Guest blog by Dr James Quigley, Medical Director, Healthwork
Dr James Quigley shares his experiences of supporting the executive leadership team at NHS Nightingale North West (NHSN NW) to set up a pop-up OH service for the field hospital in Manchester.
We were first contacted on 31st March and provided with an extensive brief for an on-site OH service. Over the following days we held discussions several times a day amongst ourselves and with the stakeholders at NHSN NW to map out what needed to be achieved to meet the OH demands of a new field hospital, with staff exposed potentially to the most attritional working environment they would ever have faced.
We rapidly identified several key priorities and themes that gave us a framework for developing a strategy to deliver:
- Communication - absolutely key in allowing us to give practical advice to staff and managers on the ground, process referrals and advise the executive leadership team on staffing levels and critical shortages (e.g. in certain directorates or wards).
- Policies & procedures - critical to ensure we were supporting staff in work, and safely returning those who were absent (due to COVID-19 or other reasons) as quickly as possible.
- Risks - not only biological risks from COVID-19 exposure and possible BBVs but other risks such as physical (heat and discomfort of PPE), psychological (isolation when wearing PPE and the distressing nature of the pandemic) and ergonomic (intrinsic to healthcare work).
To meet these needs we set up a dedicated telephone line for staff and managers to call for advice. The plan was to have this active 24 hours per day, so that any queries could be rapidly resolved to minimise unnecessary staff absence. We also set up a URL link through which managers could make referrals (directly from the ward ipads to us) which was in keeping with the field hospital being a paperless and ‘no device’ environment (other than ward ipads), to reduce risks of cross contamination.
The leadership team wanted the service to provide on-site support, with OHAs and OHPs being present and visible, and to have other facilities for support for staff (e.g. counselling, physio etc.). We also set up an EAP service for the staff to access, as well as other welfare support elements for staff.
We developed the following policies, procedures and processes that underpinned the service that the field hospital and OH would need:
- Overall plan, policy and procedure for the OH service
- Measures to protect the staff using a hierarchy of control, to ensure the hospital had adequate non-PPE control measures such as ventilation, safe working practices, and appropriate inductions/training in place, as well as appropriate PPE for staff
- Staff screening and vaccination procedure (for new starters during onboarding)
- Process of staff testing for COVID-19 (including prioritisation of staff for naso-pharyngeal swab testing)
- Staff referrals and reporting systems - simple systems were developed which allowed rapid assessments remotely with simple OH reporting and OH advice provided to the employee and manager
- A novel first day reporting scheme and follow up of all definite and suspected COVID-19 cases, with a new electronic system for us to discuss absence with the leadership team daily to pro-actively manage absences (including a twice daily report with recommendations for the senior leadership team)
- BBV and inoculation injury management
We also felt that visibility of the service was important, and we helped with the advertising of the service so staff were aware of the services available – we created a number of posters, slogans and leaflets to promote and encourage staff wellbeing and support.
Learning points/lessons for the future
- A small team project managing the set-up is key to ensure nothing gets missed and all bases are covered.
- “Necessity is the mother of invention”: we came up with several novel concepts of how to proactively manage sickness absence to reduce staff sickness levels to as low as possible, and return staff to work as quickly and safely as possible.
- The novel environment of a field hospital, operating in the midst of the highly unusual situation of a global pandemic, means novel and innovative solutions must be rapidly developed to overcome the unique challenges that arise to ensure access to quality OH advice is not compromised.
We worked almost constantly on this from 31st March until Friday 10th April, with many of our staff working late into the night to meet tight deadlines, and it was amazing to find out what can be achieved in such a small timescale.
It was great to play a small part, and a tremendously interesting project to be involved with and all of us (clinical and non clinical staff) across all levels of seniority have developed our skills in rapidly setting up a field hospital OH service in the setting of a global pandemic.