RCP clinical director for quality improvement and patient safety, Dr John Dean, discusses how recovery from the COVID-19 pandemic presents an opportunity to improve future healthcare.
Significant changes in how clinical teams deliver care has occurred during the response phase to COVID-19. Plans that might have taken a year or two were implemented in a matter of weeks. Having a clear single improvement focus for all staff within an organisation and a system at a time of great uncertainty has delivered these changes in ways we couldn’t have imagined. We are now in the phase of re-establishing services and ways of working that had stopped or had to change during the pandemic response, knowing that these have to be somewhat different because COVID-19 is still a threat. Looking further ahead, does this experience let us imagine a different future for services that are more responsive and adaptive to current needs, rather than based on historical practice?
Can we learn for this future from the rapid clinically led change we have experienced? Looking back and evaluating what has happened is important; many are using the crisis recovery framework1 to identify what we have started that we should stop, what we have stopped that we don’t want to do in the future, what needs to restart, and what we have started that we should consider improving or amplifying.
Does the removal of some of our previous boundaries when thinking about care free us to think about the future? Re-establishing services will take longer than our necessary initial response to COVID-19. Many of the barriers to change, including financial, were temporarily removed, but checks and balances will need to be in place for any changes to be sustainable. The recognition that staff and patients have felt very vulnerable and that they have largely been listened to and supported during the changes must be reflected in co-production of our future services. We have worked across teams. Change has been iterative and adaptive because it is new, because there hasn’t been time for detailed planning and because the environment has continued to change. Technology has been embraced and implemented at a pace never seen before in the NHS. This has been a significant enabler. We have pulled together and embraced change. Many of these features must be maintained to enable us to develop different services for current and future needs.
While some of these factors are good improvement practice, others have been missing. Co-production with patients and families was lacking in our COVID-19 response but must be central for the future. We must take a systems approach, understanding and balancing the many interdependent elements of healthcare delivery on outcomes, experience and efficiency. This hasn’t always happened in the COVID-19 response. We must plan for sustainability and spread of best practice. Most importantly, we must know that change is an improvement, by measuring the impact with a balanced set of ongoing quality measures. The NHS operating framework for England incorporates this approach to improvement that the RCP embraces.2 Measure for improvement, improvement methods, clinically led pathway development and building learning systems: physicians must lead in making these a reality.
Recovery from crisis has been studied and an evidence summary from the University of Manchester3 highlights some key points we should consider:
- The recovery phase, and the structures, processes and relationships that underpin it, are harder to get right than the response phase.
- Recovery should be done ‘with‘ the community not ‘to‘ the community, with communities having different needs and priorities.
- Recovery usually takes years rather than months to complete as it seeks to address the enduring human, physical, environmental and economic consequences of emergencies.
Our COVID-19 recovery teach-in on Monday 13 July (and supportive additional videos) aims to help us think about future service delivery, and how we may get there in the light of our recent experiences. So, please join us on Monday at 6:30pm or visit the recording on RCP Player after the event.
- Taylor M. The path from crisis, 2020. https://medium.com/bridges-to-the-future/the-path-from-crisis-6d3f83c96d0b [accessed 15 May 2020].
- NHS England. Operating Framework for Urgent and Emergency Services within hospitals, 2020. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/05/Operating-framework-for-urgent-and-planned-services-within-hospitals.pdf [accessed 17 May 2020].
- Recovery from COVID-19 team. Recovering from COVID-19: the key issues, 2020. https://www.alliancembs.manchester.ac.uk/media/ambs/content-assets/documents/news/recovering-from-covid-19-the-key-issues.pdf [accessed 10 May 2020].