic needs; providing an organizational response to mental health needs; and proactive tracking of socially isolated patients
Planning of a pan-organizational response in order to minimize excess morbidity, including the combining of forces between the community and the hospital:
  Defining designated “clean” treatment paths—Processual and physical separation, planning of stages for the opening of COVID wards and the continued operation of the other wards in parallel   Acceleration of discharge from hospitals into the community including a clear definition of the transfer process, the reinforcement of the hospital-community liaison staff and expansion of homecare units
    Expansion of spatial activity (in the geographic region in which the hospital and the Clalit district are located) by means of defining work processes and treatment paths that connect between the hospital and the region it serves
  ManpowerDefining the required levels of manpower; assignment and training of manpower in order to achieve an appropriate response for non-COVID patients   National information campaigns in order to counter the reluctance of the public in seeking emergency medical treatment
    Defining designated indexes of quality for COVID treatment (indexes of treatment continuity, frequency of initiated contact with homecare patients, etc.)
  Hospital outreach in the community—Shifting of physical and virtual services to outside the hospital and making them accessible to the general public for consultative medicine and urgent ambulatory treatment (such as virtual operation of the hospital clinics, outsourcing services into the community such as mobile eye injection units, etc.)   
Workgroup III—Solutions for the medical staff:   
  Minimization of the number of infected and quarantined staff members The organizational solution to minimize burnout, to support the individual employee and to maintain employee trust in the organization
Areas of focus - Defining clear and structured work processes in patient care
- Appointment of an institutional COVID coordinator, who will be responsible for revising the Corona procedures in a healthcare institution, the familiarly of the staff with the revised procedures and instructions, and supervision of their implementation
- Prioritization of COVID screening tests and protective equipment
- Formulating a plan for conveying information and intra-organizational messages to employees in a continuous and transparent manner
- Help desk for employee use
- Focus on the individual—an organizational solution for family and economic problems, childcare and problems involving other members of the family
- Consideration of employment flexibility and remote employment models
- Increasing the number of employees trained as caregivers by shifting manpower from other relevant institutions and professions
- Shifting of employees not directly involved in patient care to social or logistic tasks
Workgroup IV—Preparing for the “day after”:  
In parallel to the provision of solutions in the short and medium terms and based on the understanding that we are witnessing deep-rooted changes, this workgroup considered how Clalit should prepare for a period of “COVID routine”, which was expected following the conclusion of the first wave of infection. The workgroup began by creating an initial mapping of the long-term implications of the COVID-19 pandemic in order to provide answers to the following questions:  
  1. Which elements of Clalit’s internal and external environments can be expected to change significantly in the future?  
  2. How will the national exit from the first wave of infection and the shift to a “COVID routine” affect the achievement of Clalit’s current strategic goals and what are the risks that Clalit will face with the shift to a “COVID routine”?  
The product of this workgroup’s activity was used by the Clalit management to revise long-term strategic directions, as described in Sect. 2