UK Healthcare Workers’ Experiences of Major System Change in Elective Surgery During the COVID-19 Pandemic: Reflections on Rapid Service Adaptation

  1. Georgina Singleton
  2. Anna Dowrick
  3. Louisa Manby
  4. Harrison Fillmore
  5. Aron Syverson
  6. Sasha Lewis-Jackson
  7. Inayah Uddin
  8. Kirsi Sumray
  9. Elysse Bautista-González
  10. Ginger Johnson
  11. Cecilia Vindrola-Padros

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Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted the delivery of elective surgery in the United Kingdom. The majority of planned surgery was cancelled or postponed in March 2020 for the duration of the first wave of the pandemic. We investigated the experiences of staff responsible for delivering rapid changes to surgical services during the first wave of the pandemic in the United Kingdom, with the aim of developing lessons for future major systems change (MSC). Methods: Using a rapid qualitative study design, we conducted 25 interviews with frontline surgical staff during the first wave of the pandemic. Framework analysis was used to organise and interpret findings. Results: Staff discussed positive and negative experiences of rapid service organisation. Clinician-led decision-making, the flexibility of individual staff and teams, and the opportunity to innovate service design were all seen as positive contributors to success in service adaptation. The negative aspects of rapid change were inconsistent guidance from national government and medical bodies, top-down decisions about when to cancel and restart surgery, the challenges of delivering emergency surgical care safely and the complexity of prioritising surgical cases when services re-started. Conclusion: Success in the rapid reorganisation of elective surgical services can be attributed to the flexibility and adaptability of staff. However, there was an absence of involvement of staff in wider system-level pandemic decision-making and competing guidance from national bodies. Involving staff in decisions about the organisation and delivery of MSC is essential for the sustainability of change processes.

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  1. Version published to 10.34172/ijhpm.2021.101
  2. ScreenIT

    SciScore for 10.1101/2021.04.14.21255415: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: When HCWs agreed to take part in the study, they were asked to sign a consent form.
    Sex as a biological variableOver half of the sample was female, with the majority of participants in middle or senior management positions.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    These codes were inputted into a Microsoft Excel matrix, with the emerging codes in the columns and interviews entered as individual cases in the rows.
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Implications for policy and practice: Study limitations: The findings offered in this paper should be viewed in light the limitations of the study. First, although data were collected during the height of the first wave of the COVID-19 pandemic from a range of staff involved in delivery of surgical services, our respondent pool was mostly comprised of senior staff and was not ethnically diverse. The experiences of more junior staff may have shed light on different issues. Moreover, we only recruited staff from NHS hospitals in London, excluding private hospitals that took on additional NHS surgical work. Despite these limitations we maintain that the overall lessons taken from the case study provide useful insights into sustainable MSC that can be applied throughout the UK and across other nations with a comparable health care system. Their relevance will be amplified by further research exploring how healthcare service delivery has changed in subsequent waves of the pandemic and in other countries. Moreover, it will be important to examine the sustainability of changes over time to see if those that were identified as positive remain in place.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.04.14.21255415v1 on medRxiv