Abstract
The coronavirus disease 2019 (COVID-19) pandemic disrupted the delivery of elective surgery in the United Kingdom. The majority of planned surgery was cancelled or postponed in March 2020 for the duration of the first wave of the pandemic. We investigated the experiences of staff responsible for delivering rapid changes to surgical services during the first wave of the pandemic in the United Kingdom, with the aim of developing lessons for future major systems change (MSC). Using a rapid qualitative study design, we conducted 25 interviews with frontline surgical staff during the first wave of the pandemic. Framework analysis was used to organise and interpret findings. Staff discussed positive and negative experiences of rapid service organisation. Clinician-led decision-making, the flexibility of individual staff and teams, and the opportunity to innovate service design were all seen as positive contributors to success in service adaptation. The negative aspects of rapid change were inconsistent guidance from national government and medical bodies, top-down decisions about when to cancel and restart surgery, the challenges of delivering emergency surgical care safely and the complexity of prioritising surgical cases when services re-started. Success in the rapid reorganisation of elective surgical services can be attributed to the flexibility and adaptability of staff. However, there was an absence of involvement of staff in wider system-level pandemic decision-making and competing guidance from national bodies. Involving staff in decisions about the organisation and delivery of MSC is essential for the sustainability of change processes.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented strain on healthcare systems around the world.[1]
They were anxious about protecting patients from COVID-19, and found it challenging to prioritise who should access surgery first when addressing the backlog of patients
We provide insights into the positive and negative experiences of reorganisation as perceived by those involved in service delivery during this period of rapid change
Summary
The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented strain on healthcare systems around the world.[1] In the United Kingdom, rapid reorganisation of care delivery was required due to the National Health Service’s (NHS’s) inability to cope with patient demand in the context of limited critical care capacity. One of the strategies used to increase capacity was the cancellation and postponement of elective surgery. This enabled a number of other changes. Hospitals were able to use operating theatres and recovery areas as “surge areas” where critical care units could expand, theatre staff were liberated for redeployment and anaesthetic machines were made available for ventilation. The flow of patients who did not require urgent care in hospitals was limited, thereby reducing the incidence of intra-hospital infection
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