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Key messages for the post-pandemic world

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Interview with Prof. David Nash, founding dean emeritus of the Jefferson College of Population Health (JCPH) of Thomas Jefferson University and the Dr Raymond C. and Doris N. Grandon Professor of Health Policy, Philadelphia, U.S.

Named as one of the Most Powerful Persons in Modern Healthcare, Prof. David Nash, founding dean emeritus of the Jefferson College of Population Health (JCPH) of Thomas Jefferson University and the Dr Raymond C. and Doris N. Grandon Professor of Health Policy, Philadelphia, U.S., will be participating at the upcoming Patient Safety virtual event. Prof. Nash has achieved wide acclaim for his COVID-19 thought leadership and will be speaking at the session titled ‘Population Health BC and AC – Before COVID & After COVID’.

In an interview with Omnia Health Magazine, Dr Nash shared that the presentation will cover four key topics. “During the height of the pandemic, some of the hospitals in the U.S. were using an incident command structure, which is essentially an emergency structure that has several important themes built into it. This includes a daily huddle, or multiple times a day, where all the leaders get on a call together to talk about how things are going. Another component of the structure is issuing regular guidelines for care, as they are important in day-to-day quality and safety to improve performance. Evaluation, feedback, closure of the feedback loop, all of these things are very relevant to the quality and safety agenda.”

He highlighted that in the U.S. there has been some evidence of diffusion of an incident command culture, post-COVID-19. This means that things that worked can be carried over in non-emergency situations as well to improve patient outcomes.

Secondly, the U.S. is going to see a growth in integrated delivery systems and hospital mergers. “Many hospitals suffered terrible economic losses and layoffs,” he said. “It’s ironic that in the middle of a public health emergency, hospitals were laying off people. As a result of the financial strain, we’re going to see weaker hospitals join larger systems. But this does not guarantee that quality and safety will improve.”

Thirdly, there needs to be a recognition of the social determinants of health, factors that have affected the society the most in the COVID-19 era and have had a huge impact on health. This is especially true for poor countries that might not have the resources to tackle the pandemic, and the people who have suffered the most are the poor and minority communities in almost every country. “The impact of COVID-19 can’t just be determined by tests, procedures and laboratory results. It has to do more with poverty, lack of education, crime, drug abuse, depression, and loneliness, among other factors. Global recognition of the social determinants of health is paramount,” he added.

Lastly, the session will also touch on the struggle between public health and the healthcare system. Dr Nash explained: “When public health is working, we don’t pay any attention to it. This refers to access to clean water, ensuring restaurants are safe, the air is clean, people have vaccines for all the previous infectious diseases, so public health operates quietly in the background. But it’s severely underfunded, especially in the U.S. For example, the national U.S. healthcare spending per person is roughly US$10,000 per person, including children annually, while total public health spending per person in the U.S., in 2019, was US$275. That’s why it is no surprise that the public health system got crushed by COVID-19. It failed because it was destined to as it was so severely underfunded and under-appreciated. We are now hoping for a convergence of the public health and healthcare system in the post-COVID world.”

Army of first preventers

Dr Nash has been an advocate of creating an “army of first preventers”, people who work in the community and are focused on prevention. “It means we should focus on preventing illness rather than always taking care of people after they’re sick. The focus should always be on prevention. So, instead of first responders, we should be speaking to our first preventers,” he explained.

He also spoke about contact tracing and how most people hadn’t heard of until the pandemic.

“Contact tracing has been around for more than a century. It’s a proven technology and a well-established basic tool for improving public health. Unfortunately, the U.S. was totally unprepared to do contact tracing,” stressed Dr Nash. “People had not been trained, and most people were scared of it, as it seemed too intrusive.”

He gave the example of China, where one of the reasons for their success was the contact tracing they carried out through technology, with their cell phones. An average Chinese citizen would be tracked and photographed every day, which citizens in the U.S. would never tolerate. “We would view it as a totalitarian state. On the other hand, it’s a very successful tool for isolation and quarantine. Do you want your freedom, or do you want to stop COVID-19? It’s a culture clash,” he added.

Digital transformation

Telemedicine is a big new market that can greatly help with mental health, especially in the U.S. where there is an acute shortage of mental health workers, said Dr Nash. “During the pandemic, there was a real exponential increase in people accessing telehealth. It is a big business now, which was pretty sleepy before the pandemic.”

He also shared that the Jefferson College of Population Health has a population health intelligence course, a broad term that includes big data, analytics and predictive analytics. “While we need the collection and analysis of the data, we also need actionable items from it,” he stressed. “You need to get information from the data. The tools to derive actionable information include artificial intelligence and predictive analytics. Multiple companies in the U.S are taking advantage of this, which is exciting. I think it’ll be far more widespread in 2021 and 2022 than it is now.”

When asked about how the post-COVID-19 world should look like, he concluded: “We need better leadership; people who can put their ego aside and stimulate teams. We need people who are optimistic about the future, despite the challenges. We need leaders who can look beyond the immediate situation and have a long-term vision.

“I hope that we can have better international cooperation to fight the next pandemic, which will inevitably occur. I am hoping for improved communication and cooperation and better preparedness. We will also see a greater interest in public health.”

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Dr Nash will be in conversation with Dr Samer Ellahham, Regional Chair, Middle East Patient Safety Movement Foundation; Director, Accreditation; Cardiology Consultant, Cleveland Clinic Care Giver, Cleveland Clinic Abu Dhabi, at a session titled ‘Population Health BC and AC – Before COVID & After COVID’, on Thursday, November 5, at Patient Safety

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