Our Director of Nursing, Ann Gow, explains how the experience of the pandemic has been used to establish a toolkit that will help health and care professionals manage and respond effectively to change, while continuing to focus on the safe delivery of patient care.

Health and care staff across Scotland are currently focused on delivering the best care possible while the healthcare system’s under pressure. We know that staff are feeling overwhelmed after two years of working to respond to the pandemic. Now there is an increase in patients in hospitals, people presenting themselves to healthcare professionals much later than pre-pandemic and as a result sicker, as well as difficulties in staffing the whole system.

Moreover, many staff are new to their professions, or newly promoted, and might not have the depth of experience that allows them to respond in these new and challenging times for all. Hospital teams are opening new beds and expanding wards to cope with the additional pressures. These changes can be challenging for staff. Yet despite all this, staff are doing their utmost to ensure people receive compassionate, safe and high quality care.

But there is help. Our organisation has developed a toolkit to help staff manage and respond effectively to change, while continuing to focus on the safe delivery of care.

Learning from the pandemic

The toolkit has been developed from real experience of the pandemic and the need during that time to respond to unprecedented challenges, quickly and effectively.

Our response during the pandemic – opening and recommissioning COVID-19 wards and, in particular, the setting up and running of NHS Louisa Jordan – has given us great experience at how to manage such pressures while keeping people safe. The toolkit pulls together that experience, so that staff across health and care can use that knowledge and experience.

NHS Louisa Jordan – setting up a hospital in three weeks

In April 2020 I was asked to be Nurse Director for the NHS Louisa Jordan – Scotland’s COVID-19 Hospital. The task set for us was huge: transform an exhibition centre into a clinical unit to hold up to 1,000 patients in the space of three weeks.

Thankfully, we didn’t need to use the space for inpatients due to the Scottish public’s response in complying with lockdown rules, but we did learn a lot about pulling new teams together, altering a non-clinical environment and trying to maintain not just good clinical care but to protect the wellbeing of staff and patients. In a very short space of time, we worked with building teams to design an environment suitable for meeting the needs of a large number of people. There was an intensive care unit, oxygen piped to every bed, strict patient criteria given the restrictions of the environment and models of staff support.

With the help of former army colleagues we developed rehearsal of concept RoC drills running through mock patient journeys, putting ourselves in their shoes by being wheeled on trollies, counting the steps to the toilets, measuring time that staff might take in moving around a very large space and putting in place continuous improvement cycles. We lay on the floor to test how bright the lights would be, tried to minimise noise, which was a worry in a big echoing conference space, and also looked to factor in potential needs of staff and relatives. We called this ‘care as imagined’, in order to provide the best possible care if needed.

One thing I learned from my colleagues at the NHS Louisa Jordan was: rehearse, rehearse, rehearse. Plans on paper are only the first part of the journey – rehearsal of concept drills before bringing patients into a unit really does save lots of time, energy and effort later. The other big takeaway is the joy of teamwork and working not just with clinical colleagues but with everyone involved in making care safe.

How can our toolkit help?

While thankful that we didn’t need to use the facility, we are keen that we share the learning to help the wider healthcare system and in particular those staff who are struggling at the moment.

We didn’t have a manual at the NHS Louisa Jordan, but we did have the joy of working with a very experienced, highly expert and diverse team, many of whom were newly retired. We also didn’t have patients in the unit for those critical early weeks allowing us the space to develop and adapt and critically to plan for as many eventualities as we could foresee.

Staff working in acute care don’t have that luxury and many don’t have a great deal of experience.

The toolkit itself encourages staff to rapidly plan and test the environment using ‘Plan Do Study Act (PDSA) cycle, seeing the environment from the perspective of the patient and staff, and provides quick links to sources of further expertise. The ‘check-in to change’ provides staff with a framework to continuously improve how they do things in real time. This in turn should make running and staffing a unit rapidly more efficient and reduces risk to patients and staff alike.

The confidence to deliver care safely under pressure

We’re keen to get feedback, so we can revise the toolkit based on people’s experience. So, we look forward to hearing from you as you work with the toolkit.

I hope that this toolkit helps those who are working under pressure to increase capacity, to feel more confident in commissioning new beds and in providing care under pressure – reducing the feeling of being overwhelmed and in turn providing better care.

The toolkit should help staff to quickly expand bed numbers, have confidence in asking for staffing and to ensure the environment is as low risk as possible. Once all of this is in place, they can use the ‘check-in to change’ tools to continuously review and improve care in the new space.

If used properly, the toolkit will allow staff to deliver safe care despite the additional stresses and hopefully feel more confident in doing so.

Ann Gow is Nurse Director and Deputy Chief Executive of Healthcare Improvement Scotland and former Nurse Director at NHS Louisa Jordan.

More information

Visit our website to download the toolkit and watch our winter webinar series