Oregon health systems change masking requirements after mask mandate for health care settings lifts

The Oregon Health Authority announced last month that face masks would no longer be required in health care settings beginning April 3. The mandate had been in place for the last three years to prevent the spread of COVID-19 in hospitals, urgent cares and other medical facilities. The new guidance doesn’t prevent health care facilities from continuing to require masks, leaving providers around the state to decide whether and how to update their policies.

Asante Health System in southern Oregon will discontinue its COVID-19-era mask requirements. Holly Nickerson, vice president of quality and patient safety, joins us to talk about how the decision was made and what patients and staff can expect going forward.

Note: The following transcript was created by a computer and edited by a volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. We start today with a big COVID-19 milestone. Early on in the pandemic, the Oregon Health Authority required that everyone be masked up in health care settings. That mandate lasted for nearly three years until yesterday. Now, health care facilities in Oregon can set their own rules. The majority are loosening their requirements to a great extent, Saint Charles Legacy, Providence and OHSU are all getting rid of an across the board rule. They’ll require masks only in certain situations. Kaiser Permanente seems to have taken the most conservative approach. It will still require masks in its two Portland area hospitals. We’re going to get the perspective of one hospital system in southern Oregon right now. Holly Nickerson is the vice president of Quality and Patient Safety at Asante Health System. She joins us to talk about their newfound freedom to make their own rules. Holly Nickerson, welcome.

Holly Nickerson: Thank you.

Miller: Can you describe the new rules that the team there has put in place?

Nickerson: On April 3, the Oregon Health Authority allowed the opportunity for organizations to set their own guidance. Asante, after careful consideration, looking at our local data, our hospitalization rates, our mortality rates and really taking into account the well-being of our community and our staff, decided to make masking optional in all settings. We still require masking for people who are experiencing illness and other infectious diseases. But no longer are we masking in the hallways and in the cafeteria.

Miller: The current policy says COVID will be treated more like influenza within the health system. What does that mean in practice?

Nickerson: During flu season, we actually monitor metrics and when a certain threshold is met for flu, we will require a mask on for individuals who are unvaccinated. We’re gonna be handling COVID-19 in a very similar way. So we’re gonna monitor metrics. That is our additional precaution, that we’re providing to our unvaccinated work staff. And then if we meet certain thresholds, we may require a mask on and that gives us the flexibility and agility to bend and shape as this pandemic moves into more of an endemic state.

Miller: Are the new masking rules, the current ones as of yesterday, different from pre pandemic practices?

Nickerson: They really are not. Besides having more open dialogue and allowing staff the choice to wear a mask, we always allowed staff if they wanted to wear a mask but I don’t think it was something that was talked about, [nor was] also allowing our patients to request a mask. So if they want us to put a mask on during their care, we will respect and honor those wishes, so very similar but with different nuances from the information that we’ve learned over the last three years.

Miller: What did you hear from staff and from patients when you were deliberating over the last month or so? You had a month to figure out basically what was going to be the plan going forward as of yesterday. What did you hear?

Nickerson: I think that there are a mix of emotions, right? I think that there’s still a little bit of concern and fear. This pandemic is three years of a lot of different experiences for people in different settings. I also think that there was hope for the opportunity to take a mask off. We have to remember that a lot of our care providers who worked through the pandemic, oftentimes would have a mask on for 12 hours of their shift while they were doing incredibly challenging work. And so it’s very exciting for a lot of people to be able to have that opportunity to make a choice and take a mask off.

We wanted to make sure we heard from a lot of different stakeholders. So we interviewed physicians and staff and gave the opportunity for people to give feedback about what they might like to see. And I think across the board, people wanted that flexibility and the option to decide whether a mask was appropriate for them.

Miller: I should say that’s not the majority of the responses we got when we took to social media to ask how folks felt about OHA’s getting rid of the statewide mandate. We got a lot of negative responses. I’m gonna read some of them to you.

Annalise Fern wrote, ‘I can’t imagine seeing patients up close and personal without respiratory protection anytime in the near future. Asymptomatic spread is still a thing. And nosocomial (Miller: I had to look this up - meaning hospital based) infections can be devastating. It’s irresponsible,’ she wrote.

Jennifer said, ‘those of us with chronic illnesses and other disabilities in this state are being left behind yet again, not because of science, but because of wishful thinking. We are being cut off from accessing health care. It’s a disaster. No effort is being made to keep anyone safe.’

And E wrote, ‘I’m immunocompromised with multiple serious autoimmune diseases currently not stable enough to get my bivalent booster or even take Tylenol and cannot avoid medical settings. So I’m enraged at the state essentially giving me a death sentence because people have feelings.’

What’s your response to all of these concerns?

Nickerson: I think when we hear that . . . we did hear something similar. We have staff that expressed similar concerns. And that’s why we try to really honor choices. We want to make the experience within the health setting. So we designed a tool that’s called ‘words that work.’ It’s scripting. So when we have patients coming into the hospital, we’re asking them ‘what’s your preference? What would you like us to do in regards to masking?’ And the same with staff, respecting and honoring people’s choices. When we looked at the data and looked at the mortality, the utilization of the intensive care units, the prevalence within the community, we felt that not masking all the time was safe and we will constantly revisit that decision, but we have to honor and respect people’s concern as well.

Miller: And just so I understand the power that a patient say has if they are going in for an outpatient service and they say, at the front desk, ‘I would feel more comfortable if the people around me are masked,’ then the nurses or doctors or orderlies who they interact with, will all mask up? I mean how would that work? How do you honor a request like that but also honor the desire, say of some of those people to not wear masks?

Nickerson: There’s gonna be some imperfections. I can’t say that it’s going to be perfect. One of the things that we’ve committed to is we have a complaint and grievance process within the health system. So if people have concerns about how that process is being rolled out, we will continue to escalate and listen to those concerns. But we would hope that in an instance if someone came in and said, ‘hey, I really would prefer . . .,’ we will try to support and accommodate those requests, knowing it can’t be perfect all the time and we have to work through theirs. There’s a lot of things we don’t know, right? We don’t know what’s gonna happen next. And we have to be flexible to the ever changing landscape.

Miller: What was yesterday like or what has today been like? I mean, I imagine for the first time in three years, you and the people around you are not wearing masks at work. What’s that like?

Nickerson: This week we actually have an employee Communication and Engagement Fair going on. I’m holding dialogue and listening sessions all week so that staff can get on that session and communicate about what’s going on, what it feels like. Yesterday there was a lot of happiness and joy. I read some of the comments in the chat as you’re doing this session of being able to see smiles again, being able to connect again. Some people said, ‘hey, I’m gonna still wear a mask’ but I respect the choice other people have and are making. There was a lot of joy yesterday. That was, that was what was filtered to me. But we are assessing very closely any concerns that get brought up as we try to navigate through this.

Miller: Holly Nickerson, thanks very much.

Nickerson: Thank you.

Miller: Holly Nickerson is the vice president of quality and patient safety for Asante Health System.

Contact “Think Out Loud®”

If you’d like to comment on any of the topics in this show or suggest a topic of your own, please get in touch with us on Facebook or Twitter, send an email to thinkoutloud@opb.org, or you can leave a voicemail for us at 503-293-1983. The call-in phone number during the noon hour is 888-665-5865.