16 Nov Towards post-Covid-19: Success stories and lessons learned for the future
This is the fourth and final article from the IHF Young Executive Leaders’ subgroup, working on the overarching theme, “Towards post-Covid-19: Lessons Learned and Challenges for Hospital Leaders”. The working group members bring in professional experience in diverse areas including hospital management, healthcare leadership and nursing management. They quickly defined the most urgent issues for deliberation, discussed what makes a good leader in a special situation such as the pandemic and what people-centered actions have proven to be effective and indispensable in running successful healthcare operations drawing from their different perspectives and personal experiences. What to focus on and what precautions and changes in leadership should be taken for the future? This fourth article focuses on Success stories and lessons learned for the future.
Authors: Alhammadi, S. (UAE), Bartolo, A.M. (Portugal), Braga, V. (Portugal), Castela, E. (Portugal), Lahuerta-Valls, L. (Spain), Obwaka, C. (Kenya), Rodriguez, O. (Spain), Trummer, F. (Austria), Ulrich, K. (Germany)
Success can be defined in a variety of ways, but all the definitions have one common denominator, the achievement of set out goals or purposes. Similarly, in thecontext of COVID-19, success stories are defined and measured in various ways – from a better understanding of the disease, a greater testing capacity, a reduction in numbers of infected persons, lowering mortality rates such as the graph below from the United Arab Emirates showing a steady decline in mortalities, and other metrics.
In this short article, the Young Executive Leaders present their definitions of success and lessons learned in the era of COVID-19: care integration, flexible hospital spaces and teams, the use of telemedicine, the quick incorporation of research results and new information into the daily routine of hospitals, to name a few.
Integration of Care
Different Young Leaders have noted the increased volume of communication between different care levels, including Primary Care practitioners, Public Health doctors, doctors/nurses from seniors’ residences as well as with reference hospitals and prehospital care facilities. Success stories have been linked to the numerous examples of connections formed between different players in the healthcare space. Health professionals from different specialties, cadres and roles have supported each other during these difficult times. There have been COVID-19 task forces and mixed teams all focused on fighting the pandemic together. Different hospitals and levels of care have collaborated on clinical management of patients, not only in the monitoring and treatment of non-symptomatic patients at extra-hospital environments (primary care/hotels/social institutions), but also in the treatment of sicker inpatients.
Older patients, who are dependent on charities, retirement homes and hospitals presented an extra challenge as the healthcare system was inelastically stretched and elderly people are disproportionately more severely affected by COVID-19 disease. As a lesson for the future, this can be addressed by fortifying family support and increased funding to enable more home-based care. However, ensuring infected, asymptomatic patients stay at home continues to be a challenge in some countries.
In order to reduce the length of inpatient stay and bed blockers, there is also a need to improve the coordination between hospital clinical services. Collaboration between departments can enhance shared decision making and ensure quality and efficient choices, reflective of the group thinking. On the other hand, geriatric and rehabilitative medicine can emerge as important players in supporting prolonged hospitalization of the elderly, assessing functional status and referrals to post-discharge facilities, whether social, medical or purely rehabilitative.
Teamwork, communication and care integration thus emerged as a vital focus for clinical leaders going forward.
Flexibility of Care
Other success stories are linked to limber hospital spaces and teams. Many hospitals had, not only, to re-design work/process flows and spaces, but also to reallocate human resources in order to deal with the surge of COVID-19 patients. There were hospitals that managed to increase their bed capacity by bed reallocation for example providing pediatric ICU beds for use by adult patients and by opening more ICU beds in other areas, such as recovery rooms or operating rooms.
Smart and responsive use of all available space is a lesson for future crises as this ensures quick set up of temporary infrastructure, like isolation wards, beds and even ICUs. Moreover, some hospital staff have been trained for quick reassignment of responsibilities in similar situations with excessively high demand. High flexibility of spaces and staff can help hospitals and teams quickly respond to an unprecedented pandemic.
The necessity of isolation and the high risk of transmissibility of the infection through face-to-face contact has driven the increased uptake of remote healthcare provision. Patient risk stratification, automated screening algorithms, virtual computer consultations, and referral for the required level of care have been integrated in an accelerated manner. Telecare has also been a valuable assistant in the monitoring and home-based management of patients with chronic conditions. All this has helped to reduce the strain on hospital infrastructure and resources such as beds, staff, PPE, medications and waste disposal.
Noting the numerous benefits, it is a trend that all levels of healthcare must take forward into the ‘new normal’. Healthcare workers and patients need to successfully learn and adhere to this new form of care, allowing a transition to more virtual consultations and shared digital data. The pandemic has shown us that information and communications technology (ICT) skills will be an inescapable requirement for a good health agent of the future.
