May 2020

Medical Staff COVID-19 Survey

//////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////

Please read the preamble for each area, then answer the few short questions below it. 

 

Thank you to all that participated in the survey. The survey is now closed.

QUALITY-FORWARD: Exceptional Quality, Safety & Value

Goal: We deliver quality care that matters to the people we serve.

To adjust our strategic plan and determine what we want to focus on in year 2, PHC staff were asked “What are we doing differently now (as a result of COVID-19) that we want to continue doing?” & “What are opportunities that have not yet been implemented that you would like to see implemented?” Responses are below.

Ideas, so far. Let’s continue:

  1. Physical Distancing to maintain health and safety of staff, patients and visitors
  2. Additional education on proper PPE usage
  3. Strong hand hygiene practices (screening increased hand sanitizer stations)
  4. Cleaning and decluttering units
  5. Increased focus on Serious Illness and Goals of Care Conversations (We Can Quickly Implement Improvements to Patient   Care)
  6. More virtual care
  7. Reducing length of stay through improved collaboration
  8. Flexible access to CST Cerner raw data to support urgent PHC analytics or reporting request (CST & Quick Access to Data Improves Care)

Opportunity:

  • Design the new SPH to support better infection control and other operational changes arising from the pandemic. (The New St. Paul’s is Needed More Than Ever)

Responses received so far: 

What ideas resonate with you the most?

  • Keeping hospital cleaner overall (Covid or not!) Collaboration to shorten LOS & eliminate unnecessary visits (e.g. PAC appt can often be done by zoom).
  • Continued use of PPE until there is no community transmission for 28 days (2 x 95% CI for upper bound of incubation period).
  • Focus of clarifying goals of care conversation and emphasizing that health care teams have this conversation that clearly delineates these goals for patients Working collaboratively to reduce LOS.
  • In the new SPH we need to be measuring and reporting patient health outcomes and sharing that information broadly by the medical presentation/condition as delivered by teams to see the variations and processes that can be tweaked to drive improvement. Quality of care has to be more than how we FEEL it is, or based on patient satisfaction survey in isolation.
  • Decreasing LOS with improved collaboration.
  • Reduced LOS Ongoing increased cleanliness focus

What other ideas do you have?

  • Consider processes that were stopped during COVID that had no impact on quality of care.
  • While we likely can safely move some things to zoom, we need to critically evaluate meaningful metrics to see if we caused harm (delayed presentation, more advanced disease at presentation, worsening QOL/functional status because of delayed surgery/other appts, etc etc) This needs to be done – otherwise we run the risk of overestimating the positive effect of our extreme response to possible COVID problems.
  • Continue NP PCR testing for all newly admitted patients (i) if any symptoms, (ii) regardless of symptoms if any new cases in prior 28 days.
  • We need the organization to commit to repurposing resources from elimination of wasteful activities into an investment in outcome based, team derived patient care. Trying harder to avoid admissions that could be managed in the community – the COVID situation revealed that this can be done.
  • Earlier discharge may be possible with close virtual follow up.
  • Visitor restrictions on vulnerable wards to prevent decreased safety – each patient on such a ward may have a designated visitor with the freedom to leave the ward when seeing other visitors. More CTCT like beds in the community to decrease LOC and AMA in this population. Early addictions team intervention on an ongoing basis

What are your questions?

  • Which parts of ‘work’ can we stop doing even after COVID because these add no value to patient care?
  • What benchmarks are defined, or being discussed, around the use of COVID-19 specific PPE and testing, and any changes in what is recommended over the coming 12 months or so?
  • Is it fiscally feasible to aim the occupancy lower in years to come to allow the hospital to flow more efficiently (ie. LOS goes down because there is better access to, and coordination of, in hospital procedures, diagnostics, consultations)?
  • How can we use hospital occupancy rates to trigger stepping up of community resources to decant the hospital and improve throughput from the the ED to ward to discharge?
  • How can we approach addictions care in hospital in a more consistent way so that there is little difference in patient experience from department to unit? How can we impress the importance of infection control measures on patients in an ongoing way?

