Red Status, Green Status: Munson's Matt Wille Talks Staffing, COVID, Hospital Capacity
By Craig Manning | June 22, 2022
Facing year three of COVID-19, nationwide staffing shortages, and a busy northern Michigan summer, the team at Munson Medical Center (MMC) is getting used to a challenging new era for healthcare. The Ticker touched base with MMC President and CEO Matt Wille to find out where things stand right now for hospital staffing, capacity, and COVID-19 caseload.
Ticker: We recently heard from a reader whose mother had suffered a heart attack and needed to be admitted to the hospital. She was at the Charlevoix hospital initially, but required more care than they could provide there and needed to be transferred. When they tried to get her transferred to Traverse City, they were told that MMC was in ‘code red’ and didn’t have space – not because of COVID, but because of staffing. The patient was eventually admitted to McLaren in Petoskey instead. Is this kind of capacity strain common?
Wille: Here at MMC and at Munson Healthcare, there are times when we do have staffing challenges. And that is the same whether you’re in Traverse City, or in urban environments or rural environments across the country. This problem is not unique to northern Michigan. It is definitely an industry challenge. In this case, it's unfortunate that the timing didn’t allow us to accept this patient, because I believe that, within hours of the transfer from Charlevoix, we would have been able to do so. But sometimes, the timing just doesn't work out.
It is our goal to always keep patients close to home, but there are times that we have to do what we call ‘accepting a patient with delay.’ There are several things we’re working on to try to eliminate [that delay]. We have traveling staff that have joined the organization. We have our existing staff that are taking on extra hours. We’re trying to do same-day discharges from some of our procedural areas, so that patients who are able to safely go home the same day don't have to stay overnight and unnecessarily occupy a bed. We're trying to level out our surgical volume, so instead of having a lot of our surgical cases on one day – let's say on a Tuesday, meaning a lot of patients need to stay overnight on a Tuesday night – we're trying to spread that out over the course of the week.
And just as there are times that we may have to have a slight delay in accepting a patient, that also occurs downstate. And so sometimes we may accept patients from downstate, based upon their ability to accept that patient or not. The demand on our hospital does change day by day – and sometimes even hour by hour – depending on what's going on through the various communities.
Ticker: So what does ‘code red’ really mean at Munson?
Wille: We label our departments as either ‘green status’ or ‘red status.’ So, it's not necessarily a ‘code red’; it's just red status. And that can be driven by a couple of different factors. For instance, it could be based upon the patient volume within a particular area. If our emergency department (ED) is very busy, we may say they're in red status. And as a result of that, we then implement different processes, or we reallocate our resources in order to provide additional services in the ED. We may send additional staff or additional transporters down to that area, depending on the resources needed.
Mostly, red status is an internal communication mechanism, so that we can properly address and ensure that we are allocating staff or equipment appropriately to best meet the needs of each department.
Ticker: Are there specific departments that are more understaffed and therefore more likely to be in red status than others?
Wille: It fluctuates depending on the day. We have a daily huddle that takes place at MMC each morning, and that’s where all of our leadership comes together. We go through our departments, and people say, ‘We're in green status’ or ‘We're in red status.’ Those meetings are a chance for everybody to hear how everybody else is doing. And based upon that, we have post-huddles where we can help allocate and prioritize areas that we need to work on.
The other thing that we have seen throughout the COVID is that what we call our "Case Mix Index" (CMI) has been increasing. CMI is a calculation that shows the complexity, acuity, and severity of the patients we have in the hospital. So using that information also helps us redirect resources and ensure that we're putting the appropriate focus in the necessary areas.
Ticker: How do things stand at Munson’s step-down facilities? We’ve heard that those facilities are understaffed as well, and that as a result, it’s maybe a little harder to move patients out of the hospital and into the recovery phase.
Wille: I would say that’s accurate. These step-down facilities, whether it's nursing homes or skilled nursing facilities, just as we are trying to recruit staff, they are as well. I know they would like to accept more patients from the hospital but they may not be able to – either because some of their staff is out ill or due to COVID, or because they just don’t have the employment numbers they would like. That can delay our ability to transfer out or discharge a patient [from MMC] to another level of care, which in turn creates a challenge for us to try to get new patients into the hospital. It's a whole continuum of care, and each piece does impact the rest of the ecosystem.
Ticker: How common is it for MMC to not be able to find room for new patients?
Wille: It’s not necessarily common for us. There are times when a delay may be needed, and if that is the case, then our referring facilities may look for other options in the best interest of that patient. But we try to minimize that as much as we can.
Ticker: What about elective procedures? Is Munson having to delay of those because of staffing?
Wille: That has not been impacted. We continue to utilize our operating rooms and our cath labs, and we have not been postponing cases. But that is something we look at every single day. We have a daily planning meeting where we look at what procedures we have scheduled for the next day, and we make sure that we have the staff, the necessary resources, and the bed availability to accommodate those procedures.
Ticker: What is the COVID situation right now at MMC? And what’s the forecast for the summer months, with a big tourism season heading our way?
Wille: The winter months, just before the holidays, that’s when we had our greatest surge and our highest COVID inpatient population, which was right around 90 for MMC. That surge subsided as we started 2022, and a couple of months ago, we were down to single digits. There has been a modest surge over the last six weeks, where we’ve been hovering around 20-30 COVID patients, and that has been pretty stable. But we are always prepared and always have contingency plans, and we will be able to make changes – as we have in the past – if those numbers were to go up this summer.
Ticker: Finally, what is the long-term prognosis for staffing at the hospital?
Wille: We do have a plan for bringing in new nurses and new nursing assistants. We actually have a lot of them in orientation right now that will be coming online in the summer months. And now, during the summer months as nurses graduate from school, that's always a good hiring time for us. So there are moments when we actually believe we're starting to make some progress. We are also really wanting to make sure that we retain the incredible team members that we have. This past winter, we gave an appreciation bonus to all of our staff members and did the largest across-the-board wage increase in our system’s history. So, we are optimistic.Comment