COVID-19 crisis: US Healthcare preparedness - provider workforce

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HSS WEBINAR SERIES
April 2, 2020 | 11amET
COVID-19 Crisis:
US Healthcare
Preparedness –
Provider Workforce

McKinsey & Company 2
We are excited to be here with you today
Gretchen Berlin, RN
Partner,
Healthcare Systems & Services
Co-leader of Provider
Performance Improvement
Meredith Lapointe
Partner,
Co-leader of Provider
Performance Improvement
Li Han
Expert Associate Partner,
Co-leader of Provider Workforce
Excellence
Bryan Hancock
Partner
Global Leader, Talent service line
Dr. Pooja Kumar
Partner,
Leader of the Healthcare
COVID-19 response team
Erica Coe
Partner,
Co-leader of Center for Societal
Benefit through Healthcare
Co-leader of Center for US
Health System Reform
Kana Enamoto
Senior Expert
Leader in mental-health and
substance-use policy, data,
programs, and practice
improvement
Mhoire Murphy
Partner,
Co-leader of Provider Workforce
Excellence

Solving the COVID-19 humanitarian challenge is the top priority. Much remains to be done globally to prepare,
respond, and recover, from protecting populations at risk, to supporting affected patients/ families/ communities, to
developing a vaccine. To address this crisis, countries including the US will need to respond in an evidence-
informed manner, leveraging public health infrastructure and proactive leadership.
This document is meant to help with a narrower goal: provide a summarized fact base on the disease to
date, insights on potential scenarios for the US healthcare workforce, and potential actions stakeholders
may consider as it could relate to needs posed by COVID-19.
In addition, we have developed a broader perspective on implications for businesses across sectors that
can be found here: https://www.mckinsey.com/business-functions/risk/our-insights/COVID-19-implications-for-
business. This supplemental material discusses implications for the wider economy, businesses, and employment;
and sets out some of those challenges and how organizations can respond in order to protect their people and
navigate through an uncertain situation.
For all formal guidance, you can find up-to-date information at CDC’s COVID-19 website, with a section
specific to healthcare professionals or healthcare organizations: https://www.cdc.gov/coronavirus/2019-
ncov/healthcare-facilities/index.html

Disclaimer
This document has been prepared to provide general insights and best practices on healthcare workforce planning in
light of potential scenarios around workforce supply and demand during the COVID-19 pandemic.
Many of the approaches discussed in this document would only be considered in truly emergency capacity situations,
keeping patient and caregiver safety paramount.
This document is not intended to provide clinical guidance or medical advice/recommendations, which should
remain firmly guided by and subject to hospital, local and/or national guidelines and approvals.
Any use of this material without the specific permission of McKinsey is strictly prohibited. McKinsey does not provide
legal, medical or other regulated advice or guarantee results. The perspectives contained herein assume action
consistent with, and in no way are meant to imply that steps be taken contrary to, any applicable laws. Any actions
impacting the treatment of patients and/or clinical decisioning should be vetted by the appropriate quality committees
within your organization. These materials reflect general insight and best practice based on information currently
available and do not contain all of the information needed to determine a future course of action. Such information has not
been generated or independently verified by McKinsey and is inherently uncertain and subject to change. McKinsey has
no obligation to update these materials and makes no representation or warranty and expressly disclaims any liability with
respect thereto.

People are at the core of managing this crisis - with the clinicians
and broader patient care support teams playing indispensable roles
Healthcare stakeholders are going to need to think differently about how to solve the
workforce challenge posed by COVID-19
COVID-19 patient
care ecosystem
Lab, imaging, pharmacy specialists
Clinical specialists (e.g., respiratory
therapist, mental health professionals,
case managers)
EVS and care support
Physicians
Nurses
PCTs / CNAs
First responders
Advanced Practice ProvidersAdministrators

Table of contents:
Provider workforce
Dynamics at play for healthcare workforce
Creating and supporting incremental capacity
Longer term implications and considerations

