The pandemic seems to be abating, although it is still here. It is an uneasy truce and we don’t know when it will re-emerge in a way that could take over our day to day lives again. At least the impact on our lives has lessened so we can try to move on. It would be easier to believe that it cannot happen again, writes Dr. Peter Lachman.
It is clear that in healthcare we cannot go back to what we were doing before the pandemic. The pandemic unmasked areas where improvements are required, while at the same time it revealed areas of strength and some impressive work. Now we need to reflect on what we have learnt, especially in the areas of quality safety and public health. There have been many successes and we should thank the public for following advice, the healthcare staff for working beyond their duty and the planners and policy makers for getting things mostly right.
Now we can ask what the key lessons are so that we can do better next time. The WHO has just published a rapid review of the Implications of the COVID-19 pandemic for patient safety, to which I was fortunate to be a contributor. Ten key lessons were identified. I think it would be wise and beneficial if all managers in the HSE reflect on each of the identified areas, to assess where we could do better and where we have performance that others could emulate. The main reason for this is not to measure and judge performance but rather to learn so we can respond better next time.
Here are some thoughts on the key observations. Safety is not a given as the pandemic revealed that here are many safety gaps in our services that we need to address. For example, there have been major issues with the safety of staff, medication safety and delayed and missed diagnosis. Closing the gap will be an ongoing endeavour as we cannot and must not assume that we are safe, as even under normal circumstances healthcare is risky. When a system is stressed, safety is more difficult to achieve. We are still learning where the challenges to patient safety have been and there are several areas where it may take time for issues to be revealed, e.g. the impact of delayed diagnosis due to cancelled routine care.
As the system response to COVID created significant disruption, there were risks we had not anticipated, for example the impact on mental health. The increased safety risk to all aspects of our services will require ongoing study and we will continue to learn. We cannot simply apply the old style reactive clinical incident approach to healthcare. Rather we need proactive safety, which is agile, depending on the human ingenuity in the frontline, rather than top down regulation. We must collect longitudinal data to ensure that we have a better understanding of the impact.
Thinking laterally is essential to understand unintended consequences of COVID interventions. The vulnerable in society have been affected the most, as COVID unmasked the inherent inequity of our healthcare system. In addition, the wellbeing of the healthcare workforce and person-centred care were negatively affected. Nonetheless, there were innovations and great learning, and we can build on these successes.
A few actions can be taken from the report for all managers and executives to implement now:
- Well-being of the workforce is a priority all of the time and not only in a crisis. This will build resilience for when it is needed the most. One cannot have a safe system if staff do not feel both psychologically and physically safe.
- Kindness is an essential component of good care – to oneself, each other and to our patients. Person centred care needs to be nurtured and should not be taken for granted.
- All of us should continue to study the impact of covid on mental and physical health and actively collect data to ensure we can understand the impact on every clinical area.
- Leaders, managers and those delivering care must make patient safety core to all decisions.
- We need to look at how we can be safe under stressful conditions. This requires active inclusion of patient safety theories such as human factors into our management operations, moving from reactive approaches to patient safety design.
- Social determinants of health cannot be ignored. We must ensure that we look after the most vulnerable and make equity a core aim of care. The Quintuple Aim of improving population health, enhancing the care experience, reducing costs, ensuring staff wellbeing and equitable care summarises the approach we will need to take.
- We need to be prepared, celebrating our success while we learn and adapt for the future.
Read the report, and then ask how you and your team or organisation performed, where the safety gaps are, what you can do better and what you should continue doing.
We can all learn together and make a difference.