The COVID-19 pandemic has transformed our lives at every level. The virus has focussed a spotlight on social and economic systems across the world. It has exposed all kinds of flaws in the way we work, the treatment of essential workers and workers’ rights. After almost a year of dealing with the pandemic, we believe it’s time for organisations to reflect and identify the learnings from this crisis, to improve their disaster preparedness plans and the way they handle difficult situations.
In 2020 the world acknowledged the pandemic not just as a medical crisis, but also a social and economic one that exposed the fragility of our communities.
The pandemic has mercilessly uncovered the deep faultlines in our labour markets, with enterprises of all sizes stopping operations, cutting working hours and laying off their staff.
Many businesses are teetering on the brink of collapse due to the restrictions that are updated monthly in each country. On the other hand, healthcare workers are exhausted, still dealing with difficult situations under extraordinary pressure.
Therefore, I want to share with you my experience as a nurse working in a hospital with COVID-19 patients. I will highlight the problems I have witnessed in recent months, but also the things I appreciate from the leaders and the marvellous teams I work with. I will also describe the most valuable lessons I have learned from this crisis.
- Being crisis-ready: Could we have been better prepared for it?
- Crisis preparedness in the healthcare sector
- My experience working in a hospital with COVID-19 patients
- Preparing to do better, next time
- Emotional wellbeing after a crisis
- Tips managers can use to lead through a crisis
Being crisis-ready: Could we have been better prepared for it?
The pandemic has led to the biggest crisis many organisations have had to face in their existence. Few businesses anticipated that something of this scope would happen, and most were not prepared for it.
Many companies reacted to the outbreak by adapting whatever disaster plans they had in place.
From my perspective, the healthcare sector was caught napping by the COVID-19 pandemic. Although preventative measures – such as hand sanitiser, signage indicating the importance of maintaining social distance, the supply of hospital scrubs and wearing masks – were introduced very quickly, other measures (which I will describe later) were delayed.
I acknowledge the great effort around the world to contain COVID-19. However, in the long term, the healthcare sector – and all types of organisations – will have to handle a crowd of implications.
Rarely can crises be isolated and controlled. They will always bring unpredictable ups and downs. The question is not whether there will be a crisis or not. The important thing is whether organisations have enough preparation to survive one.
Crisis preparedness in the healthcare sector
According to a hospital preparedness checklist published in 2010 by the World Health Organization (WHO) after Influenza A virus (H1N1 subtype), “hospitals play a critical role in providing communities with essential medical care during all types of disasters.”
Hence, the usefulness of drafting a crisis preparedness plan (CPP) is undisputed. This “road map” should aim to give directions on how to act to respond to critical situations.
Moreover, this plan should include a balance between the demand and the supply of medical services, particularly when the hospital receives an unusually large number of new patients in a relatively short period of time. This rush can overwhelm the ability to meet needs if the hospital doesn’t implement exceptional measures.
Learning from this crisis is essential for the years ahead
As a general rule, healthcare workers (HCWs) need to be well prepared to safely care for patients and achieve good outcomes.
In my experience, whether it be the resuscitation of a patient or working up a patient for surgery, HCWs are methodical about preparation and execution. Moreover, everyone is aware of their role as part of a team.
We should apply this level of preparedness to the management of a pandemic.
It’s important to prepare as a whole organisation, but hospitals also need to consider pandemic preparedness in each unit. This is because different approaches to managing the challenges caused by the pandemic may be needed in some units.
This pandemic preparedness review should be done at least annually, maybe even twice a year. Policies relating to a pandemic response should be reviewed regularly (i.e. every year) and updated with the latest evidence.
Moreover, processes and outcomes should be discussed with staff from each unit. This will guarantee all teams are aware of their role when the next pandemic occurs.
