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Coronavirus: How One Rural Health System Is Coping With the Fall Surge

Analysis  |  By Christopher Cheney  
   November 18, 2020

Sanford Health's chief operating officer shares how the health system is reacting to a surge of COVID-19 patients in the organization's sprawling service area.

Sanford Health is prepared to address the challenges of the fall coronavirus patient surge, according to the health system's chief operating officer.

Health systems, hospitals, and physician practices are under strain as the country experiences record-setting levels of new confirmed coronavirus cases and hospitalizations. The fall surge is particularly challenging to health systems such as Sanford Health, which operates resource-strapped rural healthcare facilities in four states.

Sanford Health operates 46 hospitals and 210 clinics in Iowa, Minnesota, North Dakota, and South Dakota.

To see how Sanford Health is responding to the latest wave of coronavirus infections and hospitalizations, HealthLeaders recently spoke with Matt Hocks, MBA, chief operating officer of the Sioux Falls, South Dakota–based health system. The following is a lightly edited transcript of that conversation.

HealthLeaders: For Sanford Health, what is the primary challenge in coping with the current coronavirus patient surge?

Matt Hocks: The primary challenge right now is the record number of COVID-19 cases in addition to the other cases we are seeing. We are working to balance our resources to not only care for the COVID-19 patients but also care for patients with strokes, heart attacks, traumas, and other conditions who are seeking care from Sanford.

We have an obligation to our communities to be there for them in their time of need, and it would be a challenge for any healthcare organization as we see these numbers grow literally overnight.

In the early phase of the pandemic, we were able to manage pretty well. In May, our peak COVID-19 patient census was about 100 hospitalized patients. Today, we have almost 400 hospitalized COVID-19 patients. Our total hospitalized patient census is about 1,400.

HL: What strategies has Sanford deployed to deal with the pandemic?

Hocks: We set up some simple strategies right away at the corporate level in March. One strategy was to have 120 days of personal protective equipment on hand. We never wanted our clinicians to turn around and not have a mask in the drawer or on the shelf. That was non-negotiable. Our staff's safety was a priority.

Second, we needed to have modeling. We needed to know what was going to happen in seven days, 14 days, and 28 days. We knew that as we went further out, the modeling became less reliable, but from seven to 28 days it was very reliable. We shared the modeling with our markets, so they also could prepare.

Third, we needed to make sure we had coronavirus testing capabilities. Early on, we realized that we could not rely on others for the testing of our staff or our communities. So, we stood up our own testing capabilities in March.

The last strategy was to have clinical trials, so that we would have drugs available that were coming onto the market. We wanted to make sure that anyone hospitalized with COVID-19 had the opportunity to receive treatment.

HL: Sanford Chief Medical Officer Allison Suttle, MD, has been presenting weekly "State of the Union" videos. Why did the health system launch this communications initiative?

Hocks: We wanted to make sure that there was one source of truth about the virus and how we were responding to the virus. We also wanted to make sure that all of the efforts that we were undertaking to support all of the local leadership and clinicians was communicated and they knew what our strategy was. Our primary service area footprint is about 300,000 square miles, and the only way to communicate to all of our markets was to find a way for Allison to communicate. We thought State of the Union videos was a great way to do it.

HL: What kind of content is included in State of the Union videos?

Hocks: There are three criteria for every State of the Union video.

Number one is thanking our people and asking them to stay safe. We want to show encouragement and appreciation for the personal and professional sacrifices that have been going on for almost 30 weeks. Number two is to share our strategy as an organization and how we are pivoting. Number three is some educational component to help the staff be more educated about the virus because of all the misinformation that is out there.

HL: Rural hospitals and physician practices have limited resources. How has Sanford bolstered rural hospitals and physician practices during the pandemic?

Hocks: Typically, about 10% to 15% of our COVID-19 patients are not in our four main medical centers—they are in our critical access hospitals. Those patients are part of our integrated health system; and regardless of where patients come into our organization, we want them to receive the same level of quality care that they would otherwise receive anywhere else. That may mean they need to be transferred because we do not have the same level of sub-specialization in a small town like Sheldon, Iowa. But that just means patients are a phone call away from one of our main medical centers.

At our rural facilities, staff have access to PPE. The facilities have access to testing. They have access to our modeling, so they can see what will be happening in their communities. And they have access to clinical trials—if their patients need remdesivir, we can get them that drug.

Although we are spread across a large geography, our logistics are set up in a way that small hospitals can care for patients who have COVID-19. Thankfully, most COVID-19 patients can enter our rural hospitals and leave without a huge amount of medical intervention. But there are some patients who need to be in an ICU and need to be intubated, and those are the patients that we transfer to our major medical centers so that they can get the next level of care.

HL: During this fall coronavirus surge, the country is setting records for coronavirus cases and hospitalizations. Are you concerned that Sanford could be overwhelmed?

Hocks: Based on our modeling, we are going to see an increase in COVID-19 patients, and we have surge plans to accommodate those increases. Back in March, we asked what it would mean to have 600 coronavirus patients in our hospitals or 800 coronavirus patients in our hospitals. We looked at our options for care sites. We asked how we were going to work with our state governments and our departments of health. If we did not work as a team, I would be concerned. But as we bring together the power of an integrated health system working with state and local officials, we can endure this third surge.

So, we are not in a crisis mode, but we are very serious about the challenges. We know that the number of COVID-19 patients is going to increase, but we have ways to accommodate more patients.

It is a balancing act. How do you continue to care for COVID-19 patients while also caring for everyone else who needs care, too? We are focused on our coronavirus patients and how we can keep them out of the hospital. As long as we continue to do that and leverage all of our resources and challenge all of our strategies, we believe we can handle whatever comes at us next.

Related: 6 Steps for Rural Hospitals to Rise to the Coronavirus Challenge

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


Sanford Health operates nearly four dozen hospitals—mostly rural facilities in Iowa, Minnesota, North Dakota, and South Dakota.

Compared to the spring coronavirus surge, Sanford now has four times the number of hospitalized COVID-19 patients.

The health system's strategies for addressing the pandemic include securing PPE, modeling of coronavirus patient volumes, and establishing in-house coronavirus testing capabilities.

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