Exploring published literature of emerging practice as a response to challenges due to COVID-19
19 August 2020
The summaries below are of articles that might help thinking about what has been learned from the COVID-19 experience so far, along with suggestions on how this might be used to support improvement in future.
This week, featured articles include those regarding:
Overview
Across the health and social care system, focus is starting to shift to how services can be restarted and how they need to adapt to long term social distancing.
There are a lot of publications around longer term transformation based on the lessons from COVID-19. More information is emerging about the impact of COVID-19 - specifically on its unequal impact.
A new spotlight on inequality has led many to start to think about building a more equal system. There has also been a renewed focus on the workforce and workforce wellbeing. There are articles and blogs reflecting on how to better support staff - including in tackling race inequalities.
Building back for the better: a perspective from Carnegie Trust UK
This paper outlines six propositions from the Carnegie UK Trust for the medium term recovery from the COVID-19 pandemic. They are:
- national wellbeing can be the goal
- the relationship between the state and citizens can be reset
- the future can be local (as well as global)
- our relationship with work can be remodelled
- we can build a new level of financial resilience, and
- technology can be for all.
Within each of these propositions, the Carnegie UK Trust outlines a number of recommendations to policy makers on how to realise these.
The report takes the perspective that this is an opportunity to bring together economic, social and democratic structures in a way that can deliver 'the transformative systems change that so many have been calling for before and during the pandemic'.
Ingraining equity into quality and safety: a system-wide strategy
In the context of growing awareness of racial inequality through the high impact of COVID-19 on black, Asian and minority ethnic people, and the wider popular protests against racial discrimination, this report outlines an example of how to address equity and inclusion in quality improvement.
The report suggests actions that can be taken to embed equity into quality and safety systems. There is a focus on data and understanding the demographics of both the staff and population being served. This includes reviewing current data collection methods to ensure they are sensitive and provide a complete picture. The article proposes a four step strategy that health systems can utilise to ingrain equity into quality and safety work:
- Conduct a departmental needs assessment in order to establish staff understanding of equity issues.
- Focus on departmental workstream mapping and capacity building including staff demographic information. This will help identify where there are opportunities to develop a more equitable department.
- Apply equity lenses to key existing quality and safety workstreams through iterative plan-do-study-act cycles. For example, re-envisioning the root-cause analysis process through an equity lens can more effectively identify inequities and bias.
- Systems should track the impact of their equity and inclusion strategy on quality and safety work over time. These metrics should be established early and include tiered process and outcome measures at the patient, facility and system levels. These metrics should be updated and refined as the health system's approach matures.
The road to renewal: five priorities for health and care
This report from the King’s Fund looks beyond the immediate restoration of services and towards systemic changes to the system based on learning from the pandemic.
It is centred on five priorities and makes recommendations aimed at the Government as well as NHS bodies and local authorities, these are:
- a step change on inequalities and population health
- lasting reform for social care
- putting the workforce centre stage
- embedding and accelerating digital change, and
- reshaping the relationship between communities and public services.
Helplines and advice lines: practical learning for remote service delivery
COVID-19 forced most charities to start delivering some services digitally or by phone, often for the first time. Now, many organisations will be thinking about how to balance this new 'remote' offer with their existing face-to-face activities.
This guide captures key things to consider when looking at delivering information, advice and support services differently post-lockdown. It is based on learning from providers of well-established helplines and advice lines and includes:
- check that your service is needed
- establish what your callers want and how you will respond
- be clear about what your service is and what it offers
- think about how you will manage demand
- choose your technology carefully
- put quality and safeguarding measures in place
- skilled staff and volunteers are key to a quality service
- take care of wellbeing
- create information resources that complement your work, and
- think about how you will collect data and report on the difference you are making.
Technology and innovation for long-term health conditions
During the COVID-19 pandemic, many NHS providers have moved services online at astonishing pace. This paper looks at four digital innovations in health services from the UK and the Nordic countries.
The case studies illustrate the potential of digital technology to transform care. They particularly focus on:
- empowering patients
- supporting stronger therapeutic relationships and effective team-working across professional boundaries, and
- creating networks and communities to support patients.
The paper also calls on health care providers to assess the impact on staff and patients of the rapid transition to online services driven by the COVID-19 pandemic.
Find out more (PDF)
Housing inequalities
Poor housing causing health problems for nearly a third of Brits during lockdown
This provides an overview of statistics around the prevalence of poor housing and the health impact. Some of the headline figures include:
- 1 in 20 (5%) of everyone who said they had a lack of space said this had led them to seek medical help or take medication for their mental health
- 30,000 people are spending lockdown in a home that consists of one room
- more than 3,600 children are spending lockdown in a home made up of two rooms, and
- 62,580 families are living in temporary accommodation - the highest number for 13 years.
This is supplemented by comment from some members of the 'Homes at the Heart' campaign, a campaign aimed at spreading awareness around the prevalence and impact of poor housing conditions.
Comments describe how COVID-19 related lockdown measures have shown how important homes are and shone a light on unsuitable housing. They describe systemic challenges around affordability and the housing market as a driver for poor housing, along with the role of landlords and the impact of poverty.
Staff wellbeing
Turning moral distress into moral resilience during the COVID-19 pandemic
This article outlines the impact of 'moral injury' and discusses ways that people can be supported to build moral resilience going forward.
Moral injury can occur when someone is consistently in a position of doing things that go against their values and personal morality. During the COVID-19 pandemic, care givers have had to make difficult decisions about the care they give that challenge their values. For example, providers with inadequate personal protective equipment have had to choose between getting physically close to a patient to provide the kind of care they feel morally compelled to give or prioritising their own health, safety, and wellbeing.
Making these difficult decisions may go against what it means to an individual to be a good caregiver.
Suggestions for how to build moral resilience are given at the individual and organisational level.
At the individual level, it is recommended that people:
- build a daily mental practice: this can be anything that allows you to acknowledge and move through pain and connect with your values and sense of purpose.
- take action: find ways to create a positive impact, even if it's doing something to make one patient more comfortable.
At an organisational level is it recommended to:
- start with organisational values: align clinician values with organisational values and identify what is getting in the way of allowing clinicians to practice in accordance with their principles.
- build partnerships between administrators and clinicians: create an environment in which caregivers can thrive and support decision making.