When I started nursing, we watched a video called “Hospitals never burn down” in which a hospital did burn down and many patients lost their lives. What was highlighted was the total lack of preparedness hospitals had towards fire and safety. As a result, there have been significant changes and improvements, with the introduction of mandatory fire and safety training. A similar change is occurring with the management of the deteriorating patient.
In contrast, we are seeing patients and healthcare workers die unnecessarily from the COVID-19 pandemic, largely because of not being prepared.
My experience working in a hospital with COVID-19 patients
I think the best approach to crises is to recognise the possibilities, measure the risks and establish clear processes to manage them. In this way, the healthcare sector – and businesses of all types – can prepare for the unexpected and ensure they have a well-constructed plan to follow.
During the early months of the pandemic (March-May 2020), I encountered a number of issues in my workplaces:
- Creation of policies “on the run” regarding the triaging and caring of COVID-19 patients within the hospital.
- Lack of consultation with staff about how best to implement infection prevention within their unit. This was seen with the rush to introduce measures (e.g. iPADs in patients rooms) that were never used in some units.
- Lack of measures such as patient screening and designated entry and exit points to the healthcare organisation.
- Confusion about the transmission risks and how to deal with them. It was several months before governments advised hospitals that HCWs were at high risk of transmitting the virus in small rooms such as tea rooms. It was only then that hospitals introduced attendance records and tracking & tracing apps, as well as social distancing measures such as rearranging furniture in tea rooms.
- Inconsistencies with the distribution and use of Personal Protective Equipment (PPE). The stock was reasonably well supplied to most hospitals, but the type of PPE was often different depending on hospital and units within hospitals. For example, some hospital emergency departments had full hazmat suits while others had very flimsy aprons.
- Inconsistencies with how to “don” and “doff” PPE. This varied between wards of the same hospital and between hospitals. The lack of adequate training for “spotters” (who were responsible for watching staff donning and doffing) was also apparent.
- Lack of attention given to cleaners and ensuring the quality of their important work.
- Continued use of agency or casual staff who worked at other COVID-19 hospitals, increasing the risk of cross-infection between hospitals.
- Underestimation of additional workload on nurses, since volunteers, visitors and family were not allowed into the hospital during the pandemic. As a result, nurses caring for patients spent much time communicating with family members and carers about their patients.
- Postponement of routine work such as quality meetings and quality improvement projects.
Aside from these issues, many routine situations suddenly became more challenging owing to the unusual circumstances.
For example, once in the middle of the pandemic, my 8-hour shift became a 14-hour shift that left me physically exhausted. During that shift, I had to handle a cardiac arrest during a routine angiogram, a situation that is difficult at the best of times, but working in layers of PPE, it was even more so. Because of COVID-19, staff numbers had been reduced to a bare minimum, adding to the pressure on the nursing and medical staff that were caring for the acutely unwell patient.
However, it is not only acute cases that are difficult. In the Emergency Department (ED), every patient is treated as potentially having COVID-19. This adds a degree of difficulty to their care.
Caring – by yourself – for an elderly woman with a fracture and with suspected COVID-19 is not easy. Cannulating, catheterising and ensuring that analgesia (pain relief) is prompt takes time. It is distressing to both patient and HCW that pain relief is delayed because of the extra precautions that COVID-19 add to the care of a patient.
It is physical work and more so because of the PPE. Glasses fog up, scrubs become drenched with sweat and it is difficult to hear patients through the mask.
I have also had comments from visitors (once they were able to return to the hospital) telling me off because I had my mask down so I could have my first cup of coffee for the day.
Staff are also at heightened levels of anxiety/vigilance at all times, even when case numbers are low. Once I was abused by a colleague in a change room for having placed my bag too close to hers.
Although Australia has not experienced the number of cases and deaths as other countries, the stress and the pressure the pandemic has caused – and continues to cause – frontline HCWs remains significant. Until herd immunity through vaccinations occurs, the threat of COVID-19 is ever-present and so are the precautions that come with it.
Preparing to do better, next time
Disasters are tragedies. Yet they can serve to help us understand the physical and social factors governing them.
