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Why going “back to normal” is not an option: lessons from the frontline in respiratory medicine

23 September 2021 | Dr Swapna Mandal
Dr Swapna Mandal and Alexandra Hellyer from our patient safety team share how learning from respiratory teams at acute hospitals during the COVID-19 pandemic can be harnessed to improve practice in the future.

The peaks of the COVID-19 pandemic placed extraordinary demands on those working within the NHS. With the subsequent relaxation of restrictions, and the urgent need to tackle unprecedented waiting lists, the pressure on staff is arguably greater than ever. At the same time, the past 18 months have brought opportunities for staff to work in new ways and in new roles, giving them fresh perspectives, skills and experiences.

Working on the Adoption and Spread Respiratory workstreams of the National Patient Safety Improvement Programme, we have the privilege of talking to respiratory teams across the UCLPartners region. We know that these teams have been some of the busiest over the course of the pandemic, and it has been fascinating to hear about their different experiences.

Individuals have been given a variety of roles and responsibilities, often more than one, including covering COVID-19 wards, liaising with family members, supporting bereavement, planning and setting up acute and step down COVID-19 services, starting post-COVID follow up clinics, implementing new patient safety measures and taking on new clinical responsibilities that they otherwise would not have been exposed to. They have done all this whilst re-designing and adapting services to manage their regular patient population.

We wanted to learn more from the teams, first-hand, about what it has been like, so we contacted all the clinical members from our Patient Safety programme working in COPD and Asthma at acute hospitals and asked them to share their experiences of new roles and responsibilities anonymously.

Challenges

Whilst the pandemic may have in some ways enhanced the position of respiratory medicine for good, it unsurprisingly came at a price. Managing anxiety and the sheer pace of the change was often too much and exhausting – not to mention the second wave being an even greater challenge for many. Disturbingly, some reported feeling professionally unsafe when undertaking new roles or de-skilled for the first time in their careers due to seeing fewer patients face-to-face. All this in the setting of the need to avoid cross contamination and sometimes the struggle to get Personal Protective Equipment (PPE).

Opportunities

Many reported enjoying being given strategic and managerial work which they otherwise would not have been exposed to. As seen with other industries, some reported a better work-life balance with the ability to work remotely and relished doing something different. It was, for some, an opportunity to focus on improving patient recovery at home, experience improvements happening quickly within their services, and focus on problem solving. For others, it meant creating an entirely new service from scratch for post- and long-COVID patients, often resulting in ‘’true multi-disciplinary working’’ and a ‘’flattening of hierarchy’’. People reported colleagues being focussed, driven, and ‘’engaged in true collaboration’’

What do we do with the learning?

So, what do we do with all these experiences and newfound knowledge? Most teams are harnessing it and capitalising on the opportunities it has presented. In respiratory care, virtual consultations and remote monitoring seem popular with many patients and clinicians and the pandemic has allowed clinical teams to learn how this might be done safely. COPD and asthma patients have faced challenges whilst often needing to shield, and it has highlighted the increased need to develop pathways in the community, embrace technology and internal efficiencies as well as think innovatively when it comes to services such as Pulmonary Rehabilitation. UCLPartners have already made strides in this area with the UCLPartners Proactive Care Frameworks that support primary care teams to manage patients with respiratory long-term conditions. Systemic issues have been brought to the forefront, such as the need to encourage patients to seek help sooner (rather than continue to resort to rescue packs) as well as emphasising self-management of their disease whilst signposting them to good and trusted information.

The change once was fine, the change then back to usual roles and then back again in a second surge and back again was hard. Recovering services was hardest. We are still drowning in long waiting lists with exhausted staff.

It would be easy to forget the important lessons we have learned over the past 18 months and aim to go back to “how things used to be”. However, I hope that this 18-months of new experiences inspires colleagues and patients alike and we embrace the opportunity to work and think differently to enable us to recover, and even thrive.