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From curbside to inside: Strategies for the beginning of back to normal

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Things are a long way from being anywhere near back to normal, but with many states starting to relax stay-at-home orders and allowing businesses to gradually begin reopening, employers and staff alike are wondering what that’s going to look like.

Animal hospitals are no exception.

While many have been fortunate enough to continue doing business by adapting to social distancing needs—whether through telemedicine or curbside service—going back to the way things were is going to require having some kind of plan in place. NEWStat spoke with the owners of three successful AAHA-accredited hospitals in different parts of the country to find out how they planned to transition from curbside to inside and see what advice they might have for their colleagues.

Collaborate with the entire team

“A big component to the decisionmaking will come down to the geography of the practice location and how hard they were affected,” said Julie Reck, DVM, owner of AAHA-accredited Veterinary Medical Center of Fort Mill, South Carolina, and cofounder of Aspire, a veterinary management– and leadership-training consultancy and a partner in AAHA’s Culture Initiative. “I am also seeing a big difference between states in how they’re reopening. Some states are providing lots of guidelines and timetables, and others, like South Carolina, are just ‘reopening.’” South Carolina’s stay-at-home order expired on May 4, although the state started allowing businesses to reopen under minimal restrictions on April 21.

Reck has a couple of pro tips that she suggests practices consider when planning to reopen that should prove effective no matter what part of the country you’re in.

First, Reck says, your reopen plan must be discussed in a way that’s collaborative with every member of the practice: “Since this involves everyone’s health and safety, everyone should get a say.” 

Second, leaders need to lead. “Veterinarians have a scientific background and are seen in the practice as leaders. It can be extremely helpful if they collect the scientific facts surrounding the virus and present those at [a preopening staff meeting] first.”
 

Discussion topics might include

  • How long it takes to transmit the virus
  • The latest on testing
  • Implementing a thoughtful medical protocol in the event that a staff member tests positive

“This can be presented initially to the group, then group leaders [can] ask questions like, ‘With the facts that we know, what makes sense as we create a plan to reopen?’”

From there, Reck suggests that the team be allowed to carry the conversation. “If the conversation strays and we’re drifting too far away from making a plan, I steer everyone back to the initial questions I started the meeting with.”

Reck says she went through this exact process with her staff, and, as a group, everyone felt comfortable with establishing June 1 as the date that the hospital may begin letting clients come into the building. And that date is subject to change. “Everyone knows we’ll have a mini session mid-May [to] confirm if that plan still makes sense.” 

She notes that this plan is financially achievable for her practice because they were able to continue operating efficiently with curbside service: “This might not be the exact right decision for any other practice, but I’m confident that the process in how to get to the decision is very universal.”  

Consider your location and prevent burnout

In Colorado, stay-at-home restrictions began easing for much of the state on April 27, although some counties chose to extend them until May 8. One such county was Denver, home to AAHA-accredited Park Hill Veterinary Medical Center. Owner Margot Vahrenwald, DVM, a director on the AAHA Board of Directors, says she plans to continue curbside care “at least until the end of June,” but allows that the hospital may tweak their open hours so that they’re “closer to normal in June.”

“We did add a telehealth app option that will continue for the long term, past the end of the pandemic because it had been on our [wish list],” Vahrenwald said. But she added that they’ve found that many pet illnesses aren’t suited to telehealth consults, and many clients prefer that hospital staff be hands-on with patients. Although some clients, she acknowledges, “just want to get out of their houses!”

Vahrenwald also felt an obligation to stay open for the sake of colleagues at area referral hospitals to ensure that they wouldn’t be overwhelmed by their caseload.

“Transition away from curbside care will be based on area COVID-19 cases as our primary consideration,” Vahrenwald said, adding that there’s no point in risking human health since the hospital depends on the health of both clients and staff. “With Colorado and Denver making a slowish transition to opening up other businesses, we’re watching closely for any new spike in human coronavirus infections over the next weeks.” 

Vahrenwald praises her team for being “pretty amazing” in adapting quickly to change, but adds, “I’ve warned them that we don’t know yet what our new normal will be—that will take more time.”

“My advice to other hospitals would be [to plan a] transition with criteria based on a continued decrease in new cases of COVID-19 to protect human health, balanced with their business needs and capacity, including making sure that team members are not so overwhelmed that they burn out.”

Every community is going to be different, Vahrenwald says: “It is likely to be week by week, month by month, until we find our new normal and more is understood about SARS-CoV2.”
 

Evaluate what has worked well and overcommunicate

Ohio plans to start allowing some business to open starting May 12. Adam Hechko, DVM, vice president on the AAHA Board of Directors, owns North Royalton Animal Hospital in Cleveland, Ohio, AAHA’s 2015 Practice of the Year, and sees the downtime as a chance to re-evaluate.

“At the beginning of this, we were just rapidly making changes and not always having time to plan for every little nuance with all the protocol changes that we made,” Hechko says. “As we start to transition back to some of our previous operations, [we have] an opportunity to look at what was working really well in that time before the pandemic, and then what we learned from the pandemic and how we can potentially change or alter our way of doing things in the future. I think it gives us an opportunity to be more proactive with planning.” He sees this as a chance to encourage transparency in a time of considerable confusion; a chance to “be as transparent as we can be with our staff and with our clients, [by] providing them with as much information as we can about why we’re making these changes and how it impacts their health and safety.”

“We did a reopening roadmap for our hospital team with guidelines of what steps we’re going to be taking to resume some normal business activity,” Hechko says. It included some guidelines and a list of things that need to happen before returning to more normal hours. “It should be something we can share with our clients, that we’re working toward allowing pets and families to enter the hospital together. And [we’re] referring back to CDC guidelines and local and state guidelines to help us make those determinations.”

Hechko said the hospital posted a letter to its clients on Facebook and their website that details the plan. As a third touchpoint, the letter was also emailed to clients.

“We also developed talking points for our team for when clients call in. If they have questions, staff can refer to facts and data, [such as] when a client asks why we’re continuing to do something one way or another,” Hechko says. “Our team is very actively involved in the steps and the process of reopening parts of our business.”

On that point, Hechko echoes both Reck and Vahrenwald: “I think if it just comes from the top leadership, and [if] we’re not involving our teams and their thoughts and opinions on it, it’s going to cause stress because not everyone’s going to have the same comfort level or have the same perspective.” 

“Once again, it’s about open dialogue and transparency with my team. That’s going to be paramount to me as we continue through the different steps of reopening our office.”

Hechko says that hospitals in Ohio were allowed to return to elective procedures last Monday and that it went well at North Royalton. “Our team already had their roadmaps and we knew what we needed to do to accomplish that. Next week will be our first full week of returning to elective procedures as we adjust the teams that we have in place and continue to have safeguards on entering the facility for our team members, and [we’ll] continue to wear masks and help each other with social distancing as much as possible while in the office.”

Now that they have a roadmap, Hechko says it’s a matter of waiting to see what happens next.

“We’re really watching to see over the next couple of weeks what the numbers are,” Hechko says. “I really don’t anticipate that we’ll be reopening to the public until June.” When that happens, he says, he anticipates they’ll still be implementing steps to minimize the amount of traffic flow to continue maximizing social distancing guidance.

“That’s going to be out there, I’m sure, for a while,” he said.

Photo credit: © iStock/Aquir