PEOPLE-FORWARD: Inspiring People & Teams

Goal: We attract the best people and support them to flourish.

To adjust our strategic plan and determine what we want to focus on in year 2, PHC staff were asked “What are we doing differently now (as a result of COVID-19) that we want to continue doing?” & “What are opportunities that have not yet been implemented that you would like to see implemented?” Responses are below.

Ideas so far. Let’s continue:

  1. Offering staff wellness supports (Our Focus on Wellness & Supporting Our People is Making a Difference)
  2. Offering flexible work hours and scheduling for staff through remote access to balance childcare, personal, and work demands (Our People Appreciate the Enhanced Flexibility, Especially During Such a Challenging Time)
  3. Redeployment of Talented People Who Can Fill Gaps and Step Into Expanded Roles as Needed
  4. Strong Relationships Between Clinical Staff, Physicians and Corporate Staff

Responses received so far:

What ideas resonate with you the most?

  • Strong Relationships Among Clinical Staff, Physicians and Corporate Staff–ie better teamwork.
  • Tramwork continues to be a challenge tho… Flexible work arrangements wherever possible. (eg. Lab & Radiology can likely work from home more than they did in the past, OR slate can likely be lots more flexible for staff & patients, MSSU schedule can be more patient-centric rather than provider-dictated) in general, a more Agile & adaptive system.
  • Agree that most distress results from systematic organizational issues
  • Team based care, around real medical presentations such as COVID has shown the value of teamwork and that most health care providers prefer to work collaboratively towards a common goal.
  • Increased focus on organizational culture rather than individual wellness
  • Strong relationships with staff and corporate makes the most sense for a strong medical staff – if we don’t feel heard , we won’t believe we can direct change and improvement. Agree with increased focus on organizational culture rather than wellness

What other ideas do you have?

  • Concrete teamwork training to enhance collaborations and work efficiency/effectiveness (e.g. TEAMSTEPPS) It is important to note that the major cause of distress in health care professionals is not a lack of individual wellness interventions–it is systemic organizational issues. Focus on those and not just individual wellness interventions.
  • The organization did a better job during COVID of providing clear rules/policy to support physicians actions but this could be improved still — in order to support Physicians to truly thrive in this organization, we need to know that the organization “has our backs” & not feel like we need to try to figure over thing out on our own. (Good example is the visitor policy & how it affects disproportionately our marginalized patients).
  • Note that contracted physicians are not employees and are often treated as outside of the organization, or only loosely affiliated; find ways of getting their input, through flexible platforms that do not (always) require physical presence on non-work days.
  • Cohesive teams with a clear purpose and who are provided regular information about the impact of the care they provide will often prevent problems or at least solve them proactively. Do we need to measure Teamwork as a process or isn’t it more appropriate to measure the impact on patients, of having functional teams with clear and shared purpose?
  • Increased exposure of SLT to unit level meetings to create tangible connection between clinical and corporate staff.
  • More avenues to excel – the redeployment possibility is one Any changes in a department or unit’s focus or location needs heavy buy in by and transparent discussion with the medical and nursing staff involved, otherwise this type of survey is feeding into disrespect of the unit/service involved We need a system to encourage improvement in each other’s performance without simply accepting perceived barriers to such change – ie a way to successfully inspire thought ,creativity and action around optimizing team work. Offer practice sessions for codes or a designated, supplied room and training for ultrasound use at bedside for all clinical MD’s.

What are your questions?

