The COVID-19 pandemic is creating an updraft to do something. Clinical, political, geographical, humanitarian, economical and logistical forces present recognisable pressures that either inspire or dissuade action ... but not for all. Innovators are energised when they see an urgent need to dismantle the status quo. They are well equipped to capitalise on the momentum generated by emergent situations to respond in a way that is collaborative, effective and safe. It is from this whirlwind that the April Letter from America is penned.
Innovators can be challenging to be around. They see the world differently and can ruffle feathers with ideas that don’t stay on the well-trodden path. But when there is no normalcy, free thinking presents opportunities, necessitates unique partnerships and motivates organisational willingness to recalibrate. It is the responsibility of leaders and peers to appropriately harness this energy to make the most of opportunities that innovators present as they directly interface with patients.
The willingness to innovate to address the COVID-19 pandemic is inspiring. An impressive range of solutions have been devised to meet equipment and care service access challenges. Social media is a robust and widely accessible mechanism to stimulate conversations about these ideas. #MacGyverCare is one of several Twitter streams devoted to sharing unconventional solutions. MacGyver, hub members may know, is an American TV character known to improvise to get things done in difficult circumstances. Similar to the hub's own Coronavirus Share your Tips page, people are using #MacGyverCare for sharing ideas and innovative solutions to help those on the frontline manage the demands of the crisis. Examples include creative solutions to the personal protective equipment shortage across the country.
While acting to devise a new “as needed” approach may not be something everyone working directly with patients can do, there are other avenues for supporting clinicians to help them provide safe care and find comfort, resilience and even joy in that commitment. People are coming together to ‘MacGyver’ with peers during the pandemic. For example, unique partnerships with libraries are cropping up provide access to the literature, open WiFi hotspots to provide children access to school programmes and even to produce PPE. Is that a MacGyverism? At Columbia University in New York, a Research and Learning Technologies librarian partnered with a cardiology fellow to modify a freely available pattern to create face shields. Using 3D printer skills, assembly line know-how and teamwork they brought together a team to produce and distribute the equipment to staff at New York Presbyterian Hospitals. The Columbia University library shared their process to spread the innovation and encourage the wide use of their concept.
At an organisational level, agile information sharing is the bedrock of crisis management. Flexible, enterprise-wide and individualised communication strategies must be in place to respond to rapidly changing circumstances and keep those touched by the situation healthy and safe. The Johns Hopkins University in Baltimore are using peer support and crisis communication strategies to promote institutional resilience. Leadership commitment to resilience, information sharing to reduce anxiety and support network development all buttress system efforts to assure its workforce and community remain safe and healthy both during and after a crisis. The Hopkins process brings the skills of employee assistance, chaplaincy, workplace wellness and psychiatry to the fore in a multidisciplinary team-based approach to assure staff are well situated to provide safe care while staying safe themselves.
In light of the shift of resources to patients with COVID-19, delivery of services to patients with non-COVID-19 conditions must also be redesigned. The University of Wisconsin has used an administrative restructuring approach, building on military and emergency management experiences to make adjustments in surgery workforce and expertise availability to address complex shifts in care processes in response to the COVID-19 pandemic. Adjustments were made to synchronise work cycles to assure clinical expertise was reliably available, develop a single clinical pool to staff from rather than coordinating assignments based on speciality or educational level, and form strike teams to engage highly experienced clinicians as needed. These tactics invigorated information transfer, provided role clarity as situations changed and strengthened process sustainability. Team leaders anchored their work by remaining focused on a declared mission and guiding principles to support that mission.
While the uptake of new knowledge and science into healthcare practice is often shrouded under the oft-stated “17-year lag” , it is obvious through these and other examples that care innovations can be recognised, applied and improved upon quickly. Granted, it is important for innovators and the organisations they engage with to seek the advice and council of experts from the human factors, process improvement and safety domains to ensure their new ideas are developed and flow into daily work in the safest way possible. However, after this current crisis, let one of the lessons we learn from the COVID-19 pandemic be to make patient safety progress more rapidly through the use of innovative thinking, partnerships and organisation ingenuity.