Healthcare workforce is complex and different categories
of employees will have different needs during this time
The impact of disruption and potential strategies to mitigate will differ by category
Category Description Key considerations
Category 1:
COVID Caregivers
Workers who are fulfilling the need for current health
system demand related to COVID-19
(e.g., hospitalists, critical care physicians, ICU RNs,
security at the hospital, lab technicians, care
managers)
Demand is high: Creating additional capacity is critical, through flexing up, contract labor, activating
cross-trained personnel
Supply is strained: Large increase in strain on workforce with childcare, quarantine and other factors
Ensure there are strategies in place to avoid burnout
Category 2: Other
Caregivers
Workers who are caring for patients / other populations
not related to COVID-19
(e.g., speech language pathology techs, orthopedic
surgeons, clinic receptionists)
Many patients will still require life-saving and critical maintenance care, requiring healthcare workers
to continue working but potentially in creative ways (e.g., more telehealth, sanitization efforts in
care sites, home care support)
Physician and others’ productivity will be impacted which may raise questions and concerns around
areas such as compensation
Some caregivers’ skills may be useful in COVID-19 support and all hands on deck approach may be
needed with some flexing / re-skilling
Category 3:
Workers with
likely reduced
demand
Workers who are potentially under-employed or
unable to work their usual jobs because of COVID-
19
(e.g., researchers in closed labs, food workers at
closed site, home health workers)
High anxiety over job security, ability to make living wages (especially among hourly employees);
clear messaging will be needed to manage panic and show support
Need to be creative in thinking through how to mobilize some of these employees in a productive
way (e.g., supporting community programs, trainings etc.)
Considerations around flexing down of staff and/or use of furloughs where necessary
Category 4:
Workers who
must work
differently
Workers who are less impacted by COVID-19 directly
(i.e. can do same work done from home)
(e.g., administrators, coders etc.)
Tools to complete work and new ways to stay connected will be needed; likely reduction in
productivity can be expected in several areas
Considerations around how to flex staff and ensure some of “business as usual” continues so
support functions can continue to operate
Current as of April 1, 2020
These perspectives are intended to build from CDC and other guidance based on operations and management experience. Please continue to consult CDC, state health department, and medical societies for the most up-to-date
guidance. These perspectives are not intended as a substitute for professional medical advice, diagnosis or treatment. Any actions impacting clinical decisioning should be vetted by the appropriate quality committees within your organization.

Preparedness to address a set of unique challenges
in workforce readiness is critical during the COVID-19 crisis
Across a spectrum of healthcare workers
Workforce
focus
Category 1 Category 2, Category 3 All Categories
Workforce morale / “burnout”Workforce readiness / flexingWorkforce shortages
Challenges Work-related: over work and fatigue (e.g., staying
in-hospital for extended periods); anxiety from
infection risk for self and others; resource
constraints / difficult work environment (e.g., re-
using of PPE); patient losses and “war-like”
decision-making needs (e.g., which patients to triage
for limited ICUs)
Systemic: Increase in other duties (child care, sick
care etc.); lack of community support (e.g., in
prevention of infection, reducing burdens etc.); loss
of productivity from change in structure (e.g., WFH)
Guidance and communication: rapidly evolving
evidence-base for COVID-19 with new information
daily; non-centralized, disparate communication on
roles
Flexing and re-skilling: shift restrictions (hourly
and weekly restrictions); licensure ceilings (e.g.,
who can work in ICUs); time and resources for re-
skilling (needed to train in ventilator mgt.); lack of
readiness for using tech in pandemic situations
(e.g., e-ICUs, management of moderate symptoms
by phone etc.)
Increasing capacity: unsuitability of traditional
methods such as travelers (e.g., travel restriction,
global demand); difficulty in rapidly engaging non-
traditional sources (medical students, IMGs, retired
HCPs) due to regulatory, legal, patient safety issues
Reducing losses: expected COVID-19 infection of
HCPs; burnout / fatigue of frontline workers; non-
clinical imperatives for workers (childcare, elderly
care etc.)
Solutions Support for HCPs in-house (e.g., food, childcare,
online resources on working in this environment etc.)
Community support for HCPs – for childcare,
grocery pick-up, etc.
Proactive mental health support for HCPs
Centralized information from nerve center
Re-structuring shifts to improve efficiency
Identifying and flexing providers who can move to
category 1 (e.g., double boarded physicians, nurses
with ICU experience etc.)
Creating rapid re-skilling materials (e.g., e-learning
for vent mgt.)
Optimizing virtual health
Identify senior medical and surgical residents who
can be transitioned to independent practice
Policy changes to increase pool of providers (e.g.,
rapid license issuing)
Prioritizing of infection control (e.g., PPEs, public
education etc.)
Working with FEMA / support organization for
systemic response
Structure support systems for childcare, eldercare
etc.
Non-exhaustive

