EVIDENCE BASED INSIGHT
Building on Lessons Learned: Activating a Global Pandemic Master Plan
September 21, 2020 • 6 min read
Although the scope and scale of the COVID-19 crisis is unique, the lessons learned in responding to both natural disasters and the previous SARS and MERS outbreaks have been essential to the pandemic plan. Any success the company has experienced has been rooted in advance preparation and a structure that supports a data driven, agile response in a rapidly changing environment (Figure 1).
FIGURE 1 | The company’s crisis and pandemic plan
The Global Medical Office, in partnership with regional crisis and operational teams, believes that the company’s pandemic master plan is a keystone of its global response. Such a plan is built on a sophisticated matrix that aligns efforts across the company’s vertically integrated business units at the global, regional, and local levels, with regional crisis teams as the execution leads for the plan. This approach marries the organizational structure with four main areas of activation: people, product, process, and policy (Figure 2).
FIGURE 2 | The matrix structure of Fresenius Medical Care’s pandemic and crisis master plan is built around four main pillars and aligns resources and response at global, regional, and local levels, as well as across the company’s vertically integrated business units.
A HOLISTIC FOCUS ON PEOPLE
Protecting the health and safety of patients and staff during the pandemic is paramount, and this includes recognizing that all their lives have been fundamentally disrupted. Helping them cope with this upheaval is a critical part of the company’s clinical pandemic plan.
First-level protection begins with fastidious requirements for personal protective equipment (PPE) for all dialysis patients, staff, and visitors. This seemingly aggressive approach, which even preceded government regulations, has clearly been effective in limiting the spread of the disease. For example, by the end of the April 2020 surge period in the United States, fewer than 1 percent of the company’s patients and fewer than 0.5 percent of staff had been infected. While the company’s policy on PPE was initially deemed more conservative than what the Centers for Disease Control and Prevention recommended, the field of kidney disease care soon adopted similar guidance. Through agile operations, Fresenius Medical Care was an early adopter of the national PPE standards across many diverse countries, including providing masks to all staff in the United Kingdom, Ireland, South Africa, China, and beyond.
In Fresenius Medical Care dialysis clinics, the lack of early availability to polymerase chain reaction (PCR) testing led to a very conservative approach to screening and isolating patients. This has included isolating patients who were known to have the disease as well as those with higher suspicion or exposure.
Reducing exposure to infected persons has required cohorting patients into groups—rearranging the logistics of care, such as the location and time for dialysis shifts for those needing to be isolated, which was a monumental effort—providing PPE for patients and staff, testing to confirm infection status, and making practical arrangements to ensure patients could get to and from their treatments. This has involved carefully planned strategies based on the unique physical design of each individual clinic, accounting for the structure of their waiting and public areas, treatment spaces, and available isolation areas.
Addressing potential shortages in care staff also has involved careful monitoring of shift scheduling and time management. Across the world, Fresenius Medical Care has deployed volunteer teams of workers who chose to be mobile and travel to hot spot areas to help address any staffing challenges in specific areas.
SAFEGUARDING ACCESS TO CRITICAL PRODUCTS
Even with meticulous planning, protecting Fresenius Medical Care’s supply chain and safeguarding access to therapeutics and medical supplies for patients are complex challenges. Maintaining distribution of raw materials to manufacturing plants, supplies to clinics, and equipment to where demand is spiking requires the global team to orchestrate ever-changing logistics within the company’s product network.
Add to this an unexpected influx of COVID patients with acute kidney injury who require hospitalization, and the complexity of the problems becomes even more dramatic. To meet the immediate need, the company’s global procurement efforts have focused on maintaining supply levels of mission-critical products across the 150 countries where Fresenius Medical Care operates. This involves not only shifting the distribution of PPE, but also doubling manufacturing capacity for consumables and increasing premixed dialysate fluid capacity by 75 percent.
This work extends beyond Fresenius Medical Care’s own clinic walls and addresses care-related shortages at the societal level. COVID-19 has caused a dramatic spike in people experiencing acute kidney injury. During the virus’s surge periods, the demand for acute dialysis increased as much as three to five times normal use in some regions. In North America, the company announced in April 2020 the formation of its National Intensive Renal Care Reserve. It provides additional dialysis machines for the nation’s hospitals during this unprecedented crisis—creating a pool of approximately 150 pieces of equipment ready for rapid deployment—and nearly doubles the volume of consumables available to perform treatments.
