Berkshire Hathaway Specialty Insurance-sponsored Business Insurance Risk Perspective

Learning from risks to enhance resilience

Healthcare firms rebound with forward-looking focus

By Leo Carroll, Head of US Healthcare, Berkshire Hathaway Specialty Insurance

Coming through remarkable challenges since early 2020, the healthcare industry's resilience has been tested, along with the mental and physical endurance of its practitioners. The coronavirus pandemic and daily case reports, up to now, have dominated headlines and accounted for significant percentages of patient censuses at acute care facilities. In times like this, it's easy to fall into a short-term, reactive mindset, but providers are keeping their eye on ongoing risks. Resilience to the broad set of risks that healthcare organizations and providers face requires them to adopt a longer-term, forward-looking focus.

Perseverance comes to mind when thinking about what healthcare practitioners and caregivers have achieved in this pandemic era. Despite risks to their personal health, providers have heroically met the need to deliver life-sustaining medical care. In the early days of the pandemic, these efforts were made amid shortages of personal protective equipment and other resources.

Healthcare supply chain challenges have since dissipated. To stay resilient and continue to persevere in delivering care no matter what comes next, healthcare providers are gaining tremendous insights from the experience of these past months and elevating existing risk management protocols.

Lessons in resilience

There is a popular notion that people never truly know how strong they are until they're tested. For healthcare providers, the pandemic era offers a similar kind of test, and the vast majority have demonstrated a noble strength under unrelenting pressure. There are several lessons to take away from this experience, including:

  • Dark clouds can have silver linings. Before the pandemic, relatively few organizations realized the advantages that telehealth and online care could provide when in-person access is restricted. Those channels of care delivery have proven successful and are likely to grow in acceptance. Another lesson is the need to balance urgent care with broader wellness initiatives, to examine total health and not just treating the immediate condition.
  • Preparation is paramount. If no one fully foresaw the impact of COVID-19, that is not necessarily a failure, though some observers had been warning about global pandemic risk for several years. Regardless, preparation for the unexpected is of paramount importance, to ensure operational continuity. Hospitals, for example, understand the need for backup power generation if local conditions result in an electricity outage, so they invest in generators. What other factors might disrupt critical supplies and endanger safety and care quality? What can providers do to mitigate the impact? Preparation starts with understanding the risk environment, even if certain scenarios seem remote.
  • A long-term focus guides resilience planning. More than most industries, healthcare can ill afford long disruptions, especially in acute-care settings. Lives can be lost in hours, so the ability to continue delivering care is a critical concern. To conduct effective resilience planning, healthcare providers are best served by taking a long-term focus. That calls for asking questions and testing assumptions around enterprise risk management. What care we do today to increase our resilience and bolster continuity of care?
  • Managing risk in healthcare takes ongoing effort. Just as there is a continuum of care for many conditions — requiring monitoring and follow-up — managing healthcare risks is a continuous process. As we saw during the pandemic, new risks can emerge and complicate existing exposure profiles. "Set it and forget it" simply doesn't work, either in delivering quality care or administering effective risk management programs. Providers are monitoring dynamic conditions, anticipating changes and adjusting accordingly.
  • Partnership empowers recovery. One of the great reminders during the pandemic is that isolation tends to weaken recovery, while strong partnerships improve it. Going through any difficult episode alone is much harder. This applies not only in the context of patient and provider — where each has responsibilities before, during and after treatment — but also in the context of healthcare organizations and their risk management partners. Seeking specialist advice to address risks and exposures, and develop prioritized plans for preparation and response, is worth the investment.

Risks in co-morbidities

One way to think about the healthcare risk environment is to consider the impact of co-morbidities on acute conditions. Underlying chronic conditions have been exacerbated by COVID-19. According to data from the Centers for Disease Control and Prevention, 95% of deaths where COVID-19 was listed on the death certificate involved co-morbidities. The CDC calculated that each such COVID-19 death had an average of 4.0 morbid conditions. Just as patients need to carefully consider the broader circumstances impacting their care, and take steps to manage existing conditions, healthcare organizations know they are most effective when taking a holistic approach to risk management.

Uncertainty is not a comfortable place. It can be paralyzing and frustrate decision making. The aim of risk management, in addition to protecting people and preserving value, is to reduce uncertainty and volatility. Ongoing vigilance is essential: COVID-19 is not the only pathogen that practitioners and facilities need to monitor. Other infectious pathogens in the healthcare setting, including methicillin-resistant staphylococcus aureus (MRSA) and catheter-related urinary tract infections, have increased sharply during the pandemic, according to studies compiled by the National Healthcare Safety Network.

Managing risk collaboratively is an effective way for healthcare providers and organizations to improve their resilience, reduce uncertainty and recover to a stronger operating environment beyond the pandemic.

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Leo Carroll is Head of US Healthcare at Berkshire Hathaway Specialty Insurance. He is responsible for the strategic growth and performance of the group's Healthcare Professional Liability products.

Berkshire Hathaway Specialty Insurance ( provides commercial property, casualty, healthcare professional liability, executive and professional lines, transactional liability, surety, marine, travel, programs, accident and health, medical stop loss, homeowners, and multinational insurance. The actual and final terms of coverage for all product lines may vary. It underwrites on the paper of Berkshire Hathaway's National Indemnity group of insurance companies, which hold financial strength ratings of A++ from AM Best and AA+ from Standard & Poor's. Based in Boston, Berkshire Hathaway Specialty Insurance has offices in Atlanta, Boston, Chicago, Houston, Indianapolis, Irvine, Los Angeles, New York, San Francisco, San Ramon, Seattle, Stevens Point, Adelaide, Auckland, Brisbane, Cologne, Dubai, Dublin, Hong Kong, Kuala Lumpur, London, Macau, Madrid, Manchester, Melbourne, Munich, Paris, Perth, Singapore, Sydney and Toronto.

The information contained herein is for general informational purposes only and does not constitute an offer to sell or a solicitation of an offer to buy any product or service. Any description set forth herein does not include all policy terms, conditions and exclusions. Please refer to the actual policy for complete details of coverage and exclusions.

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