Stakeholders are already coming together to deploy a
number of tactics
Source: Wall Street Journal, CNN, The New York Times, Time.com, Fiercehealthcare.com, Uber.com, AP News, expert interviews March 2020
Protect health and safety of
employees
Initiating safety precautions – e.g.,
PPE rationing and PPE usage
protocols in event of shortage
Designing segregated areas for
COVID-19 cohorts to prevent
contamination to other departments
Seeking PPE donation from other
healthcare specialists and the public
Restricting visitors at hospitals
Shifting more to telemedicine
where possible
Crowdsource workplace issues and
best practices for fighting COVID-19
among healthcare workers
Create additional workforce
capacity
Hiring temporary nurses and
medical workers
Asking employees to volunteer
more shifts
Building volunteer lists and staff
databases that can fill workforce
gaps at hospitals (retirees, those in
different professions)
Enlisting medical school students
for nonpatient-facing duties (e.g., call
center triage, pharmacy support,
blood donation support) with
supervision
Provide solutions beyond the
scope of traditional
employee support
Identifying and offering child
care services for healthcare
workers (through own resources
or partnerships with
cities/municipalities) in
compliance with standard group
size limits
Providing housing
accommodations for employees
during quarantine or who want to
ensure a separate living place to
avoid potentially exposing family
members to COVID-19
Keep morale up and prevent
burnout
Increasing system-wide
communication/engagement (e.g.,
townhalls, question hot lines, etc.)
Showing public recognition and
support for healthcare workers from
broader society (e.g., recognition
posts on social media, healthcare
worker applause campaigns)
Increasing access to behavioral
health resources (e.g., Ginger
offering U.S. health systems free
behavioral health coaching through
June 2020)
Providing meals (e.g., UberEats,
Sweetgreen offering free meals to
healthcare workers and first
responders)1
Not Exhaustive
Examples of recent initiatives and efforts to support healthcare workforce
1 On 3/16, Uber Eats committed to 300,000 free meals in US and Canada; As of 4/1, Sweetgreen has delivered 10,000 meals to hospitals across the country and is
partnering with World Central Kitchen with a goal of serving over 100,000 meals.

Table of contents:
Provider workforce

We expect demand to exceed the current supply of workforce in
many areas of the country
Illustration of factors impacting clinical FTEs during COVID-19 epidemic
KEY TAKEAWAYS
Healthcare worker shortage in any region
influenced by
 Infection rate by COVID-19
 Call-out rate
 Availability of specific types of roles (e.g.,
across physicians, nurses, RTs)
 Setting – urban or rural (e.g., population
density, healthcare infrastructure)
Certain levers may help alleviate
workforce constraint
 Utilize overtime, which could be enabled
by health, safety and support for family /
dependents
 Redeploy other available staff,
supplemented by upskilling and new team
based care models where appropriate
 Expand pool of staff by re-hiring former
practitioners, bringing back retirees,
seeking caregivers from outside of
geography, etc.
Nurse FTE likely reduced during COVID-19
due to infection and call-outs
Certain levers can help improve workforce
capacity, but still expect to be a shortage
Base /
normal
nursing
workforce
Loss in
workforce
due to
COVID-19
infection
Loss in
workforce
due to
call-out
Remaining
nursing
workforce
available
Flex up with
additional
shifts,
overtime
and contract
labor
Remaining
shortage
Expand
total pool of
staff beyond
immediate
workforce
Redeploy
other staff,
with up-
skilling and
new team
based care
models
Higher than
normal nurse
workforce
needed during
COVID-19
Illustrative ONLY
These perspectives are intended to build from CDC and other guidance based on operations and management experience. Please continue to consult CDC, state health department, and medical societies for the
most up-to-date guidance. These perspectives are not intended as a substitute for professional medical advice, diagnosis or treatment. Any actions impacting clinical decisioning should be vetted by the appropriate
quality committees within your organization.

