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.”

Cooperation mode

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.”

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.”

Adaptability

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.”

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.”