What a difference a pandemic makes – are we getting the safety culture we always knew we needed?

Summary

I had been away from the hospital for a week and I was reluctant to go back in, fearful of what I would face, but I am amazed at how much has been achieved in 7 days.

Content

After working last week and caring for patients who were pending COVID-19 swab results, four days later I woke feeling unwell. A slight cough, tired, pale, feeling freezing cold but no temperature and generally feeling rubbish. This carried on for a few days, I then ended up with common cold-like symptoms and a residual cough.

Normally, I probably wouldn’t call in sick, I would have just carried on. Following current guidance, I called in sick and was advised to take the next 7 days off. At this point testing was unavailable for NHS staff. I was sat at home not knowing if I had the virus or not while my colleagues were having to pick up the slack.

If I am completely honest, I was glad I didn’t have to go back. I was anxious that we didn’t have the right personal protective equipment (PPE), systems for donning and doffing were not in place, we didn’t know what to expect over the coming days, training for redeployed nurses and doctors was not happening. I just didn’t want to go back anyway. I felt a coward.

Over the coming days while I was at home, my husband then became ill, then my youngest son, then the eldest. All with mild symptoms, but still no idea if we had it or not. While I was off, I was contacted by the ‘staff welfare team’. It was just a quick phone call to see how I was, but it made all the difference. I felt like I wasn’t just a ‘worker’ off sick, I was someone that they cared about and were obviously keen to make sure I was coming back! This has never happened before.

Reluctantly, I return to work, but it was like I had stepped into a different Trust.

Wards with infected patients were labelled as RED wards; huge signs were outside the wards with designated places to don and doff PPE. There were clear guidance on which PPE to wear displayed in poster format. There were green footsteps and red footsteps on the floor enabling you to know which area you were in. PPE safety officers had been deployed to reassure and ensure all departments have enough stock.

It felt safer.

Leadership at all levels is being tested at this time. Where I work in Brighton, we are invested in ‘Patient First’. This is headed up by our Kaizen Team. All staff are trained in differing levels of quality improvement (QI). All wards and departments have improvement huddles, where they can raise a mini project and see it through. We all speak the same QI language.

I dread to think what would happen if we didn’t have this in place during this awful time. By having this process, it has empowered ALL staff to speak up and give permission for frontline staff to improve processes where they work.

Our executive leadership team have done an amazing job in such a small amount of time. They have increased ITU capacity, they have reshaped rotas, redeployed staff, re employed staff, transformed patient pathways (red and green pathways), pooled staff, set up systems for donations…

There has been so much achieved in a short amount of time; the top-level organisation has been incredible. All this in seven days.

They have been phenomenal at strategy, planning and overall management and leadership of what I call ‘the big stuff’. What they are not so good at is the ‘small stuff’. We, frontline workers are brilliant at this. The practicalities of work – where can I don and doff, where the bins should be, how do I know this bed has been cleaned? What do we do when someone dies? Can relatives visit? How do we know who is who in PPE? How can we make sure we don’t contaminate clean areas? How do we take blood now? We know what needs to be improved, we know what is missing.

It’s the small details that worries staff, it’s the small details that can save lives.

As I was walking seeing patients from different wards, I heard staff saying – this isn’t right – we could improve that. They can raise a ticket on the huddle board and they could initiate the change. If the change could be replicated else where in the Trust, the Matron or ward manager can then raise it at the Bronze meeting, the bronze would then raise it to Silver and then implemented.

I often hear that we use a top down, bottom up approach but never really thought it works, as there is so much red tape involved in healthcare. Quite often frontline ideas never reach the top level and they fall flat. This time it’s very different.

To test the system, you need to stress the system.

This system of QI and communication is working. We are all learning together. None of us have dealt with a pandemic before. Frontline staff have been given the permission to improve the way real work is done, quickly and safely, while the top-level management are concentrating on strategy, planning, implementation and co-ordination of services.

We are listening to each other, we are rapidly changing and adapting, the whole Trust is in a constant state of PDSA cycles. It feels dynamic, proactive and controlled.

If this pandemic happened 10 years ago in our trust, I am convinced that we would not be in the position we are now. We have enough intensive care beds, we have the capacity to expand further, we are ready.