Many geographies are likely to experience shortages in
staff at peak COVID-19 demand scenarios
20
0
60
40
20-3010-200-10 30-40 40-50
Current capacity
 Use existing ICU
and acute care beds
only
 No conversion of
beds
Assertive capacity
 Convert other beds
for ICU and acute
care use
Scenario 1
(2% attack rate2, “Wuhan” ramp up curve)
Bed
resource
capacity
Scenario 2
(15% attack rate2, slow ramp up curve)Gap analysis to follow
Demand for nurses1 Base case supply of nurses1
0
20
40
60
10-200-10 20-30 30-40 40-50
0
20
60
40
0-10 30-4010-20 20-30 40-50
20
60
0
40
30-4020-3010-200-10 40-50
Workforce gap
Workforce gap
Workforce gap
Workforce gap
(thousands of workers)A
B
C
D
EXAMPLE FOR AN ILLUSTRATIVE METRO AREA
CRITICAL & ACUTE CARE NURSING EXAMPLE
1. Includes nurses in both critical care and acute care settings. Base case supply of nurses assumes there will be reduction due to infections & call offs, but no overtime and no redeployment of resources
2. Proportion of confirmed cases compared to total population
Source: McKinsey’s COVID-19 Workforce Capacity model
(days)
(thousands of workers)
(days)
(days)
(days)

Model A
 Disease: 2% attack rate2
and Wuhan ramp up
 Current bed capacity: use
existing critical care and
acute care beds only, no
conversion
Model D
 Disease: 15% attack
rate2 and slow ramp up
 Assertive bed capacity:
convert additional beds
to critical care and acute
care needs
~35K
~62K
Forecasted
workforce demand at
peak period
Count of nurses1
1. Includes nurses from both critical care facilities and acute care facilities; length of peak period is set at 10-day interval
2. Proportion of confirmed cases compared to total population.
Includes overtime
only
Includes overtime
and clinician
redeployment
Base Case, with
reduction due to
infections & call offs
~24K
(68%)
~22K
(62%)
~15K
(41%)
~44K
(72%)
~39K
(63%)
~27K
(43%)
Even by flexing these levers, significant workforce
gap exists to be planned for
1 2 3
Shortage of nurses at peak demand (# and % of need unfilled)1
EXAMPLE FOR AN ILLUSTRATIVE METRO AREA
CRITICAL & ACUTE CARE NURSING EXAMPLE
Preparing for flex capacity may help meet the gap, but will require
taking action now
Source: McKinsey’s COVID-19 Workforce Capacity model

Options to address: Example staffing levers with potential to create
flex capacity in the system in emergency situations
 Minimize staff infection rate through established protocols, training, and support
 Manage staff call-out rate by providing assistance in non-work related matters
— Concierge-like help with childcare, family care, living arrangements, etc.
— Physical, psychological, and emotional support and consultation
 Expand use of overtime where possible
 Hire additional contract agency resources
 Productivity enhancements (e.g., tele-consults and remote monitoring, discharge planning, care models)
 Redeploy healthcare professionals across regions, potentially tapping into furloughed
healthcare employees from other areas
 Where appropriate, retrain or upskill healthcare professionals from other settings or
specialties and incorporate as part of new team based care models
 Reactivate trained healthcare workers who are not working in healthcare
 Tap into pool of recent clinician retirees
 Increase connection to clinicians in training programs (e.g., nursing, medical schools) to support
appropriate roles
 Address staffing needs beyond critical care clinicians, including behavior health professionals,
logistics providers, and more
Fully deploy
current staff to
current roles
Redeploy other
capable staff to
new roles
Expand pool of
total available
staff
Flex levers will need to be
accompanied by staff training
and oversight/support, as well
as legal protections
1
2
3
NOT EXHAUSTIVE
Risks and tradeoffs
must be thoroughly
evaluated for all levers

