Learning to Manage Change Became an Essential Skill During the COVID-19 Pandemic

Amid the stress and chaos of the first months of the COVID-19 pandemic, oncology pharmacists became essential team members for managing change, according to a session at the Association of Community Cancer Centers 38th National Oncology Conference.

In the presentation, Debra Patt, MD, PhD, MBA, FASCO, executive vice president of Texas Oncology in Austin, discussed the effects of rapid change in the oncology sphere as well as lessons learned and potential challenges in the years ahead. Implementing guidelines, managing staffing shortages, and creating novel solutions were 3 major obstacles early in 2021, and Patt said the repercussions from these changes are still echoing now.

In March and April 2020, Patt said oncology evaluation and management visits dramatically decreased. Although there was some recovery later in the year, rates continued to decline and remain low, and they are still suboptimal today. Patt said this decrease in screenings could have a powerful impact on cancer rates and outcomes in the decade ahead.

“Screening is what allows detection of cancer, and early detection saves lives,” Patt said in the presentation.

Patt estimated that approximately 30% of cancers may not have been diagnosed during the pandemic due to the sharp decrease in screenings. Because of this decrease, she predicted stage migration, with patients presenting with more advanced cancers. This migration is likely to result in worsening morbidity and mortality rates.

“This is really concerning for cancer care providers, and I think many of us are already seeing this in our clinics,” Patt said.

In addition to delayed and missed screening appointments, Patt noted significant delays in routine care. Many patients missed routine care due to fear, lack of appointment availability, competing priorities, insurance hassles, financial concerns, or transportation issues. Notably, Patt said many of these concerns disproportionately impacted communities of color during the pandemic.

“If you had any hurdles in your life to navigate, these were further exacerbated by the pandemic,” Patt explained.

Health systems and oncology clinicians also had a myriad of hurdles to deal with, Patt said, including the rapid implementation of guidelines, unprecedented stress on the health care system, and the development of novel solutions. Many new guidelines, such as social distancing, masking protocols, and vaccine mandates, had to be implemented extremely quickly, which strained the already overwhelmed health care system. Furthermore, staffing shortages impacted an already-stressed workforce, and the need for new at-home staffing models led to some confusion and chaos for many health systems.

Patt noted several major takeaways from the management of these competing obstacles. Firstly, communication is key when handling rapid changes in a stressed workforce, although she said there is no one perfect way to manage communication. At Texas Oncology, Patt said they implemented periodic town halls for staff to ask questions, in addition to emails, newsletters, and signs posted throughout the clinic regarding new policies and procedures.

Another major takeaway is the importance of being nimble, both in identifying resources for staff and in reenvisioning staffing solutions. Thinking differently about how to support the workforce will be a requirement for health systems moving forward, Patt said, including new staffing models to help accommodate employees with unique challenges.

“Working from home and digital health care solutions, I think, are part of managing this change moving forward,” she said.

Finally, Patt discussed the implementation of vaccine mandates and challenges that come with these mandates in health systems. Texas Oncology does have a vaccine mandate, and they were in the midst of the implementation process at the time of Patt’s presentation. When looking at other organizations’ vaccine mandates, Patt highlighted encouraging findings. For example, Florida Cancer Specialists had a 94% compliance rate with more than 4000 employees. A key for this success is creating a streamlined process for religious and medical exemptions, as well as a clear deadline for termination of employees who do not comply.

“I don’t think anyone likes the idea of developing a mandate for health care workers,” Patt said in the presentation. “But the imperfect vaccination rates led us to feel compelled that a vaccine mandate was necessary in order for us to improve our compliance numbers.”

The mandate by Florida Cancer Specialists was announced on August 3, 2021. As of Patt’s presentation, 84% of employees were vaccinated and 99% of physicians were vaccinated. Employees with approved exemptions began testing weekly starting October 4, 2021, and the deadline for vaccination was September 30, 2021, for those without exemptions.

Despite all the challenges during the past 2 years, Patt noted a few silver linings and opportunities to learn from the pandemic. First, telemedicine has evolved extremely quickly, and acute care visits can now be managed well virtually, allowing for alternative staffing models as needed to manage ongoing staffing issues. Virtual staffing can also allow for the provision of care in many communities that would not otherwise have access to oncology experts, such as rural and underserved communities.

“In my mind, this is the silver lining of the pandemic,” Patt said. “This is the change emerging out of the crisis that really blossoms into an opportunity for providing cancer care.”

REFERENCE

Patt D. Cancer care’s road to recovery from the global pandemic. Presented at: Association of Community Cancer Centers 38th National Oncology Conference; November 9-10, 2021; virtual. Accessed December 8, 2021. https://www.accc-cancer.org/home/attend/national-oncology-conference/keynote-speakers