“Building the plane while flying it” Reflections on pandemic preparedness and response; an organisational case study

Abstract

Background The COVID-19 pandemic provided a unique opportunity to learn about acute health organisations experiences implementing a pandemic response plan in real-time. This study was conducted to explore organisational leader’s perspectives and experience activating a COVID-19 pandemic response plan in their health service and the impact of this on service provision, clinicians, and consumers. Methods This study was conducted at a large metropolitan health service in Australia that provides acute, subacute, and residential aged care services. Semi-structured interviews were conducted with 12 key participants from the COVID-19 leadership team between November-January 2021/2022. A semi-structured interview guide was developed to explore how the health service developed a clinical governance structure, policy and procedures and experience when operationalising each element within the Hierarchy of Controls Framework. Thematic analysis was used to code data and identify themes. A cross-sectional survey of frontline healthcare workers on the impacts and perceptions of infection control practices during the COVID-19 pandemic, was also completed in 2021 with 559 responses. Results Twelve organisational leaders completed the semi-structured interviews. Key themes that emerged were: (1) Building the plane while flying it, (2) A unified communications strategy, (3) Clinicians fear ‘my job is going to kill me’, (4) Personal Protective Equipment (PPE) supply and demand, and (5) Maintaining a workforce. When surveyed, front-line healthcare workers responded positively overall about the health services pandemic response, in terms of communication, access to PPE, education, training, and availability of resources to provide a safe environment. Conclusion Health service organisations were required to respond rapidly to meet service needs, including implementing a pandemic plan, developing a command structure and strategies to communicate and address the workforce needs. This study provides important insights for consideration when health service leaders are responding to future pandemics. Future pandemic plans should include detailed guidance for acute and long-term care providers in relation to organisational responsibilities, supply chain logistics and workforce preparation.

Australian health care workers experience of PPE related side-effects. A cross-sectional survey

“…Staff within the operating suite were the only department in the Health Service to consistently wear surgical masks and eye-protection pre-pandemic. PPE was used periodically in other departments throughout the health service, when caring for patients in transmission-based precautions however, the time spend in PPE would be limited to patient interactions and was not consistent with the prolonged duration of PPE use during the COVID-19 pandemic ( 8 ). A study into factors that influence compliance with PPE use, identified that poor compliance and inconsistent use of PPE has been the main cause of healthcare associated transmission of COVID-19 ( 23 ).…”

“…The significance of the increased use of PPE can be seen from the analysis of PPE consumption data, demonstrating that there was an exponential increase in PPE supply and usage. In a 6–12 month period during the pandemic, the use of P2/N95 masks was equivalent to 25 years of pre-pandemic use, and the storage of long-sleeve gowns increased significantly, with a reported 40,000 gowns maintained on-site as a reserve supply ( 8 ). Guidance provided to HCWs during the COVID-19 pandemic on the minimum PPE standard for providing care to patients with suspected or confirmed COVID-19 included: respiratory protection in the form of surgical masks and P2/N95 respirators, long sleeve gowns, eye protection including glasses and face shields, and gloves ( 9 ).…”