Valuable information gathered during the hours, days, months and years following a disaster can lead to policies and practices that enhance the effectiveness of risk preparedness, awareness and education, warning and mitigation.
In this regard, post-disaster reviews are needed so we can learn the lessons that are there to be learned.
According to Lisa M. Koonin, author of “Novel coronavirus disease (COVID-19) outbreak: Now is the time to refresh pandemic plans,” the quick conceptualisation and implementation of plans, either by updating existing ones or by creating new ones, increases the chances that the organisation will more effectively get through a prolonged crisis.
Importantly, during the post-crisis phase, the training of individuals and teams becomes the guarantee of an increasingly effective future management of contingencies.
I believe the main learning for the healthcare sector from the COVID-19 crisis is for hospitals to be as prepared for a pandemic as we are for a fire. It should be able to happen with a flick of a switch. This requires:
- Up-to-date policies based on best practice and evidence.
- Good communication systems and practices. This is key and was done quite well, with regular weekly updates being well received by staff. On the other hand, executives would do well to meet with staff from time to time (while ensuring COVID-19 precautions are in place, of course).
- Frontline staff involvement in their unit’s pandemic preparedness reviews.
- Training of all staff so they are pandemic-ready and aware of their own role in the response.
- Rostering practices suitable for the circumstances of a crisis that can be quickly implemented. For example, a fly-in/fly-out roster (where a group of staff work one-week-on-one-week-off) would allow better managed breaks for staff. This will also accommodate staff that need to be furloughed if they are exposed to the virus.
Improvement opportunities for hospitals
Drawing on my own experience and that of my co-workers, there are some specific actions that could help hospitals become better prepared for the next crisis:
- Collective reflection. Fully engage with frontline staff and tap into their experience of the pandemic for improvements. It’s important to reflect on the things that didn’t work, but also to reflect on the things that were done well.
- Improved education and training of staff in relation to pandemic preparedness.
- Review the resources available to assist frontline healthcare staff. This includes reviewing staffing levels to ensure high quality and safe care is maintained, as well as measures to check on the physical and mental health of staff.
- Improve staff amenities and facilities. Improve tea rooms and changing facilities (so we don’t have to change into scrubs in a toilet). If possible, provide access to outdoor areas for meal breaks.
- Review and revise communications in relation to PPE and other infection prevention and control measures, to ensure clear and consistent information is provided to staff.
- Improve communication practices with patients’ families. Many nurses were not able to work at the frontline for a range of reasons. In a crisis, they could be deployed to communicate with families by phone/video calls.
Use MEERQAT to guide your collective reflection
My colleagues at MEERQAT have developed Pandemic Preparedness process maps that can assist hospitals to engage all their staff in a review of the pandemic response. The maps are based on international and national guidelines for the management of pandemics. They provide a resource for all hospital staff, from the kitchen through to the executive and everyone in-between, to review what happened.
Taking part in a collective reflection helps frontline staff make sense of their pandemic experience. It also gives staff an opportunity to contribute to identifying issues and finding solutions for those issues.
Reviewing the maps helps with educating staff about what is required of them during a pandemic. It also reassures staff that they have the right processes in place that can, at a flick of a switch, be readily implemented.
🥇 Manage and monitor your crisis response efforts in a single platform. Contact us for a demonstration.
Emotional wellbeing after a crisis
Australia has shown incredible leadership and determination through the COVID-19 pandemic. This provides a strong path for recovery, uncovering opportunities for innovation that would not have been evident or possible months ago.
However, frontline HCWs are at risk of developing traumatic stress symptoms. These stress reactions are natural, but it is important to promote self-care, social support and sleep, to prevent prolonged psychological consequences such as post-traumatic stress disorder and depression.
In this sense, resilience and healing from trauma is something that happens best in the context of supportive relationships.