1: Childcare and other ‘outside of work’ support services can help
reduce staff call-out and enable overtime
Health systems and hotels
providing lodging for workers
who don’t want to and/or cannot
go home due to risk of exposing
other people (e.g., elderly parents,
immunocompromised spouse or
children)
Caregiver platforms and
childcare services providers
working on new programs
Source: Wall Street Journal, The New York Times, New York Post, wkow.com, Fiercehealthcare.com, expert interviews March 2020
Local daycares staying open
for children of healthcare /
essential – supporting
maximum of 10 children, in line
with “Shelter in Place” order
Crowdsourcing to match
caregivers to needs on local
social medial platformsPrivate companies convert
office space into 24/7 daycare
centers; have staff ensuring
safety, hygiene, and nutrition for
children
NOT EXHAUSTIVE

 Family Med. - Adult Medicine
 Internal Med. - Endocrinology, Diabetes
& Metabolism
 General Practice / General Family Med.
 RN – Rehabilitation
 RN – Community care
 RN – Case Management
Group 3:
Healthcare professionals with
related skills requiring
upskilling to cover components
or some of the skills needed
 Surgery - Surgical Oncology
 Surgery - General Surgery
 Internal Med. - Hematology & Oncology
 Internal Med. - Cardiovascular Disease
 Internal Med. - Infectious Disease
 RN – Oncology
 RN – Med / Surg / Tele
 RN – LTAC
Group 2:
Healthcare professionals
with complementary or partial
skills who could flex into roles or
partial roles needed
Group 1:
Healthcare professionals
currently doing this work and well
versed in skills needed
 Intensivist
 Anesthesiology - Critical Care Medicine
 General Emergency Medicine
 RN – Critical Care (ICU,
Medical ICU, SICU, CVICU,
Specialty ICU, etc.)
 RN – PICU
 RN – Step down
Nursing role examples:Physician role examples:Groups of suitable roles
Critical Care (ICU) Example
Sample Skills needed: Managing patients on ventilators, managing critical care plans, inserting central lines
2: Example healthcare workforce groups that may readily, or to some
capacity, flex to support demand in emergency scenario
NOT EXHAUSTIVE: EXACT LIST WILL BE HIGHLY DEPENDENT ON CARE MODEL AND TRAININGS
 Respiratory technician
 RN – Med / Surg / Tele
 RN – Pulmonary
 RN – Critical Care (ICU,
Medical ICU, SICU, CVICU,
Specialty ICU, etc.)
 RN - ED
 Respiratory therapist
 Nurse anesthetist
Resp. Therapist examples:

3: Calls to action to ‘expand the pool’
Example from New York State
 To collect qualification information, NY State Health Department
website hosts a survey for healthcare professionals and medical
schools
 More than 50,000 people have heeded the governor’s call for
assistance, including 2,300 physicians, 16,300 RN, 900 physician
assistants,160 respiratory therapists, and 8,600 mental health
professionals
 Governor announced initiative to create reserve
workforce of healthcare professionals "on call" for
coronavirus response
 Initiative called for support form individual healthcare
professionals, as well as medical schools and public
health schools
 New York Department of Health will also accelerate
recertifications to expedite the process
Source: CBS news, New York Department of Health
Other states similarly taking
action (e.g., CO, IL, CA)

