WHILE the trauma of this pandemic is undeniable, far-reaching and ongoing, there have been striking and positive developments that bear acknowledgement. This article will focus on the opportunities within the crisis.
I am working in a general hospital network in Melbourne and these reflections are based on my experiences here.
One thing that pandemics reveal is our fundamental interdependence, our capacity to affect one another’s lives for better or worse. Borders are figments of our imaginations. International isolationism is no longer possible. We cannot limit the spread of this virus within man-made borders.
Although I hear so much about social distancing, lockdown and isolation, I recognise ever more acutely at this time how much we need one another, if we are to withstand this pandemic. Even as globalisation is under review, and a return to a more insular, self-sufficient approach to production and manufacturing is being proposed as the way of the future, at the same time, many of us are also realising more profoundly, that strength and survival comes from overcoming differences and working together to solve this international crisis. Sharing our knowledge, research, innovations, advances, as well as our entertainment, wealth and donations, and our successes in building local community encouragement provides hope and sustenance. This paradox of isolation and unification is fascinating.
In my hospital, this interdependence has been manifest in many ways. Every morning, in response to coronavirus disease 2019 (COVID-19), there is an organisation-wide Zoom videoconference to which all employees are invited to attend from their computers or phones. At this meeting, brief reports are provided on bed occupancy and activity including in our emergency departments and the intensive care units across the state, staffing levels, and the state of readiness of all departments, including the IT department, hospital services, and community outreach. This initiative provides a unifying opportunity across the network and informs all employees about the significant events and challenges that the complex organism of this hospital network will be grappling with that day. There are also daily bulletins from the hospital executive, keeping staff well informed of COVID-19-related developments, particularly when any media-worthy issues or staff infections are causing concern.
This recognises that all members of the organisation play an equally critical personal role in containing this pandemic, protecting each other, and protecting patients and families. Regardless of role, from cleaner to CEO, each staff member is at risk of contact with COVID-19 and of passing on that infection to others. This highlights the need for timely, understandable communication that penetrates every level of the organisation.
Another innovation since COVID-19 is the use of desktop videoconferencing for hospital grand rounds. Again, this has led to far larger attendance at these rounds, particularly the COVID-19-related rounds. These recorded sessions are then shared on the education site and emailed to staff. Within the palliative care department, moving to videoconferencing has revitalised our education program. Previously, our widely dispersed clinicians struggled to attend these lectures in person. It has also led to new possibilities for an interorganisational education program for our advanced trainees in this area of Melbourne.
Emphasis is placed on staff wellbeing, always encouraged, but now in a more poignant and consistent manner. Ensuring adequate personal protective equipment is available to all frontline staff has been given high priority and has greatly reduced anxiety levels for many of us. Reminders to check in on each other are frequent. Recognition of the exhaustion that accompanies the preparation for the anticipated, but not yet experienced, surge has prompted calls to be kind to one another. The vigilance that is required to be ever alert to the potential for sudden outbreaks to affect and seriously compromise a major hospital and place all at risk, as experienced by the Burnie hospital in Tasmania, puts everyone on permanent alert. Morale-building activities include the occasional provision of free lunch to all staff. Members of the local Vietnamese community donated thousands of items to the hospital, an act of generosity appreciated by all. Compassionate exceptions on family visiting restrictions for dying or very ill patients ease the staff grief occasioned by seeing people dying alone.
Another opportunity arising from fears of surge of COVID-19 has been the interest among junior staff in improving their capacity to have conversations with patients and families about end-of-life care, resuscitation and goals of care planning. Many feared being faced with having to conduct more of these conversations, but now under more difficult and distressing circumstances. COVID-19 has brought death out of the closet, with death and dying at the forefront of our minds since the pandemic took hold. This has prompted the establishment of small group teaching and support sessions, facilitated by palliative care, geriatrics and oncology specialists. Recorded presentations and guideline documents on end-of-life care and adult resuscitation plan conversations, goals of care and advance care planning communications by palliative care and geriatric specialists have been uploaded onto the hospital education website.
While these changes are responses to an acute situation, it can be hoped that some will continue once this crisis is over. The sense of all pulling together, the relational care that includes all members of an organisation as well as patients and families, the recognition of the need for open transparent communication, the use of videoconferencing to connect people across the network, and the willingness to acknowledge that the care of the dying is an integral part of being a health care provider are all valuable lessons that this pandemic has taught us. No doubt there are many more that readers have experienced and many more lessons to learn.
Once we dreamed we were strangers,
We wake up to find that we are dear to each other
— Stray Birds, Rabindranath Tagore, 1916
Associate Professor Odette Spruijt is a palliative medicine specialist and founder and chair of Australasian Palliative Link International (APLI). She is affiliated with the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.