Abstract
The unexpected advent of the COVID-19 pandemic led to a sudden disruption of routine medical care, with a subsequent reorganization of hospital structures and of care. Case studies are becoming available in the literature referring to the logistical difficulties involved in a hospital resuming normal activity following the first COVID-19 lockdown period. This paper details the experience of a study site, a private hospital in Dublin, Ireland, in the redesign of service delivery in compliance with new COVID-19 prevention regulations to facilitate the resumption of routine hospital activity following the first wave of COVID-19. The aim was to resume routine activity and optimize patient activity, whilst remaining compliant with COVID-19 guidelines. We employed a pre-/post-intervention design using Lean methodology and utilised a rapid improvement event (RIE) approach underpinned by person-centred principles. This was a system-wide improvement including all hospital staff, facilitated by a specific project team including the chief operation officer, allied therapy manager (encompassing health and social care professionals), infection prevention and control team, head of surgical services, clinical nurse managers, patient services manager and the head of procurement. Following our intervention, hospital services resumed successfully, with the initial service resumption meeting the organizational target of a 75% bed occupancy rate, while the number of resumed surgeries exceeded the target by 13%. Our outpatient visits recovered to exceed the attendance numbers pre-COVID-19 in 2019 by 10%. In addition, patient satisfaction improved from 93% to 95%, and importantly, we had no in-hospital patient COVID-19 transmission in the study period of July to December 2020.
Highlights
Rather than “killing” the idea of restricting non-essential services ((a) High Reward/Low Effort Solutions reducing patient volumes through the organisation), as we explored the root of that idea, The collaborative and inclusive approach adapted from the outset of this rapid improvement event (RIE) allowed the issue was clarified, as the ability of the study site, to create extra space to accommodate the project team to implement the identified high reward/low effort (Figure 2) improvehigh volumes of patients who had to social distance while attending high acuity critical ments within the seven-day RIE
Comparing the period from July to December 2020 to the same period in 2019, inpatient admissions in the organisation increased by 6%, inpatient surgeries increased by 21% and outpatient surgeries increased by 4%
Oshry (2007) suggests that senior executives can become overburdened by unmanageable complexities; frontline workers may feel vulnerable and neglected by authority figures whom they see as insensitive to the requirements of their jobs and middle managers feel pulled in opposing directions [29]
Summary
The COVID-19 pandemic presented health services across the globe with an unprecedented need for rapid changes to how services were delivered, and created a number of ethical dilemmas, for those providing direct clinical care [1–3]. Never before had health services had to change so quickly, with healthcare organizations around the world facing unprecedented challenges in responding to the first wave of the COVID-19 pandemic. The management of increased volumes of acutely unwell patients challenged even the most advanced healthcare providers. A private hospital indicates the organisation operates independently of the state health services and receives no state funding. Care is funded through private health insurance. The hospital provides services across all specialties, including oncology, orthopaedics, general medicine, general surgery, intensive care, emergency medicine, and paediatrics as well as all supporting services. As with every healthcare organisation, the delivery of care changed dramatically in March 2020
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