Example Federal actions1 (non-exhaustive)
Flexibility in working across state for Medicare and Medicaid
Waiver to allow providers to render services outside of their state of enrollment
for both Medicare and Medicaid
Flexibility in enrollment for Medicare
Blanket Medicare waiver to simplify provider enrollment (e.g., waive of
background checks, application fee), with equivalent Medicaid waivers upon
request by states
Telehealth reimbursement for Medicare FFS
CMS announced Medicare FFS would reimburse telehealth services at the
same rate as in-person for many common office visits, with no restrictions on
patient location
Limit liability for volunteer healthcare professionals during COVID-19
emergency response (Cares Act)
Additional provisions (CMS and Cares Act) facilitating healthcare worker
benefits, transfer of patients, top of license performance, ease of
documentation, and more
Example state actions (non-exhaustive)
Flexibility in enrollment for Medicaid2
Florida and Washington states have successfully applied for Medicaid waivers
to simplify provider enrollment (e.g., waive of background checks, application
fee)
Waiver of state licensing requirements for out-of-state providers
Examples include:
Washington3 – allows registered volunteer healthcare practitioners verified to
be in good standing in all the states where they are licensed to practice in
Washington without obtaining a Washington license4
Tennessee5 – allows healthcare professionals licensed in another state to
practice, if they are assisting in the medical response of COVID-19, upon
discretion of the Commission of Health
Waiver of state licensing requirements for retired providers
Example include:
Illinois6 – Physicians whose licenses are expired or inactive for less than three
years can temporarily restore their license, for no fee or continuing education
requirement7
2/3: Government actions in
response to capacity
constraints – Workforce
1. CMS Guidance, March 13 2020 https://www.cms.gov/files/document/covid19-emergency-declaration-health-care-providers-fact-sheet.pdf
2. Florida State’s Approval Letter March 16 2020 https://www.medicaid.gov/state-resource-center/downloads/fl-section-1135-appvl.pdf
Washington State’s Approval Letter March 19 2020 https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/federal-disaster-
resources/?entry=54022
3. Washington Medical Commission https://wmc.wa.gov/news/emergency-volunteer-health-practitioner-act-activated
4. Once activated and assigned by the state's Department of Health
5. Tennessee executive order https://publications.tnsosfiles.com/pub/execorders/exec-orders-lee14.pdf
6. Illinois state news https://www2.illinois.gov/Pages/news-item.aspx?ReleaseID=21290
7. To work under the direction of Illinois Emergency Management Agency ("IEMA") and the Illinois Department of Public Health ("IDPH") or in a long-term
care facility, hospital, or federally qualified health center ("FQHC")
Current as of March 23, 2020

PPE best-practices
Targeted skill
building
On-boarding and re-
entry to IP medicine
and critical care
Types of training Description Audience
Guidelines and effective use
Personal sanitation
Intubation
Ventilator management and patient care
IV maintenance and infusion therapy
ARDS
ACLS
Critical care patient management
COVID-19 patient management
All audiences
Alternative care
sites
Management in field setting
Patient triage and diversion
Potential provider
CDC
Administrators
Volunteers
Attending physicians
EMTs
FEMA/HHS
Physicians or nurses being
upskilled or flexing across
settings
Inactive physicians and
nurses re-entering the IP or
critical care environment
Leading public or private
health systems
American Red Cross (ACLS)
Medical associations and
accreditation bodies (e.g.,
ANA, AACN, AMA, SSCM)
Medical or Nursing school
faculty
NOT EXHAUSTIVE
2/3: Examples of potential upskilling / training needs during
COVID-19 emergency situations
SOURCE: Expert interviews March 2020

Table of contents:
Provider workforce

4 steps organizations are considering as they manage their way
through the Covid-19 crisis
Implications
for broader
business
Step 1
Resolve
Determining the
scale, pace and
depth of action
required
immediately at the
state and
business levels
Keep all
employees safe,
and well informed
while ensuring
business
continuity
Step 2
Resilience
Formulating the
broader resilience
plans to manage
the shock that
begins to upturn
established
industry structures
Manage resources
carefully, while
adopting a
through-the-cycle
mindset
Step 3
Return
Returning
businesses to
operational health
after a severe
shutdown and to
manage around
the risk from a
second surge
Support
employees in
getting work done,
productively and
with strong
engagement
Implications
for talent
leaders
Step 4
Reimagine and
Reform
Learning from the
plethora of social
innovations and
experiments, and
identifying which
innovations, if
adopted, might
provide substantial
uplift to economic
and social welfare
Rethink operating
model and ways of
working in the next
normal
Critical near
term focus Looking ahead

