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:
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.