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Situation: There’s no comprehensive national strategy for vaccines.

Yes, HHS, CMS and DoD have developed a skeleton plan for distribution and monitoring. But there’s no unified playbook for getting hundreds of millions of Americans inoculated against SARS-CoV-2. Detailed decision-making has been left to states. Some have chosen to be hands-on in their recommendations and others are taking a back seat, tossing the operational hot potato to providers themselves.

The resulting patchwork of guidance complicates the already daunting task facing healthcare providers charged with the quick and efficient administration of whatever doses are allotted to them. With that responsibility and a compressed timeline, we turned to Roger Ray, M.D., the chief physician executive at The Chartis Group, for how healthcare executives can act quickly and responsibly without clear guidance. Then we added a couple of notes regarding the communication of your plan.

Quick Counsel:

• Check in and check around: Quickly create and maintain open communication channels with nearby provider organizations and community health entities. It benefits everyone if you can achieve consistency at the community level.
• Don’t stop at the state line: Many provider organizations have patients or employees or both in more than one state. Be sure to align, if possible, with the distribution plans of your neighbors.
• Look to the literature: When all else fails, base decisions on published studies and guidance concerning vulnerable populations.
• Take good notes. In the absence of clear guidelines from state or federal agencies, bring together your executive, operations, clinical, marketing and comms teams to make a plan. Your people are well trained and will make the best possible decisions. Be confident in that and record your thinking so you can defend it later.
• Communicate your strategy…whatever it is. Tell your story. Those notes you took? All of this is happening so fast, and everyone is affected, so people (everyone – the public and your employees both) will want to know what decisions you’re making about who gets doses when – and how you arrived at them. Bottom line: If you don’t talk about your strategy, someone else will.

”Do as I do, AND as I say.”

That might as well be the motto of healthcare’s efforts to guide the U.S. population towards rapid adoption of a COVID-19 vaccine.

With doses about to arrive, common sense would suggest that hospitals and health systems prioritize vaccinating frontline workers in direct patient care roles before healthcare industry leaders and administrators working from their guestrooms or offices.

Or does it?

Though many Americans are anxious to be inoculated, many are skeptical – including healthcare workers. We’ve heard this firsthand from our clients, and a recent survey found that 67 percent of healthcare workers intend to delay vaccination. Asked if they would volunteer for a COVID-19 vaccine, two out of three nurses polled by the American Nurses Association poll said “no” or “unsure.” So, it’s a tough sell. Allowing someone to move to the front of the line does no good if they don’t accept the invitation.

The solution might just be to find someone else to go first.

Last week, three former U.S. presidents announced they would take the coronavirus vaccine on live television to inspire public confidence in the immunization. Healthcare system presidents should consider doing the same for their people. If health systems are encouraging caregivers to take the vaccine, there’s no better way for their leaders to communicate confidence in the science and reassure their team of vaccine safety and efficacy than by taking a vaccine themselves.

Otherwise, the risk is caregivers asking their executives: “Well, if you won’t get it, why should I?”

As doses are shipped, health systems grappling with a reluctant workforce should weigh the potential benefits of a similar gesture. How to go about this?

• Identify your organization’s most trusted leaders related to the pandemic. Is it your CEO? Your chief medical officer? Your chief nursing officer? Your infectious disease experts? Would trusted leaders receiving the vaccine inspire confidence in your clinical workers?
• Develop an effective communication strategy. How might you communicate this step? Perhaps a memo or a video message from leadership would be effective.
• Weigh the implications. If you receive severely limited doses of the vaccine and are seeing high demand among your clinical workforce, would it send the wrong message to allot any of these to non-clinical roles?
• Continue to set an example in other ways. Even if your system decides not to provide the vaccine for key leaders, leaders should serve as role models for how your team should behave in other ways, like continuing to wear a mask, wash hands and practice physical distancing.

On April 16, I wrote about the need for hospitals to plan for the potential of invoking crisis standards of care. Put another way: rationing of care. Eight months later, that frightening and tragic possibility has returned to the forefront.