Due to the highly infectious nature of COVID-19, care facilities undertook a raft of measures for risk reduction. Many hospitals established new patient flows aimed at separating suspected/potential COVID-19 patients from regular hospital patients. Some hospitals reassigned some peripheral wards for this purpose while some set up temporary shelters like tents outside of the main hospital. Healthcare workers working in these high risk areas were not simultaneously assigned to work in the regular wards as an important measure to protect other healthcare workers and to mitigate the risk of outbreaks within hospitals. New infection prevention protocols were formulated and instituted to govern access to the hospitals and infection and prevention control (IPC) teams were mandated to ensure all hospital users were trained in and adhered to the new guidelines.
There were changes in rules around hospital visitations with some hospitals limiting it to one visitor per patient for one hour per day only which has caused quite a strain on family members. Families were mainly updated via telephone and virtual platforms. This ensured that the families were not kept in the dark concerning the status of their relatives as well as allowing the healthcare workers to consult the relatives on decisions that needed to be made. For the future, hospitals need to maintain and even enhance the channels of communication between the healthcare team and the families of inpatients.
Provision of Safe, Quality and Humanistic Care
Health professionals by virtue of being on the front line of care and being exposed to a large volume of potentially infectious individuals on a daily basis are at a particularly increased risk of contracting COVID-19 themselves. To this end, the provision of safe and adequate personal protective equipment (PPE) has been a priority for all from the onset. Nevertheless, there was a global shortage of the same as there was panic buying and individual hoarding for personal enrichment motives. As a lesson for the future, effective supply chain management has proven to be a very important tool in the fight against the invisible enemy. There is also need for foresight and preparation for such circumstances with adequate stocks of long expiry and/or easily procurable consumables.
Hospitals struggled with measures and strategies to deal with patient groups who have unique emotional and psychological needs such as children, the elderly and even adults in isolation and quarantine. This required innovative skills. A warm smile or touch was replaced by a calm voice tone and gloved touch, which remained imperative for people to deal better with their emotions and hospitalization. This empathetic and loving approach has even been shown to even improve clinical outcomes of hospitalized patients.
During the pandemic, hospital workers have had to keep up with the latest research as the characteristics of the virus and its natural history were largely unknown and knowledge was and is rapidly evolving. Conducting high quality clinical trials, cohesive international collaboration between research scientists and translating research into daily practice ensure that hospitals are practicing evidence-based medicine in the fight against COVID-19.
COVID-19 triggered dynamic changes in leadership styles and patterns. Teams were driven to be more efficient, leaders had to quickly come up with concrete plans of action and improve on the speed and clarity of multilevel communication. The already experienced and skilled staff had to be kept engaged and motivated so as to cater to their unique needs while maintaining a patient-centric approach to provision of care. Decisions had to be made swiftly with as much breakdown of unnecessary bureaucracy and bottlenecks in organizational silos. The team spirit had to be maintained and targets achieved despite a higher workload, fear of contracting COVID-19 and worry over the safety of oneself and others. A major learning point from this has been that speed beats perfection in emergency and pandemic situations. Executives should be open to implementing new and sometimes unprecedented interventions at the beginning of the crisis then be flexible enough to adapt as more information is made available.
Health leaders have had to work even more closely with political leaders such as national and regional government officials with reference to educating the public on social measures for example lockdown, remote work, restriction of entertainment destinations/ shopping centers or postponing sports events. This collaboration extends to situations in which the healthcare facilities would need additional financial support/ subsidies for health products such as testing equipment, PPE, ventilators etc. Leadership linkages would enable the global population to sustainably achieve the goal of “Testing and Treatment for All”.
Continuum of Care
As demonstrated in the following graphs, some countries around the globe have already experienced and recovered from a second wave of infections and deaths. Other countries are currently undergoing one while others will possibly experience the second wave in the near future. It is unpredictable how many waves COVID-19 will possibly have and thus it is imperative that we all maintain at the lessons learned thus far be implemented for this and any future pandemics.
In conclusion, the pandemic has led to cataclysmic healthcare changes and radically novel approaches to care, but now more than ever, we must remember to maintain the universal attributes that characterize healthcare provision: rigor, excellence, humanity, professionalism and consistency to continue providing world-class care to the patients and families we care for everyday now and in the future. We must translate and extend all the lessons learned into improvement in care across the board.
“Life is divided into three terms – that which was, which is, and which will be. Let us learn from the past to profit by the present, and from the present, to live better in the future”.
William Wordsworth (1770–1850)