  • Do we measure teamwork in an explicit way? If not, I suggest that we do and act on the findings as indicated (There are validated surveys to measure teamwork, which can be administered to samples of the staff).
  • We need to have more compassion for each other as physician colleagues. This is lacking in many Physician “leaders” so how can we hold these individuals accountable? How can we create a culture where we feel safe & connected?
  • What kinds of assessment and monitoring tools can maintain optimal 2-way discourse between physicians and the organization overall, and key other cadres (eg., nursing) implicated in the problematic issues that arise?
  • Should we increase the scope of some teams like we have seen Covid do – include perspectives of cleaners, food services, accounting staff etc to give input to the regular interdisciplinary teams – especially on wards which allows the care to be much more informed.
  • Why, with all of these sources of input, do physicians (and other staff) on the ground still feel unheard about several issues – and blindsided – on changes occurring to and within their work areas?How can decisions within the hospital be more safety and patient focussed?

LEARNING-FORWARD: Discover, Learn & Innovate for Impact

Goal: We create a culture where every person can learn, grow, imagine, and bring forward new ideas.

To adjust our strategic plan and determine what we want to focus on in year 2, PHC staff were asked “What are we doing differently now (as a result of COVID-19) that we want to continue doing?” & “What are opportunities that have not yet been implemented that you would like to see implemented?” Responses are below.

Ideas so far. Let’s continue:

  1. Adapting learning events/training/education/standing events to virtual sessions, where appropriate.
  2. Rapidly pivoting in times of urgent need and improve capacity and scope for collaborative ventures and research.

Responses received so far:

What ideas resonate with you the most?

  • Rapidly pivoting in times of urgent need and improve capacity and scope for collaborative ventures and research.
  • Provide selection of vetted online learning materials for various pandemic/emergency/ disaster preparedness.
  • Learning from catastrophes.
  • Pandemic plan/overwhelming emergency plan needed and should be periodically revisited.

What other ideas do you have?

  • There is a body of knowledge out there about ‘learning from catastrophes’ and how to plan for the next one (there will be a next one) so that we are not caught by surprise.
  • Crowd sourcing ideas for change/improvement Office for ideas!! Innovation does not need to be thought of a some huge research thing… It’s the little new & better ways we develop for getting our work done too!! Everyone needs to know & live this! Continuous Quality Improvement mind set.
  • Provide periodic updates (monthly) on key insights from published, peer reviewed literature to help separate science from mass media speculation and anecdote.
  • The lines of communication were nascent at the beginning of COVID but as the crisis wore on, these lines became more clear/solid. Is it possible to be able to map out these lines and once having done so, add/subtract after reflecting on what was helpful or not?
  • Organizational wide platforms for virtual clinical encounters that are embedded in workflows to drive LOS downwards.
  • Revisit new hospital design wrt infection control insights Debrief on lessons learned from all angles once risk is levelled.. Include outside sources of new ideas if relevant.

What are your questions?

  • Can we develop organization-wide educational opportunities about preparing for disasters?
  • When is the Office for ideas coming?
  • Can we have an official line of communication designated (not a limited group on whats app) that has clear and consistent messages/answers (ie NOT ‘ don’t use hospital scrubs – bring your own , but it’s unsanitary to remove scrubs from hospital once used as they won’t be properly cleaned’) from the get go in a rapidly changing environment.

PARTNERSHIPS-FORWARD: Partnerships

Goal: We embrace partnerships, digital health and technology to offer seamless care.

To adjust our strategic plan and determine what we want to focus on in year 2, PHC staff were asked “What are we doing differently now (as a result of COVID-19) that we want to continue doing?” & “What are opportunities that have not yet been implemented that you would like to see implemented?” Responses are below.

Ideas so far. Let’s continue:

  1. Expanding use of virtual health technology, where appropriate, for patient care supports and programming (Partnering with Experts in Digital & Virtual Platforms Enable Care & Connection)
  2. Improving collaboration between PHC departments and with regional and community partners (e.g. Health Authorities, FNHA, Universities etc.) (Collaborating Across Programs and With Provincial, Regional and Community Partners Improves Transitions in Care)

Responses received so far:

What ideas resonate with you the most?

