Ann-Marie Alameddin is the president and CEO of the Arizona Hospital and Healthcare Association (AzHHA). In this Q&A, she discusses how Arizona hospitals are continuing to cope with overwhelming conditions even as COVID-19 numbers begin to improve in the state, and how she hopes the governor and legislature will continue to support the health care workforce. She also brings up what she believes will be the long-lasting impacts of the pandemic on the health care system.
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State of Reform: As COVID numbers continue to generally improve, Arizona hospitals are still extremely full. What are hospitals doing to continue to weather these overwhelming conditions and provide quality care for as many patients as possible?
Ann-Marie Alameddin: “Because hospitalizations are a lagging indicator, hospital capacity is still strained. These counts are, in fact, going down in terms of what’s publicly reported. I think we have to keep in mind that a lot of people are doing at-home testing at this point, and so we don’t have the same sort of publicly reported data on positivity right now. But hospitals are continuing to weather this incredibly long process of the pandemic, and they are taking care of patients to the best of their ability despite staffing shortages, supply shortages, and blood shortages.
If patients are being brought in by an ambulance, ambulance offload times in a normal course of business, from when a patient is transferred from an ambulance to the hospital, that might be minutes. Now, in some parts of the state, it’s been hours and at times we’ve reported 10 hours in terms of offload time to have that patient care transferred to care at the hospital. Some hospitals have opened up separate units for patients before they’re brought into the hospital, where the ambulance is still taking care of that patient. That takes out ambulances that are on call and available for emergency services.
There has been backup in the whole healthcare system. [This is also happening] on the back end, with discharging patients. Say the patient needs some sort of skilled nursing facility or some sort of post-acute care. Patients might be ready for discharge, there may be a skilled nursing bed available for them, but it’s transporting that patient to that facility that sometimes can take days. So it’s really a patient throughput issue in terms of being able to get patients out of the hospital when they don’t need those care services.”
SOR: Gov. Ducey has made recent announcements that he will invest in efforts to graduate more nurses in Arizona and thus support hospital workforces in the state as they continue to experience shortages. What are your thoughts on his proposed investments?
AM: “We really appreciate the governor’s recognition that we have a severe nursing workforce shortage in Arizona, and we will take all of the help and assistance from our policymakers and our governor to really help address this in the long-term. We have had short-term solutions during the pandemic to help, but we really do need to expand the pipeline and to get more nurses educated in the state, and then we need to retain them. We have a bill HB 2691 that Rep. Joanne Osborne is sponsoring that looks at expanding preceptorship across the state and funding those preceptorships by creating what we call a transition to practice program that helps new graduate nurses acclimate to the hospital environment, creating mentorship opportunities, and supporting those new grads so that they feel supported and that they want to make a career long-term in this field.”
SM: What are Arizona hospitals doing to help support staff and increase workforce retention? What is AzHHA doing to support hospitals?
AM: “In the short term, every hospital in the state is really committed to the health and well-being of their health care workforce. There have been many programs that hospitals are implementing with their staff to really help prevent burnout and to deal with the mental health challenges that have come as a result of the strength of the pandemic. There’s a well-being collaborative that we participate in that’s really looking at best practices nationally, and what we can do to support frontline health care workers. We’re a part of that to ensure our hospitals are represented in that effort, because this is really about people, patients and providers, and making sure that we’re supporting our providers, because they sure have been supporting us these past few years and beyond.”
SOR: What will be some of the lasting impacts of these surge periods of the pandemic, where hospitals have been under immense strain, on Arizona hospitals and hospital systems?
AM: “For the next five to 10 years, I think we’re going to be evaluating many after-action reports in terms of what was done, what could have been done, and then prospectively looking at what we can do to really strengthen the resiliency of our healthcare system in terms of the need to strengthen our healthcare workforce. I think we have been a ‘just in time’ health care system in terms of supplies and staff, and I think we need to have more redundancy in that system so that we have those necessary supplies and those necessary stockpiles. We have got to change the model to make sure that it’s meeting the needs of whatever catastrophe, whatever crisis, whatever future pandemic or mass casualty event we might have … There’s so much room for improvement because who knew that our health care system was as fragile as we’ve seen throughout the pandemic?”
SOR: Mask and vaccine mandates are an extremely contentious topic in the state, especially for legislators right now. What are your thoughts on this and what it means for Arizona hospitals?
AM: “I think it’s unfortunate that masks and vaccines have been politicized. Vaccines, as we all know, are safe and effective, and this is how we have saved millions of lives in the United States, and this is ultimately how we’re going to put this pandemic behind us, or at least at a manageable rate. It’s one of our most important tools, and we should expand and make sure that it is as available as possible because … it saves hospital capacity so that everybody can get care when they need it. I wish we could really move beyond the politicization of this and get to common sense and reasonableness and just do what we know works from a public health perspective. And the same with masks– they work and they’re effective. We’ve got to have all of our tools so that we don’t bring the system to the brink of a crisis, and that we can keep people healthy and safe, and people can keep themselves healthy.”
This interview was edited for clarity and length.