President

Chaminade President Dr. Lynn Babington hosted an engaging and timely forum at the University on April 6 to explore the post-pandemic healthcare needs of Hawai‘i’s communities, how innovation can play a role in addressing inequities in care, and what type of healthcare workforce the state should build to address gaps in services and ensure the best outcomes for patients and their families.

The University’s School of Nursing and Health Professions organized the event—called “Looking Forward: Building a Healthy Community After COVID-19″—to mark National Public Health Week. Lt. Gov. Josh Green, an emergency room physician and Hawai‘i’s COVID-19 Liaison, The Queen’s Health Systems President and CEO Dr. Jill Hoggard Green, Waimānalo Health Center CEO Dr. Mary Frances Oneha, and Hilton Raethel, Healthcare Association of Hawai‘i President and CEO, tackled key questions as the event’s panelists.

COVID’s exposure of vulnerabilities

All of them agreed the pandemic exposed significant vulnerabilities in Hawai‘i’s healthcare system, including a shortage of key medical professionals in disadvantaged and rural communities. The health impacts of COVID on the hardest-hit populations, they added, could be felt for years and years to come.

But, said Dr. Jill Hoggard Green, there is reason for optimism.

“As we step out of this, we have learned so much,” she said. “The innovation and the ability for us to lean in—between government, business leaders, healthcare and all of our communities—have helped us demonstrate we can do so much more. We need the next generation and we need a lot of innovation.”

Oneha added that it’s important to note that healthcare inequities don’t happen in a vacuum. Addressing social community needs, including unemployment, poverty, food insecurity, homelessness and education, are all part of working to ensure healthier outcomes.

Lt. Gov. Josh Green agreed that addressing the healthcare provider shortage is key to helping communities meet post-pandemic needs, and said the surge in telehealth services because of COVID-19 could be a real opportunity to expand access to care. “It’s particularly good that programs like Chaminade are ramping us up and creating more nurses, nurse practitioners,” he added.

Raethel said the healthcare system also needs more investment, including from government, and a renewed focus on preventative care centered around innovation. “We need to move in that direction. We need to invest in communities,” he said. “It’s a real challenge getting equal access to care.”

Preparing for tomorrow

So how can the state prepare a healthcare workforce to meet Hawaii’s needs today and tomorrow?

Babington noted that the “team-based” model to care has shown the best outcomes, stressing collaboration between primary care physicians and other healthcare professionals, including nurses, mental health counselors or psychologists, specialists, and healthcare educators or coaches.

Dr. Jill Hoggard Green also expressed support for the team-based model, saying that focus will be especially vital as Hawai‘i healthcare organizations and their patients “catch up” on health screenings—for everything from cancer to diabetes—that were missed because of the pandemic.

Oneha expressed similar concerns, pointing out that many families are also behind in childhood immunizations and wellness screenings and that health maintenance efforts also need to be addressed.

“We need to be lifetime partners to individuals,” Green said.

She noted the success of telehealth during the pandemic is a real high point—and a “dramatic opportunity for us to improve access” to underserved areas. Before the pandemic, Queen’s was getting about 400 telemedicine visits a month. But in April 2020, that surged to 14,000.

“We know we can use technology. I believe it’s one of our greatest opportunities.”

Raethel also underscored the promise of telehealth in improving health outcomes and broadening access. “The pandemic has created these alternative ways of providing care. So many more people have tried telemedicine,” he said. “It really demonstrated how effective telemedicine can be.”

Importance of healthcare professionals

In discussing how to improve health outcomes, Babington also touched on the importance of community health workers—health educators, coaches, advocates and others who serve as partners to patients and help support them “to achieve their highest level of wellness.”

Oneha said those professionals are a vital part of the healthcare workforce. Healthcare information needs to be provided in a diversity of languages, she said, and delivered by trusted health partners. She said the community also needs to be part of the conversation—”and part of the solution”—in discussions about expanding care and delivering innovations in health and wellness.

During a question-and-answer session, the panelists tackled more elements of Hawai‘i’s healthcare response to the pandemic and what the future could hold. One participant asked about the potential for burnout among healthcare workers on the frontlines of the pandemic and how to support them.

Dr. Jill Hoggard Green, of Queen’s, said during the height of the pandemic healthcare workers were moving quickly to learn whatever they could about the disease, improve patient care and get all the necessary supplies. She held back tears as she recalled the “inspiring courage and great compassion” of healthcare teams who came into work, day after day, despite the personal health threats they faced.

“When you think about the amount of pain and suffering our caregivers saw, of course there is a dramatic potential for burnout,” she said. “Most of our caregivers put all of their energy into taking care of the person.” Throughout the pandemic until today, she added, Queen’s has been providing a significant amount of mental health and other supports to its healthcare workers.

“Our teams are working extraordinarily hard,” she said.

Investing in Hawai‘i’s healthcare

Raethel added that while Hawai‘i must expand access, invest in healthcare and embrace innovation, the state should also be proud of its response to COVID. Throughout the pandemic, Hawai‘i has had the nation’s lowest infection and death rates. He noted that early estimates put the number of possible fatalities from COVID in the islands at between 2,000 and 8,000 in a year.

Instead, Hawai‘i is currently below 500.

He attributes that to the response of healthcare workers, mitigation measures and on a sense of community responsibility in the islands. “It’s one of the great things about Hawai‘i: That sense of ‘ohana, the aloha spirit,” he said, adding that gives him great hope for Hawai‘i’s healthcare system in the future.

“I believe a number of the issues that we’re talking about are solvable in the state of Hawai‘i, whether it’s homelessness, whether it’s mental health. These are finite problems and there are solutions to these problems. It’s going to require collaboration and cooperation between the public and private sector, but there’s an incredibly strong desire to address these issues. We can make these things happen.”

Looking Forward: Building a Healthy Community after COVID-19