Self-care: what every manager needs to know

In this paper, we will look at some of the strategies that managers and team leaders can use to support themselves as they grapple with the effects of the demands being placed on them in the post-pandemic health or social care workplace. In the next paper in this series, we will consider how managers can support their teams and promote a sense of wellbeing. Copyright © 2022, OmniaMed Communications Ltd. All rights reserved.

THE EFFECT OF CONVERTING AN INTEGRATED BEHAVIORAL HEALTH PRACTICE TO TELEHEALTH DURING THE COVID-19 PANDEMIC

STATEMENT OF PROBLEM/QUESTION: When COVID-19 emerged in March 2020, we transitioned to 100% telemedicine visits. We asked: 1. Is our practice providing equitable depression screening and care for patients after transitioning to telemedicine? 2. How might we improve access to care and increase equity for depression in our practice and systemwide? DESCRIPTION OF PROGRAM/INTERVENTION: In March 2019, we integrated mental health services at our academic faculty internal medicine practice consisting of over 5000 patients. We implemented the Collaborative Care model (University Washington, AIMS): 1) to consistently identify patients in primary care with distressing depressive symptoms, and 2) to quickly treat patients with distressing symptoms of depression. We began systematically screening patients for depressive symptom severity and treated using a team-based approach. The team-based approach included psychotherapy, psychiatric consultation, support for psychosocial needs, and online resources. MEASURES OF SUCCESS: We will describe our workflow and program evaluation measures. We explored whether differences in screening and treatment rates occurred based on age, sex and payor status comparing patients screened and treated one year before versus one year after the start of the COVID pandemic as we transitioned to using telemedicine. Patients were defined as “screened” if the Patient Health Questionnaire, 9-item version (PHQ-9) was administered at their physical examination, Annual Wellness Visit, or new patient visit. Patients were defined as“treated” if they enrolled in our mental health program and had more than one visit with the program psychologist. Chi-square tests of independence were conducted to determine associations between time period (Pre COVID vs Pandemic) and equity variables: age (<65 and 65+ years), payor (Medicaid vs. all others), and sex. FINDINGS TO DATE: The number of Annual Wellness, physicals and new patient visits dropped from 2,333 during the pre-COVID period to 1,464 during the pandemic period. The percentage of patients screened for depression using the PHQ-9 at physical examinations initially dropped, then increased dramatically in the Fall of 2020 and has trended back up to pre-COVID rates. Overall, our results may indicate we are offering equitable care. There were no significant differences in screening rates comparing the pre-COVID and pandemic periods stratified by age (p=.24), payor (p=.16) or sex (p=.32);patients who screened positive for depression, stratified by age (p=1.0), payer (p=.15) or sex (p=.22);or for patients who were treated on age (p=.14), payer (p=.51) or sex (p=.39). KEY LESSONS FOR DISSEMINATION: Screening and treatment of depression markedly improved in our primary care ambulatory setting since integrating mental health services. Depression screening after the start of the pandemic nearly ceased but has nearly returned to pre-COVID levels. Screening for depression in the clinic served to improve screening rates, but additional solutions are needed to modernizing telehealth tools for screening for depression.

Learning is what happens between seeing patients: defining clinical access

The inability to access clinical placements during the COVID-19 pandemic stimulated us to reflect on key elements of the experience, beyond history taking and examination. We were also mindful of concerns about work readiness of new graduates. We identified seven aspects of clinical experience distinct from those requiring direct patient contact. These are: recognise and contribute to the collective competence of multidisciplinary teams;apply project management principles to the complexities of clinical care;integrate personal and team-based clinical reasoning;deliver patient-centred collaborative care;achieve an integrated perspective of clinical care;demonstrate adaptability to health systems;consolidate professional identity formation. We consider that making these aspects explicit in learning objectives and assessments in medical schools is likely to improve the work-readiness of new graduates and should also be reflected in accreditation standards. © NZMA.

Mirrors study: A prospective cohort study assessing the feasibility of robotic interval debulking surgery for advanced-stage ovarian cancer

Introduction/Background MIRRORS (Minimally Invasive Robotic surgery, Role in optimal debulking Ovarian cancer, Recovery & Survival) is the largest prospective cohort study of robotic interval debulking surgery (IDS) in women with advanced-stage epithelial ovarian cancer (EOC) to date. MIRRORS has investigated the feasibility of obtaining consent from women, the acceptability and success of robotic IDS and its impact on short-term surgical outcomes and quality of life. Methodology Eligibility Women with FIGO IIIc-IVb EOC undergoing neoadjuvant chemotherapy and suitable for IDS. Exclusions: pelvic mass >8cm, extensive HPB and/or extensive bowel involvement. Surgery commenced with an initial laparoscopic assessment, for all women recruited, followed by a decision to proceed immediately to robotic or open IDS. Result(s) 23/24 eligible women recruited. Following initial diagnostic laparoscopy, 20 women proceeded directly to robotic IDS, 3 women received open IDS. All patients were debulked with maximal surgical effort to R<1, 39% to R=0. No robotic cases were converted to open. Median EBL for robotic IDS: 50ml, open: 2026ml, median operating time 05:58 robotic vs 05:38 open, length of stay (LOS) 1.5 days robotic vs 6 days open. Bowel resection with stapled anastomosis 15% (3/20), diaphragmatic stripping 60% (12/20), fullthickness diaphragmatic resection 5% (1/20), pelvic peritoneal stripping 70% (14/20). Conclusion MIRRORS has shown significantly enhanced recovery with short LOS, reduced blood loss and reduced HDU/ITU demands, enabling faster re-commencement of chemotherapy in women with FIGO IIIc-IVb EOC. This proved to be greatly beneficial during the COVID-19 pandemic. In experienced hands robotic IDS proved feasible in cases with a pelvic mass up to 8cm. Robotic surgery is not suitable for peritoneal disease covering the anterior abdominal wall close to port sites but does facilitate pelvic and diaphragmatic stripping and arguably provides better visualisation of these peritoneal surfaces in women with high BMI. The planned multicentre MIRRORS-RCT will assess whether robotic IDS offers improved quality of life and recovery with non-inferior progression-free and overall survival. We present the evolution of our surgical technique with illustrative surgical videos and qualitative patient feedback, supported by the objective surgical outcomes for this trial.

How to manage difficult people (part 1): Am I the problem?

Leading people in health and social care is a challenge at the best of times, let alone during an unprecedented global pandemic. While many staff are hard working and willing to get on with their roles, there are a significant minority who are difficult to manage at best and downright disruptive at worst. The best leaders know how to recognise these characters and use their understanding of the causes of behaviours to their advantage and challenge and manage behaviours when they cannot be redirected.