Response of UK community hospitals to the COVID-19 pandemic: an appreciative inquiry.

INTRODUCTION: The 500 community hospitals in the UK provide a range of services to their communities. The response of these small, mainly rural, hospitals to the COVID-19 pandemic has not yet been examined and so this study sought to address this gap. METHOD: Appreciative inquiry was used to understand staff perspectives of how community hospitals responded to the COVID-19 (SARS-CoV-2) pandemic. A total of 20 organisations participated, representing 168 (34%) community hospitals in the UK. Qualitative interviews were conducted, with a total of 85 staff members, using an online video platform. 30 case studies were developed from these interviews. RESULTS: Staff described positive changes that were made in the context of the fear and uncertainty experienced in the pandemic. Quality improvements were reported in a wide range of services and models of care such as the use of the inpatient beds, and the access and management of urgent care services. Rapid changes were made in the way that services were managed, such as communications and leadership. Programmes of accelerated training were offered for existing and redeployed staff. Attention to staff health and well-being was a feature and there were a variety of innovations designed to support patients and their families. The impact of the changes was viewed as strengthening of integrated working between staff and sectors, the ability to rapidly innovate and improve quality, and the scope to use local decision-making to make changes. CONCLUSION: Staff of community hospitals described innovative and rapid quality improvements in their community hospitals in response to the pandemic. The case studies illustrated the features of community hospitals, showing that they can be resilient, flexible, responsive, creative, compassionate and integrated. The case studies of quality improvements are being used to encourage sharing and learning across community hospitals and beyond.

“One of the team” patient experience of integrated breast cancer care: Managing Community Care

Purpose>This paper presents my experience of breast cancer care in which I describe my care as positive and integrated.Design/methodology/approach>I have applied an autoethnographical approach to my patient story to analyse my care in order to reflect and share insights. I have applied my knowledge and experience in integrated care through my research, management and practice.Findings>In my patient story I describe being empowered and feeling like “one of the team.” Vertical and horizontal integration was evident across staff services and agencies. This included integrated working across multi‐disciplinary teams, between primary and secondary care and also between the NHS and a voluntary agency. I identified features that were important to me in my care under the headings of: certainty, communication, contact, compassion, continuity, cohesive, care and collaboration.Practical implications>I consider the implications of sharing patient stories to inform quality improvement, influence education and training for staff and design support for patients. I consider how patients can be more involved in the evaluation of their care.Originality/value>This viewpoint has been written from my perspective as a patient and a professional, and was written in order to recognise good practice and share the learning for continual quality improvement. There is every sign that person-centred integrated care is starting to be embedded in some of our services and hopefully this will be recognised, celebrated and sustained.

Guest editorial: Managing Community Care

Intermediate care: integrated, local and personal The coronavirus disease 2019 (COVID-19) pandemic has heightened awareness of the need to scale up safe, effective and person-centred community alternatives to acute hospital care, particularly for people with chronic conditions or frailty. The continuum of intermediate care services includes Rapid Response alternative pathways for falls;Hospital at Home;discharge to assess and nurse-led transitional care programmes;reablement and rehabilitation at home;and step up and step down beds in community hospitals, care homes or skilled nursing facilities. [...]Corbett and Lewis share a personal reflection on their experience of rapid redesign of a community Frailty Support Team in response to the pandemic.