Competitors Who Collaborated During COVID-19

Executives from competing hospitals and health systems shared operational information during the pandemic to better serve patients in their communities and to roll out vaccination efforts.

This article appears in the May/June 2021 edition of HealthLeaders magazine.

During the chaos and confusion early in the COVID-19 pandemic, hospitals and health systems turned to each other to share insights and information about the novel coronavirus and how to meet the needs of their patients.

HealthLeaders spoke with executive leadership from Oregon-based Legacy Health and Florida-based Tampa General Hospital, two examples of organizations that cooperated with their competitors and created partnerships to better serve their communities and roll out successful vaccination efforts.

Sharing the 'mundane'

Legacy Health, a nonprofit health system with hospitals and clinics in Oregon and Washington, is no stranger to partnering up with competing health systems to serve patients. In early 2017, Legacy Health collaborated with Adventist Health, Oregon Health & Science University (OHSU), and Kaiser Permanente Northwest (Kaiser) in creating the Unity Center for Behavioral Health, a 24-hour behavioral and mental health center in Portland, Oregon, which offers emergency services for those in a mental health crisis.

These established relationships enabled some of these competitors to team up again during the pandemic, to share non-competitive information and create a vaccine strategy.

When the pandemic hit the Northwest, with the first-ever COVID-19 case in Washington state, there was a lot of confusion, lack of resources, and panic.

"Nobody had a playbook for this situation," Trent Green, COO of Legacy Health, says.

Early in the pandemic, Green says he and other health system leaders across the state would hold weekly phone calls with the Oregon Association of Hospitals and Health Systems to discuss the virus. 

This idea was modeled off of ongoing meetings the organizations' CMOs had around regional flu response, which have been happening for years. Similarly, during the pandemic, the CMOs of the different organizations broke off into "splinter groups," to share information about clinical issues and what cases they were seeing in their hospitals.

The COOs developed a weekly virtual meeting that Green describes as a "self-help group" for the leaders of Legacy Health, Providence Health & Services in Oregon (Providence), Kaiser, OHSU, and PeaceHealth.

Green says, "[We shared] non-competitive [information], in a lot of ways [it was] very mundane, but also in a lot of ways relevant given the amount of organizational energy that was [needed]." He says that none of the information shared involved trade secrets, just operational information and how to keep their patients and communities safe.

The leaders worked in concert on visitor restrictions, restricting surgical procedures, and capacity issues.

"We found that there were a number of things that we could learn from one another and draw from one another's individual decisions and information," Green says. "We would work together to come up with similar decisions or ideas on certain operational impacts."

Collaborating for community vaccination efforts

Legacy Health also partnered with Providence, Kaiser, and OHSU to jointly stand up a "high-throughput vaccination effort" for the state's metropolitan area called "All4Oregon," Green says.

"Sometime in late December, we had a discussion with the Oregon Health Authority," Green says. "It became clear to us after talking to the state that they didn't have a plan [or] a clear response from local public health as to how they might stand up vaccination efforts."

He continues, "[In mid-January], we had a meeting of all the chief operating officers with key members of our health systems who had been involved in vaccination efforts, and we made a decision in about four hours that we were going to come together and stand up a high-throughput vaccination effort."

While the organizations didn't have goals set when they first started meeting, their goal eventually became to vaccinate as many people as they could, in a timely and orderly fashion, Green says. Design models were created for vaccinating up to 15,000 patients a day. The organizations have provided 293,541 people with 549,471 vaccines, as of the morning of June 17.

The health systems created a memorandum of understanding for the vaccination effort.

"It was unlike any healthcare contract I've ever negotiated," Green says. "We did it in about 20 minutes, and it was essentially: 'We're doing this in the best interest of our community, and the partners agree that we will ultimately share in the costs, and to the extent that there are any revenues associated with our vaccination efforts, we'll share those in an equal fashion.' It's about as simple as that."

Success in launching the community vaccination effort was due to the health systems' combined effort in collaboration, communication, and teamwork. Each organization took the lead in different efforts, including the combined use of Legacy Health's Epic health records to keep track of the vaccinations. Other organizations led pharmacy efforts or medical site efforts.

"It's been a phenomenal partnership," Green says.

The health system executives also took different roles around the vaccination effort. The day Green spoke with HealthLeaders, he served as incident commander at the Oregon Convention Center, where they rolled out over 7,000 vaccinations to the community that day.

Partnership outcomes

"[As far as outcomes,] I would say one is, we still meet. We still find value in meeting even if we don't have formal things on the agenda," Green says. "We still find value in [sharing] how many COVID patients [we have], [if we're] still doing testing, [and where we are] doing testing."

Another outcome is that the vaccination throughput the four health systems implemented is now the leading vaccination effort for Oregon. The Federal Emergency Management Agency (FEMA) also told the organizations that they were one of the highest-throughput vaccination centers in the country, an achievement they are proud of, Green says.

Green says that he doesn't think the different organizations would have been able to succeed if they had not partnered and supported each other through the pandemic.

Partnering also helped the health systems gain a louder voice within the communities and states they serve for future public health decisions and considerations.

"We have an outsized voice," Green says. "We've shaped a lot of the decisions around how Oregonians sign up for our vaccine, how they're communicated with, [and] all that's been driven by us, operationally."

The formal collaboration among the health systems will unwind following the high-throughput vaccination effort, Green says.

