In November, we got not one, but two, doses of good news on the COVID-19 vaccine front. Both Pfizer and Moderna announced that they had produced vaccines that were 95% effective in preventing or mitigating the effects of the virus with few or no side effects detectable in the early stages—truly a miracle of modern science. Today, the silver bullet to stop the pandemic is within reach.
Effective vaccines have been held out as the only acceptable way to achieve the herd immunity necessary to return to normal social interactions. Nevertheless, a few economists have suggested that achieving herd immunity by allowing infection and mortality rates to go unchecked would be a financially rational solution. Setting that debate aside, the logistics, human behavior, and moral complexities of distributing and administering the vaccines (plural) will require deft leadership and managerial skills.
The vaccines will provide protection, but getting the silver bullet to its intended target is another matter altogether. Vaccines developed using the messenger RNA approach are difficult to handle in that they require deep-freezing storage. Therefore, large health systems with existing infrastructure will likely be the first to receive and distribute the vaccines. Such an arrangement is also logical in that the employees of large health systems should be among the first tier to receive the vaccine, as they are at the highest risk of exposure. The other populations in the first tier will be those at greatest risk of contracting the disease because of underlying risk factors such as age, weight, and comorbidities. For these populations, the biggest hurdle to overcome will be human behavior.
Despite the threat that COVID-19 presents, many people will resist vaccination based on personal beliefs. Others will not get the vaccine or complete the dosage series out of sheer laziness. Compounding the problem of vaccine resistance, these people are most likely to ignore social distancing guidance and put others at risk. However, the moral challenges of individuals are relatively modest compared to those that public health and health system leaders face.
Who gets access to the vaccines and in what order—those are the biggest decisions to be made as manufacturers and distributors scale up to meet demand. Beyond the obvious need to protect frontline workers, every subsequent decision is fraught with the potential for iniquities. If unchecked, the endemic problem of health inequality in the United States will impede vaccine distribution to populations that have been hit especially hard by the pandemic. Moreover, the wide differences between vaccine distribution in North America and Western Europe compared to other parts of the world will aggravate animosities that have simmered for hundreds of years. How Americans deal with the questions of access will be seen as a referendum on our country’s role as a world leader and partner in the health of the planet. Loading the silver bullet and hitting your target are two different things. I do not envy the policymakers who will have to pull the trigger.
Several pieces in this issue of the Journal of Healthcare Management touch on the topic of COVID-19, including the interview with Paula H. Song, PhD. Dr. Song recently moved from the University of North Carolina at Chapel Hill to take on her new roles as a professor in and chair of Virginia Commonwealth University’s Department of Health Administration. She shares her thoughts on COVID-19’s impact on the education of healthcare’s future leaders.
Our new yearlong exploration of essential innovation in healthcare opens with a column by Jon Burroughs, MD, FACHE, FAAPL, president and CEO of the Burroughs Healthcare Consulting Network based in Glen, New Hampshire, and Ron Smith, MD, FACP, president and CEO of the Southeast Georgia Diagnostic and Prevention Center in Vidalia, Georgia. They make the case for providers other than physicians playing a larger role in primary care.
We also introduce a yearlong series of columns describing great comebacks—robust responses to the pandemic that have laid the groundwork for the healthcare sector’s sustained recovery. Tamra E Minnier, RN, FACHE, chief quality officer at the University of Pittsburgh Medical Center (UPMC) system based in Pittsburgh, Pennsylvania, tells how UPMC’s Wolff Center has taken the lead in addressing the needs of patients and providers alike.
Our first research article is by Cheryl A. Connors, DNP, RN, NEA-BC; Vadim Dukhanin, MD; Matt Norvell, BCC; and Albert W. Wu, MD. They track the successful deployment of volunteers at Johns Hopkins Medicine in Baltimore, Maryland, to promote resilience among stressed care provider teams—especially important these days. It is a proven program that many health systems may wish to emulate.
Next, Mary E. Homan, DPH, of the School of Public Health at the University of North Texas Health Science Center in Fort Worth, and Kenneth R. White, PhD, AGACNP, ACHPN, FACHE, FAAN, of the University of Virginia School of Nursing in Charlottesville, study the changes in organizational structures of Catholic hospitals. These facilities form an essential segment of the U.S. healthcare delivery system. Understanding their evolution is an important undertaking.
In a related vein of organizational theory, researchers from Florida Atlantic University in Boca Raton, the University of Alabama at Birmingham, Louisiana State University in New Orleans, and the University of the Incarnate Word in San Antonio, Texas—Neeraj Puro, PhD; Nancy Borkowski, DBA, FACHE; Scott Feyereisen, PhD; Larry Hearld, PhD; Nathaniel Carroll, PhD; James Byrd, PhD; Dean Smith, PhD; and Akbar Ghiasi, PhD—explain how available resources, or slack, can buffer financial distress. Many hospitals and health systems are experiencing distress as a result of the COVID-19 pandemic, and this article may provide some insights into how they will fare going forward based on the resources they had available at the start.
This issue concludes with a research article by Nicholas Garland; Andrew N. Garman, PsyD; Patricia S. O’Neil; and Jeff Canar, PhD, representing Rush University and Rush University Medical Center in Chicago, Illinois. Like Puro and colleagues, the authors dig into the financial aspects of health system management—bond issuance and ratings, in particular. Bonds are the lifeblood of not-for-profit organizations’ ability to invest and innovate. How leaders manage their bond portfolio is a critical success factor.
Note. The September/October 2020 issue of the Journal of Healthcare Management featured a column titled “Think Twice: Coleadership and Representation of Women.” The American College of Healthcare Executives and JHM strive to ensure a balanced representation of leaders and the roles they play. This column did not intend to perpetuate a paradigm of roles tied to gender, and we appreciate the feedback we received in this regard. The JHM editorial team will continue reviewing our high-quality content with an eye toward our profession’s commitment to advancing diversity, equity, and inclusion.