Using learnings from COVID-19 crisis to faster track training and top of license focus for clinicians
Hard-wiring approach for future healthcare workforce planning (e.g., estimate number of staff
needed, sourcing from pre-qualified reserve staff with more regular ‘true ups’ / skills training,
determination of emergency staffing model) in response to future emergency crises
Partnership opportunities sparked by new collaborations / resourcefulness (e.g., public as a more
active participant in healthcare workforce, private sector resources)
NOT EXHAUSTIVE
Looking ahead: Potential themes to consider for longer term
healthcare workforce needs
Resilience Planning and support for workforce needs in impacted non acute locations (e.g., dialysis, long term
care, home health)
Return
Reimagination
and reform
Preparing to support increased needs for behavioral health services (e.g., use of peers, tele-
support, enhanced consultation/screening) in post COVID-19 recovery (for caregivers, patients,
families) and communities (as economic effects take hold)
Workforce implications given emergence of modern tools and technologies (e.g., telehealth,
remote workforce, self-diagnostic apps, artificial intelligence and chatbox) as a more permanent
part of care pathway and patient/caregiver expectations
More permanent, mobile-friendly e-tools to enable rapid, supportive, staff communication and
engagement; pursuit of additional approaches to support caregiver healing post-crisis

Q&A and reflections
from entry poll

Appendix: Provider checklists

Detailed checklist: Clinical workforce (1/2)
COVID-19 risks exacerbating the current national shortage of healthcare (nursing) workers
Monitoring and protecting workforce healthShifts in staffing supply
These perspectives are intended to build from CDC and other guidance based on operations and management experience. Please continue to consult CDC,
state health department, and medical societies for the most up-to-date guidance. These perspectives are not intended as a substitute for professional medical
advice, diagnosis or treatment. Any actions impacting clinical decisioning should be vetted by the appropriate quality committees within your organization.
Develop clear action plan for staffing to ensure full coverage
in case of demand surge (e.g., reduced workforce supply,
increase demand from disease), including plans for:
 Recruiting and training additional labor
 Uptraining or cross-training personnel for appropriate
specialty skill set
 Ensuring adherence to union/labor contracts (e.g., liability
insurance, temporary licensing)
 Delivering just-in-time training where appropriate
 Identifying local support measures (e.g., travel, childcare,
care for family members) to enable staff flexibility for shift
reassignment and longer working hours
Consider extra safe-guards/isolation for staff who are pregnant, immunocompromised, cannot
wear PPE for extended periods or are the sole caregiver of dependents from treating high
risk/COVID-19 individuals
Establish protocols and processes for employees around:
 Monitoring (e.g., self-monitoring with delegated supervision, active monitoring for fatigue
and ulcers from extended PPE wear) and reporting protocol
 Rapid detection and evaluation (e.g., when symptomatic)
 Quarantining enforcement protocol (inpatient and at-home)
Deploy latest CDC/public health recommendations on means, need and duration for
continuously monitoring employee symptoms
Ensure effective systems of behavioral health support and self-care to mitigate / address
healthcare workforce fears, distress, anxiety and fatigue

Detailed checklist: Healthcare workforce (2/2)
COVID-19 risks exacerbating the current national shortage of healthcare workers
These perspectives are intended to build from CDC and other guidance based on operations and management experience. Please continue to consult CDC,
state health department, and medical societies for the most up-to-date guidance. These perspectives are not intended as a substitute for professional medical
advice, diagnosis or treatment. Any actions impacting clinical decisioning should be vetted by the appropriate quality committees within your organization.
Using CDC guidelines, source / develop and deliver accurate training to all care
personnel on COVID-19 response protocol in multiple formats, including:
 Clinical guidelines (e.g., screening, treatment, isolation, transport)
 Patient communication scripting around diagnosis, evaluation, treatment,
quarantine etc.
 Infection control (e.g., donning/doffing PPE, N95 fittings, waste management)
 Laboratory specimen collection and handling/waste
 Hospital Incident Command System
 Internal and external communication
Regularly test and strengthen staff knowledge on critical areas
 Periodic relevant drills / exercises for pathogen outbreak
 Individual knowledge assessments
 Surveillance testing (e.g., “mystery patient”)
 Update hospital staff contact list
 Establish system to monitor staff absenteeism, including contingencies
for ill or injured
 Ensure staff are up-to-date on appropriate immunizations
Training and education General human resource management

COVID-19 crisis: US Healthcare preparedness - provider workforce

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