Successes and challenges
An effective response requires trust, efficiency, communication and
leadership, at every level. Focused daily higher management briefings
are cascaded across departments via clinical leads and directors. On a
daily basis, department huddles address staffing and the current local
COVID-19 situation. Attendance is limited to key clinical and managerial
decision makers from all maternity areas: antenatal, postnatal, delivery
ward and paediatrics. This allows us to respond immediately to arising
challenges and ensures dissemination of information about predicted
workload. Hospital-wide issues such as access to theatres, anaesthetic
staffing and equipment levels are evaluated and responded to on a
departmental level.
There is an overwhelming volume of information being received by staff.
At our unit we discovered that the most up to date staff were engaged in
national Whatsapp groups and Twitter. To prevent information overload
and focus staff on information relevant to the unit a single daily
update email is fed into by all staff. Virtual meetings via video
conferencing ensure all staff have an opportunity to learn about
upcoming changes and ask questions.
Information for the women booked with our unit has also been a key part
of our response. Our Head of Midwifery conducts Facebook Live sessions,
with all our social media channels regularly updated. Appreciation for
the reasons behind changes made has improved their reception. Our local
Maternity Voices Partnership, an independent forum for maternity service
users, commissioners and other crucial stakeholders that reviews and
collaborates on quality improvement work for local maternity
units(7), has been a key partner in this two-way
communication.
Personal protective equipment (PPE) has presented its own unique
challenge with ever changing guidance and availability. When national
PPE guidance from PHE(8) changed, we dealt with
elevated anxiety levels amongst staff who felt that changes were either
made too late or were being driven by supply issues rather than safety.
Daily presence on the wards from our team leaders and being open about
the uncertainty helped our staff. At the time of writing, daily
emergency drills, with active consideration of required PPE are being
carried out. Talking through the processes is not sufficient and all
members of the multi-disciplinary team need to be involved.
Staffing concerns mean that we have prepared for staff to work outside
their normal clinical areas. Homebirth and community midwives have been
working in the hospital and ward staff have changed locations. Doctors
have been stepping down to cover parts of the rota. For midwives we
created a skills passport – a list of key skills each area required,
and each midwife possessed. This allowed team leaders to appropriately
allocate staff, and our practice development team to offer targeted
training. In addition, our junior doctors created one page summaries of
their key duties and ‘how-to’ guides to support senior staff stepping
down.
We have focused on preserving essential parts of our service. Our key
values remain unchanged and have been used as a guide when looking at
changes required. When introducing change the following were considered:
- Avoid single points of failure: never have only one person critical to
a process.
- Use the ‘unit memory’. Past projects and ways of working have been
scrutinised to evaluate the reasons for their success, failure,
potential for amendment and utilisation in the current epidemic.
- Avoid duplication and wasted effort. Offers of help have been
plentiful. Central coordination is essential to ensure any projects
undertaken align with current priorities.
- Be prepared for local adaptation/interpretation of guidance. Where
staff were found to be varying from the new guidelines we looked at
why and considered if their approach was better.
The thread that brings everything together is transparent communication.
This is a marathon and longevity requires engagement and commitment from
all staff over the months ahead.