Lessons from the corona crisis
The covid pandemic brought pressure to bear on many things. Neurology professor Karin Faber and assistant professor of Healthcare Management Daan Westra look back on a turbulent time. The crisis exposed many problems, in particular the shortage of healthcare professionals. But it also made other things possible. “It’s important to have a bit of success too.”
They call it a baptism of fire. Karin Faber had only just been made director of patient care at the Maastricht UMC+ when the crisis broke out. She wasn’t taken by surprise, however. “As soon as the first patients were diagnosed in the Netherlands, the hospital installed a crisis policy team that took measures like no longer shaking hands so promptly that people gave us strange looks: what on earth are you doing? We were able to keep staff engaged through informational meetings and, later, weekly live streams. It was nice to see everyone rolling up their sleeves towards the same goal.”
Karin Faber and Daan Westra
Daan Westra realised covid was “a big thing” when the measures prevented fellow researchers from attending meetings at the hospital. Under ordinary circumstances, Westra studies how hospitals are organised and managed. He decided to shift his focus and immediately received full cooperation. “We concentrated on how the five Limburg hospitals were responding to the crisis, in particular what it meant for the deployment of staff. Every three months we administered a questionnaire: how do employees feel, are things getting better or worse? We produced interim reports so the hospitals could adjust their policies accordingly.”
Looking back, Faber sees many things that went well. “Everyone, from high to low, went into ‘cooperation mode’; there was a strong sense of togetherness. We were also proud of how quickly we got things done. A teaching hospital can be a cumbersome organisation, but the MUMC+ rapidly set up a social team to monitor the psychological and social burden.”
Karin Faber is director of patient care at the Maastricht UMC+ and director of the expertise unit on Quality Innovation and Research. During the covid-19 pandemic, she was a member of the crisis policy team. She is also professor of Neuromuscular Disorders at the Department of Neurology and the Mental Health & Neuroscience research institute of the Faculty of Health, Medicine and Life Sciences.
Short-stay units were turned into covid wards, and suddenly employees were dealing with several deaths a day. “That’s a huge emotional burden for those who’d never experienced something like that before. Then it’s important to have a bit of success too.”
In retrospect, of course, there are also things that could have been done better. Faber cites the division that arose between employees working from home and employees on the front line. “It was difficult to keep the remote workers involved. That’s something we should organise better.” As Westra sees it, in a crisis things go wrong by definition. “You make decisions based on insufficient information, but you have to make them. Our research shows that adaptability is important. You make a guess at where things might be heading, act on that and reflect later to see what you can learn. Is this necessary, can it be done differently? And it’s a recurring cycle.” In this sense, every measure taken is an opportunity to learn.
Westra is critical of the current assumptions around catching up with regular care. “People take it for granted that now covid has receded somewhat, hospitals will be able to catch up quickly on regular care. But that’s not how it works. Even without covid, hospitals tend to be fully booked; they don’t have hundreds of employees hanging around with nothing to do.” He questions whether staff can be expected to handle all that catch-up care in any case. “They can’t just do twice as much as normal. After such an intensive covid period, they need rest too.”
Daan Westra is assistant professor of Healthcare Management at the Department of Health Services Research at Maastricht University. He is coordinating a study funded by the Netherlands Organisation for Health Research and Development (ZonMw) on how hospitals are adapting to the covid pandemic and its effects on staff deployment. He recently received a Veni grant for his research on networks and partnerships in healthcare.
And so we stumble upon what they both see as the real problem exposed by the covid crisis: the shortage of healthcare workers. To some extent, preventive medicine and digital resources can relieve the burden. The crisis triggered an explosion in digital resources, Westra says—a turning point that was not initiated earlier, despite the many studies stressing its importance. But neither believes these solutions will suffice.
Ultimately, the ever-increasing demand for healthcare will have to be reduced. “We can’t avoid putting this up for discussion,” Faber says. “We need more information on what treatments are useful or not, and we should discuss this openly with patients more often. The compensation system should also be geared along these lines; at present it’s focused on interventions and treatments.”
You make decisions based on insufficient information, but you have to make them. Our research shows that adaptability is important.
Westra cites a lack of appreciation from society as the main cause of staff turnover and shortages. “Nurses couldn’t fathom it. ‘I’m working day and night, doing my utmost to help people, and just up the road there’s a huge festival where nobody’s sticking to the measures.’” Faber: “People are becoming less understanding than in the early days about delays in treatment.” Both are positive about the Integral Care Agreement (IZA), which stresses themes such as reducing regulatory pressure and offering development opportunities.
Appreciation is also essential in the workplace, Faber notes. “Healthcare professionals are intrinsically motivated; you have to give them the feeling that the work they’re doing is valuable. Let them decide for themselves how this should be done.” Westra: “You’re talking about crucial factors such as a good team atmosphere. How does my manager treat me? Will I have access to development opportunities? This has direct consequences for the wellbeing of employees and thus for how well they can take care of others.”
A new wave
Both are loath to predict a new corona wave. “A big difference now,” Faber says, “is that the most vulnerable people and the healthcare staff were vaccinated fairly quickly. Still, there may be other variants, there may be a flu wave. Experience has shown that in this hospital we can deal with a great deal.” Westra: “Even if there’s no new covid wave, that’s not to say all is well—there is another problem.” Indeed: what impact will the consequences of the new poverty have on hospitals?