STREAMLINING THE PROCESS
If Fresenius Medical Care is to meet its obligations to patients, organizational agility is not just a goal, it’s a requirement. Throughout the pandemic, the company’s operations and administration team has been working to streamline logistics throughout the organization and to find solutions to ever-evolving challenges. In every country where Fresenius Medical Care operates, regional Clinical Services and Medical Office teams work carefully with operations staff to update company policies that address rapidly shifting guidance from local and regional authorities. Whether making real-time changes to standard operating procedures to address new protective requirements, adjusting internal policies to adapt to new telehealth opportunities, or shifting workflows to manage real-time supply change challenges, the ability to adapt global logistics to the constantly evolving pandemic has been paramount to successfully reducing disease spread.
The organization’s ability to move quickly and at scale has been greatly facilitated by the creation of the Global Medical Office COVID-19 Response Hub (Figure 3). It provides a single information and communications source for company employees, physicians, and affiliated caregivers. More than 60,000 associates from all regions use this portal to access and share information, learn in real time, and quickly share best practices.
FIGURE 3 | The Global Medical Office COVID-19 Response Hub
The response hub is just one example of how Fresenius Medical Care’s technology solutions drive agility. Another is the swift activation of the work-from-home protocol when the pandemic began. It included distributing laptops to employees and equipping them with secure access to vital operational systems. The company quickly deployed a new automatic virtual private network (VPN) connection for employees from their home and remote computers.
In the area of patient care, the company’s technology infrastructure has enabled the rapid transition to telehealth protocols for large patient cohorts and providers. By establishing additional telehealth opportunities based on policy shifts from governmental agencies, the company has ensured that no patients have to travel to their home training site for a monthly visit by the interdisciplinary team. Examples include deploying Microsoft Teams-based telehealth in North America and the EuCLiD televisit solution in the Europe, Middle East, and Africa region and the Asia Pacific region, which allows real-time patient monitoring by the care team.
Finally, Fresenius Medical Care’s data and analytics capabilities are facilitating understanding of the present and modeling the future. If it is possible to predict who is likely to become ill or where the next hot spot might be, it will be possible to better anticipate global medical and operational needs. For example, the company collects more than 11 million datapoints per day in its EuCliD quality management system and provides real-time records of patient and dialysis machine data from each dialysis session, with automatic import of laboratory test results. EuCliD now also monitors the status of suspected and positively tested patients, using predictive analytic models to analyze symptoms of COVID-19 infection and monitor local outbreaks.
POLICY: ADVOCATING FOR PATIENTS
A critical aspect of Fresenius Medical Care’s pandemic plan involves managing evolving policy shifts, both inside the company and in the public policy arena, including adjusting company operational policy for crisis requirements and addressing health policy variability across organizations, governments, and societies.
Fresenius Medical Care has assumed a leadership role in advocating for all patients with kidney disease. Around the world, a number of regulatory bodies and health systems considered curtailing care for specific groups of people. The company’s position has been steadfast and consistent: People with advanced kidney disease should be offered treatment options in accordance with their wishes and the decisions they make with their medical team (Figure 4). This includes supporting individual decisions around mechanical ventilation and other aggressive intensive care measures if a patient becomes ill from COVID-19.
FIGURE 4 | The Global Medical Office's worldwide advisory to the company's physicians, employees, and patients
The statement of principles of care also asserted that lifesaving dialysis vascular access surgery was not elective, and that preserving dialysis frequency and time was necessary to avoid additional hospitalizations.
To amplify the statement of principles and Global Medical Advisory for all of Fresenius Medical Care, the company published an editorial perspective advocating for all people with chronic kidney disease (Figure 5).
FIGURE 5 | The editorial highlights the urgent issue of care apportioning during the COVID-19 pandemic
PURPOSEFUL PLANNING FOR THE FUTURE
The COVID-19 pandemic is the first major healthcare crisis that Fresenius Medical Care has faced since the Global Medical Office was created in 2019. Just as the crisis recognizes no borders, neither does the company’s response. Even in the face of delays and uncertainty among other global stakeholders, Fresenius Medical Care clearly articulates the organization’s principles to protect the health and safety of patients and staff worldwide. Simultaneously, the company has learned from counterparts around the globe and adapted solutions to meet the needs of people in 150 different countries.
There’s no question that when COVID-19 is no longer a threat, the world will be a different place. That future will require adjustments to the new normal while staying true to Fresenius Medical Care’s mission of caring. Just as the lessons of the past have assisted with weathering the COVID-19 pandemic, the most recent experiences help prepare for whatever is ahead for both the company and patients.
