QUALIT Y IMP ROVEMENT


staff; no difference in disease progression; no substantial difference in service use; and lower transaction costs compared to traditional clinic-based care.6


They cite a number of


lessons learned from the Scottish experience suggesting that in-person support may be needed to tackle both technical issues (such as assessing technical readiness and installing web cameras and monitors) and operational ones (such as identifying and redesigning key workflows – for example, for picking up prescriptions or medication) in the early stages of implementation. Training of clinical and non- clinical staff (preferably delivered remotely), and guidance for clinicians and patients on how to make the most of a video consultation, are likely to help widespread adoption.7 Primary care was very quick to change to triaging and telephone consultations at a speed which is described as ‘unthinkable’ just months before.8


The King’s Fund found


that primary care is much more agile relating to change than its acute care neighbours. There is a clear challenge to ensure that excess bureaucracy and complexity does not return. GPs want to be able to exercise informed choice about the technology that they implement, rather than having it imposed on them. There are also many inequalities in digital access which will need to be the focus of a sustained effort to ensure that people’s access to care is not affected.


Teamwork and communication Many new teams were formed during the crisis, with staff re-deployed and intensive care units doubling or trebling their bed numbers. Communication and training had to be excellent and continuing. The pandemic has forced all healthcare staff to work flexibly, across traditional boundaries and many in multidisciplinary teams for the first time. Working long shifts in full PPE did not help the normal communications and learning, but fostered new ways of working and learning. Teams developed a ‘one team’ approach and could see that a culture of learning and improvement was working for many new situations. Professor Michael


The King’s Fund found that primary care is much more agile relating to change than its acute care neighbours. There is a clear challenge to ensure that excess bureaucracy and complexity does not return.


West advises that sharing key principles to support emerging teams and effective team working during times of uncertainty and ambiguity, is vital to focus and integrate new team members effectively.9


Key principles on


how to maintain effective team working are shown in Figure 1.


Conclusion


It may take the NHS a very long time to recover from such a year; the relentless pressure, teaching new colleagues, working very long hours and being subject to stress, strain and many deaths will have taken their toll. Compassionate leadership will be needed at every level for the service to return to an effective and efficient healthcare system. Many organisations will want to embed the transformations that their hospitals have encompassed in the last year. They may have to pick and choose the really positive benefits and discard others. Chief executives should work with their staff to reflect on what is positive and what has not worked during the crisis. Empowering frontline staff will be a key element of this transformation to a different culture. The experience of working in multidisciplinary teams may be an element which staff will want to hold on to, to break down the organisational silos which existed before COVID. There will be a great deal of effort required to establish the new norms. There is a huge and overwhelming backlog of surgery and other specialties to catch up on which may take years. The key elements in this author’s view, are to ensure that the staff have recovered and are sufficiently resilient to face this work, and a transformed service.


CSJ


References 1 Health Foundation. Quality made simple 2013. Accessed at https://www.health.org.uk/ publications/quality-improvement-made-simple


2 Health Foundation. The role of improvement during the response to COVID-19. Accessed at https://q. health.org.uk/get-involved/report-the-role-of- improvement-during-the-response-to-covid-19/


3 Ibid 4 Health Service Journal 2020 How a culture of improvement powered health systems’ response to COVID-19. Accessed at: https://www.hsj.co.uk/ coronavirus/how-a-culture-of-improvement- powered-health-systems-response-to- covid-19/7028038.article


5 Gilbert A. Billany J, Adam R et al Rapid implementation of virtual clinics due to COVID-19: report and early evaluation of a quality improvement initiative. Accessed at https:// bmjopenquality.bmj.com/content/bmjqir/9/2/ e000985.full.pdf


6 Greenhalgh T, Whereton J Shaw S et al. 2020 The BMJ editorial. Video consultations for COVID-19. Accessed at https://www.bmj.com/content/368/ bmj.m998


7 Scottish Government. Scotland’s digital health and care strategy: enabling, connecting and empowering 2018. Accessed at: https://www.gov. scot/publications/scotlands-digital-health-care- strategy-enabling-connecting-empowering/


8 King’s Fund blog 2021 What enabled rapid digital change in primary care during the COVID-19 pandemic? Accessed at: https://www.kingsfund. org.uk/blog/2021/02/rapid-digital-change-primary- care-covid-19-pandemic


9 West M. Principles of effective team working. Accessed at: https://people.nhs.uk/teamworking/ the-key-components-of-effective-teamworking- during-the-covid-19-crisis/


THE ELISA FAMILY The future of intensive care ventilation


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