Hospital leaders must act now as some areas of the country are running out of ICU capacity. We are experiencing record-setting numbers of cases and hospitalizations nearly every day, with no end in sight. “Informal rationing of care” has been noted in Utah, and the possibility of “thresholds for admitting patients to hospitals” shifting was recently raised by Melanie Evans in The Wall Street Journal. Other states, including New Mexico and my own state of Idaho, are close to the edge.

Despite loud warnings, there’s no indication that the growing spread is causing alarm or inducing Americans to dramatically alter their plans – including holiday travels. Yet based on what we know about the virus and what we observed following Canada’s Thanksgiving in mid-October, there’s every reason to expect the surge to grow over the next couple of weeks.

As if this weren’t enough, we’re also bracing for the annual influenza epidemic. CDC numbers show 140,000 to 810,000 influenza hospitalizations each year in the past decade. This year, we also have the specter of co-infection with influenza and COVID-19, resulting in more severe disease and poorer outcomes.

All of this could serve as the tipping point for many hospitals currently strained by large numbers of staff in isolation or quarantined due to the virus. And, unlike in April when COVID-19 flare-ups were regionalized and resources could be redistributed, there are fewer options for moving healthcare workers into or patients out of hard-hit areas at a neighboring hospital or state.

In short, we must mobilize now. Here are seven points to consider:

1. Know your state’s crisis standards of care. Ensure that your physicians and staff are familiar with your state’s standards and are prepared to implement them should the time come.
2. Keep your board up to speed. Ensure they understand how dire the situation is becoming and what the implementation of crisis standards of care will mean for the hospital and your community.
3. Communicate with your community. The public may not understand exactly what rationing of care means or its full implications. People probably aren’t aware, for example, that your bed capacity is not your number of beds but the number of beds you can staff. They likely think that hospitals can simply hire more staff, open more beds or create field hospitals. And, critically, your community may not realize that capacity constraints don’t just apply to COVID-19 patients – the lack of staffing and bed capacity can affect availability of beds for patients with heart attacks, strokes or trauma injuries. Without proactive education, you face the strong likelihood that the public will react negatively to hospitals for failing to warn them and for failing to take steps to prevent this.
4. Arm your clinicians with messaging. Make sure that you have specific doctors and nurses prepared to carry the message on media and press interviews. Your communications staff should also be prepared to respond quickly to social media.
5. Clarify who will make triage decisions. It’s wise that this is a team effort, not an individual. Placing responsibility on a single person comes with risk. First, that person could become ill and unavailable. Second, one person should not bear the weight of care rationing decisions. A team can provide support and lessen the burden. Finally, you could be operating under the crisis standards of care for a while. Even if your state were to implement mandates at that time or other public health orders, it likely would take weeks before the pressures on hospitals was relieved.
6. Stay in touch with your insurer. Be sure that your general counsel reaches out to your liability carrier to notify them of this impending event given the potential for lawsuits. Hopefully, your state has enacted liability protections in association with a declaration from the governor that crisis standards of care are in effect.
7. Be empathic. Have a game plan to provide emotional, spiritual and psychological support to families, staff and physicians during the time of these decisions. Families of patients who will not receive every intervention possible will no doubt be angry. Staff and physicians who have to make these wrenching decisions or who will be providing comfort care to patients who would in other circumstances would have received aggressive treatment may suffer tremendous discomfort and discord in not being able to do everything possible for every patient.

I hope this can be averted and that your preparations for crisis standards of care will not be needed. However, with each day, I grow increasingly concerned. This will be a dire time and the most challenging of the entire pandemic. This time will test your leadership like no other. I am praying for you, your physicians, your staff and your communities.

The moment has arrived.

With the UK granting emergency use authorization and Europe and the US FDA close behind, doses of COVID vaccines will be rolling through healthcare providers’ doors in the blink of an eye. And, with healthcare workers at or near the top of the priority list, providers must lay the groundwork now with the media, the public and employees about how they will distribute the vaccine(s) once they arrive and address safety concerns that arise.