"[The vaccination effort is] an enormous amount of work that we can't continue to sustain long term. We have a mission to accomplish and get as many people vaccinated as quickly as possible, but we'll unwind that sometime in late spring, early summer is our expectation," he adds.

While the formal partnerships will phase out, Green says the relationships he's built with the other COOs will be something he enjoys forever, and they plan to communicate informally.

"The spirit of collaboration and information sharing among us as chief operating officers will be sustained," Green says. "I now get texts or phone calls not infrequently from one of my peers at the other organizations on topics that are totally unrelated to COVID."

How to work well with competition

"We still compete with these organizations," Green says. "But what we have found beneficial is [sharing] the stuff that's non-competitive. Everybody's got to have a visitation policy, everybody's going to be doing screening, these are areas that are really non-competitive, and frankly, non-differentiating."

"There's just been enormous value in moving in concert with one another," he adds. And "it does multiply the power in ideas and experience with … these significant challenges … in healthcare."

However, like any relationship, there can be downsides to partnering with direct competitors.

"We don't always fly in formation perfectly. There are different personalities … [and] we've had our share of differences of opinion," Green says. But they were always able to successfully work through those differences, he adds.

Building on established relationships

Similar to Legacy Health, Tampa General Hospital in Florida has partnered with competing hospitals and health systems in the Tampa Bay region of the state to combat the pandemic.

John Couris, CEO of Tampa General Hospital, tells HealthLeaders that the hospital and USF Health's ongoing partnerships with BayCare, AdventHealth, and HCA are going strong. The CEOs of each organization meet weekly to share non-competitive information including COVID-19 data, staffing issues or concerns, patient loads, and what's working and not working in their facilities.

The idea to collaborate came from a conversation Couris had with Ravi Chari, CEO of HCA's West Florida Division, during Florida Governor Ron DeSantis' first press conference on COVID-19 in March 2020.

"We both thought it would be incredibly beneficial for the health of our community if the major health systems came together on an ongoing basis to share information," Couris says. "So, we put a plan together and became full partners in this historic, coordinated, collaborative effort that we believe helped save lives in our region during that initial devastating wave of COVID-19 in spring of 2020."

"We share best practices, ideas, [and] coordinate efforts," Couris says. "We're typically fierce competitors, but when it has come to COVID-19, we have been good collaborators and we're continuing to do so."

Another way the healthcare organizations collaborated was when vaccines were starting to get rolled out for healthcare workers in the state, much like Legacy Health's partnerships.

"Tampa General Hospital was selected to be one of the first hospitals in the state of Florida to receive the Pfizer vaccine. We were asked by the state to not only begin vaccinating our own healthcare workers, but we were asked to support and distribute vaccines to HCA, AdventHealth, BayCare, Moffitt [Cancer Center], and Bayfront [Health St. Petersburg]," Couris says.

That first shipment of the first vaccine carried "20,000 doses of hope," Couris adds.

As of June 16, Tampa General has administered over 11,000 vaccines to team members, family, and medical staff, and over 16,000 vaccinations to patients and the community.

The hospital was able to seamlessly coordinate and work with the other organizations to distribute the vaccines to health facilities because of their established relationships.

"I'm a little biased because I know most of the CEOs and leaders of the healthcare organizations that make up the health system in the state of Florida," Couris says. "These are good people … who take seriously the idea and notion that our responsibility is to safeguard the health and wellness of the community, particularly the communities that we serve."

Although the competition among Florida healthcare systems is "fierce," there was no doubt among the organizations that they would join together to care for the 4.5 million people who live in the Tampa Bay region.

"Early on, we all agreed that when it came to treating COVID patients, and safeguarding the health and wellness of this community, that we would work together and collaborate. We would not allow competition to get in the way of doing what was right for our community," Couris says.

Because the organizations were partnering to respond to a public health crisis, and weren't sharing competitive strategies or trade secrets, there were no legal documents involved in the collaboration, much like Legacy Health.

"We didn't feel like we had concerns around legal issues about collaborating, because … this was all about clinical care and response to COVID," Couris says.

The organizations don't have plans to partner past COVID but will continue to loosely collaborate.

"We came together for a very specific reason, and we'll stay together, and we'll communicate, coordinate, and work together until COVID is no longer a problem," Couris says.

He adds, "As soon as [the pandemic] becomes something that's manageable, that we can live with, and vaccines have been proliferated to a point where we're getting close to herd immunity and COVID becomes a much more manageable infectious disease, we'll still communicate, we'll still share information, we'll still work together as it relates to COVID. But there are no plans to go beyond that."

'You have to transcend competition'

When working with competitors, Couris says to keep an open mind and be willing to learn from others, and have a willingness to be part of something larger than yourself.

"When you're dealing with a public health crisis to the magnitude that we have been dealing with, you need to come together as a team," Couris says.

He also says to keep the patient at the center of everything your organization does.

"We're stronger together than we are apart, when it comes to a crisis or an emergency … [and] when it comes to taking care of the health and wellness of a community," he says.

"You have to transcend competition," Couris adds. "We compete fiercely in this market. Florida is a very competitive state for healthcare … competition's good in normal times. Competition makes you better, makes you stronger, makes you sharper. But in a public health crisis, where the community looks to you to provide a safety network to care for and treat … you have to be able and willing to transcend competition, push that to the side, and focus on what's most important.

"In this case, what was most important was confronting COVID-19 together and supporting a community who relies on us to provide world-class healthcare to them, and that's exactly what we did."

Editor's note: This story was updated June 18 to reflect Tampa General's updated vaccination totals.