As I reflect on my own experience of the pandemic, a few things stand out to me that helped me to survive the year.
I feel really lucky that the places I work in have wonderful staff. We are very supportive of each other. The hospital also offers mental health support for the ones who need it.
One doctor particularly stood out. He did this by supplying coffee, food and regularly emailing everyone with suggestions for keeping up their spirits.
I’m also aware that the community as a whole gave healthcare workers incredible support. This includes everything from heavily reduced shoe prices (I have gone through two pairs), free coffee, McDonald’s and letters of support from local schools, through to Foxtel with free movies.
More stories for you:
- How to re-engage unmotivated employees post-COVID-19
- How to add value to consultations through structured conversations
- Culture starts from the top, but takes root and grows from the bottom
- MEERQAT: A journey to increase staff engagement in quality improvement
Our state government made it easy to isolate if needed. They offered free accommodation away from our families if COVID-19 exposure had occurred. I am aware this was not the case in some countries such as the Philippines, where many of my extraordinary colleagues are from.
Support in difficult times
While there was a great deal of support available from the hospital, I found my family and friends to be incredibly supportive. My husband, children and extended family were a source of strength for me throughout 2020 and continue to be so.
I also try to regularly exercise and connect with the outside and this helps keep me spiritually and emotionally well. I eat as healthy as possible and have reduced my alcohol intake. In addition, I have found much value in my pre-COVID-19 purchase of an Elliptical exercise machine!
Moreover, I would advise reducing stress reactions by doing breathing exercises, meditation, and physical activities.
👉🏻 You can read more about mental health in the age of COVID-19 here.
Finally, I’m forever grateful to the public for following the advice of the government and epidemiologists by isolating if needed, wearing masks, maintaining distance and washing hands. The fact that our community always finds ways of expressing kindness, patience, and compassion made working a little easier.
Tips managers can use to lead through a crisis
Although the pandemic hit different sectors of the economy unevenly, its impact on people at a personal level has been remarkably similar. There are feelings of uncertainty, anxiety and fear; management of family situations and the loss of loved ones has been particularly challenging. Dealing with these impacts has needed the empathy of leaders in the workplace to understand, engage and motivate people.
A constant dialogue between leaders and their teams was – and is still – necessary. This is an essential aspect of supporting staff.
According to McKinsey and Company: “A crisis is when it is most important for leaders to uphold a vital aspect of their role: making a positive difference in people’s lives. Doing this requires leaders to acknowledge the personal and professional challenges that employees and their loved ones experience during a crisis.”
The leaders of the hospitals I work at have been tireless in their efforts to keep staff up-to-date on the ever-changing status of COVID-19. It was great to receive the weekly video and website updates as well as the emails. However, I must admit I did suffer a little from email fatigue.
Furthermore, I have found myself equally motivated by leaders as by many other workers in the hospital. I’m proud of the cleaners, orderlies, clerks and my medical and nursing colleagues that fronted up each day with a great attitude.
Keeping employees engaged and motivated
Leaders in healthcare need to ensure that accurate information is communicated to staff and that it is consistent with information being communicated in other healthcare organisations (HCWs at different hospitals know each other and talk to each other, so different messages can be confusing).
They also need to listen to the frontline staff. Moreover, they need to set up channels of communication for this to occur (no surveys, please!). This needs to be done regularly.
A good leader is someone that enables their managers and frontline staff to do the work that is required of them.
It is nice to see their faces every week, but providing the things we need most – the right PPE, adequate numbers of properly trained staff, good communication and technologies, good spaces for tea breaks and change rooms – that’s what makes working at the frontline bearable during a pandemic.
Moreover, I agree with John A. Quelch, Business Administration Emeritus at Harvard Business School, who shared a straightforward and clear message of the Seven “C’s” leaders should follow for crisis survival:
Here is Mr Quelch’s complete explanation on the 7 C’s:
🎉Wishing our readers well-being, learnings, health, love and laughter for 2021.