Here are the three communications imperatives providers need to consider today. We’ll be picking each of these apart with specific actions over the next couple of weeks:

Get the talk right internally: Your staff needs information just as much as the general public does, both because they can advocate for a vaccine in the community and because they will be asking many of the same questions. If doctors, nurses and other caregivers aren’t comfortable getting vaccinated, we can’t expect patients to line up for immunizations. Now is the time to develop a plan for centralizing all information related to a vaccine, initiating regular updates and equipping leaders at all levels to cascade information to their teams.

Be the voice of authority in your community: Patients will look to their local healthcare providers for reassurance. With vaccines being rolled out in phases, each phase represents a milestone to remind patients, the media and your community about the safety, efficacy and urgency of getting vaccinated. This is work that will unfold over the coming months, but now is the time to identify spokespeople who have the right expertise and empathetic communications skills and who reflect the patient population they’ll be working with.

Prepare for the pitfalls: There are, unfortunately, a host of issues – real and perceived – that could crop up during the vaccine rollout: Security and cold chain logistics, anti-vaxxer activity, helping underserved communities and people of color feel more comfortable receiving a vaccine, to name just a few. In addition, thanks to the (Warp!) speed with which these vaccines were developed, the public and media will be watching closely for any sign of danger. It won’t be a surprise to see any side effects magnified and attempts to link deaths to receipt of a vaccine dose. Providers don’t necessarily need canned responses to every possible issue, but they do need to prepare a framework for how to talk about anything that might come up.

With the holidays upon us, healthcare leaders and workers are facing a nightmare scenario: Already high COVID infections will surge to new heights in the wake of holidays gatherings.

Healthcare workers who are already exhausted physically, mentally and emotionally will be left to care for patients who did not heed the warnings of public health officials. And healthcare leaders face a daunting array of high-stakes communications challenges that must be thoughtfully navigated.

We are focusing our attention on five areas where communications can help your organization confront the COVID-19 surge and prepare for other imminent milestones:

• Workforce resiliency and support. Healthcare workers are drained. To make matters worse, many people continue to ignore public health recommendations that would help limit the spread of the virus. That leaves already-exhausted healthcare workers to deal with the consequences – potentially even including rationing of care. Healthcare leaders need to make sure their employees have access to mental health resources. We are helping organizations take stock of their employees and provide them with much needed support. Our new volume of The Art of Change addresses this critical issue, with both high-level context and practical insights. (We will continue to add to this volume over the course of the next month as we evaluate the pandemic’s ongoing toll on our employees.)
• Prepare communications for the most likely COVID scenarios. It’s a bit of déjà vu for healthcare leaders: needing to prepare communications for suspending services, limiting visitation, staffing shortages, calling in COVID-19-positive but asymptomatic caregivers to work, capacity issues, facility closures, remote work and even the possibility of rationing care. We can help you prepare for these scenarios and others by proactively developing talking points, FAQs, memos, media materials and more.
• Share your safety message. Patients need to feel safe so that life-saving care is not delayed. We are helping healthcare organizations develop and share their safety message by highlighting tactics like mask requirements, isolation of COVID patients, enhanced cleaning procedures, etc. Patients need to continue hearing these messages.
• Be the healthcare voice of authority in your community. With the election over and COVID infections surging, the media is again focusing on the virus. Use media interest to your advantage. We are working with clients to provide regular media and community leaders briefings. This will rightly position your organization as the community healthcare expert and will give you the ability to lay the groundwork for strategic issues like public health, your caregivers’ commitment and additional government funding.
• Develop a communications strategy for the next hot button issues: vaccine distribution and the January 1 CMS price transparency rule. In a matter of weeks your organization will be tasked with sharing information about these issues. We are working with clients to develop messages for internal and external audiences, communications toolkits with talking points, FAQs memos, media statement and communications cadences.

We know the challenges you face are daunting, and we are here to help.