  • Both ideas so far are excellent. No need to work in isolation.
  • Need to collaborate better with VCH especially. During COVID response, sometimes we were supposed to be following VCH “Regional” policy & other times, PHC policy… It’s always been confusing & this should be improved!
  • Expanded use of digital tech for patient contact, follow-up and treatment support.
  • Collaboration.
  • Expanding health technology.
  • We need more community involvement/collaboration to help solve the many social and practical issues our marginalized patients bring with them to the ER. The hospital is trying to provide answers for chronic issues that need a more community based approach.

What other ideas do you have?

  • Include as collaborators scientists from other centers/universities who can facilitate use of digital technologies (e.g. WelTel).
  • There should me much more (and easy!) Ways of collaborating with of proposing projects to educational institutions & corporate partners — partnering together to deliver and improve our delivery of care.
  • For hard to reach patients/ high risk of loss to follow-up, set up digital support groups consisting of hospital or specialty clinic med staff, outreach and social workers, primary care MD, etc as appropriate – including patient but, if not feasible, to support patient even without their direct involvement (if unable to manage digital tech for whatever reason).
  • More OPAT, CTCT availability Partnering with community groups to store patient belongs beyond a designated volume We should actively be assisting with CST approach for other hospitals – in a more concrete way than we experienced. A designated pharmacy that AMA or vulnerable patients can have recommended treatment arranged to facilitate community care ( often communication issues with how patient leaves our care) Outreach patient digitally via community clinics that agree to support such specialist reviews in house.

What are your questions?

  • What is the process for keeping our eyes on potential new partners, other than the ones listed?
  • Is someone formally challenging the limits on innovation being imposed by PHSA current approach?
  • How can we leverage private industry partners to create value for PHC, not just for the industry partner?
  • How can we ensure partnerships are ethical and free of unwanted biases, expectations? Who is doing this successfully at present?

ORGANIZATION WIDE THEMES

To adjust our strategic plan and determine what we want to focus on in year 2, PHC staff were asked “What are we doing differently now (as a result of COVID-19) that we want to continue doing?” & “What are opportunities that have not yet been implemented that you would like to see implemented?” Responses are below.

Ideas so far. Let’s continue:

  1. A robust, reliable, user friendly COVID-19 website (Keep Communicating Clearly, Quickly and Often)
  2. Interactive Townhalls with senior leadership presence
  3. High degree of collaboration and genuine, laser focus on the problem solving (Keep the Rapid-Decision Making as we Move Forward)
  4. Addressing clients’/patients’ needs through purposeful team meetings to plan, prioritize, and act. (Focus on a Common Goal, and Mobilize Resources to Support It)

Responses received so far:

What ideas resonate with you the most?

  • Addressing clients’/patients’ needs through purposeful team meetings to plan, prioritize, and act. (Focus on a Common Goal, and Mobilize Resources to Support It).
  • Collaboration and measures to support rapid decision making.

What other ideas do you have?

  • Learn from other sources/sites about how to have effective and efficient team meetings (including virtual), decision-making processes, and action plans with accountability.
  • In relation to the above, take the idea of a very well-defined patient pathway for COVID-19 PUI and create similar efficient pathways for recurrent problem types that generate poor health outcomes (eg, addicted patients with serious infections leaving hospital prematurely ) Much more effective to use an existing patient pathway that recreate it every time you need it.
  • Improve supports for allowing high quality discussions after admission that address the degree of intervention patients actually want vs. a one time very quick ‘code’ discussion which isn’t easy for the provider (sometimes who sees the patient one time) or the patient/family.
What are your questions?
  • Are there regular ‘walk-arounds’ by hospital leaders to meet ‘front-line’ staff and learn about what is going well, and what can be improved? If not, I suggest that this process be built in to daily work for these leaders.
  • Do we have frequent and detailed analysis of our performance with hard-to-treat patients (addiction, mental health, social disorganization etc) that would point to the most important patient pathways required?
  • Once provincial phase 3 and 4 responses are ongoing can we work towards having a physical work environment within the hospital that is quieter (as it is now) with less foot public traffic which more conducive to thinking, collaborative teamwork and providing high quality care for a few hours per day? Consider visiting hours back again on a trial basis?