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BackgroundThe COVID-19 pandemic disrupted the delivery of elective surgery in the UK. 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 UK, with the aim of developing lessons for future major systems change. MethodsUsing a rapid qualitative study design, we conducted 25 interviews with frontline surgical staff during the first wave of the pandemic. We also carried out a policy review of the guidance developed for those delivering surgical services in pandemic conditions. We used framework analysis to organise and interpret findings. ResultsStaff 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. ConclusionSuccess 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 major systems change is essential for the sustainability of change processes.
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ObjectivesTo explore healthcare workers (HCWs) perceptions and attitudes towards the COVID-19 vaccination programme in the UK, including their expectations, concerns and views on whether to promote vaccination to others. To understand the key factors shaping HCWs attitudes towards COVID-19 vaccination in the UK. DesignThis study was designed as a rapid qualitative appraisal integrating data from a review of UK policies and guidance on COVID-19 vaccination with data from in-depth semi-structured telephone interviews with frontline HCWs in the UK. Data were analysed using framework analysis. ParticipantsInterviews were carried out with a purposive sample of HCWs from two large London-based hospital Trusts (n=24) and 24 government policies and guidelines on the vaccination programme were reviewed. ResultsThe level of uncertainty about the vaccines long-term safety and efficacy against mutant strains made it difficult for HCWs to balance the benefits against the risks of vaccination. HCWs felt that government decisions on vaccine rollout had not been supported by evidence-based science and this impacted their level of trust and confidence in the programme. The spread of misinformation online also impacted HCWs attitudes towards vaccination, particularly among junior level and Black, Asian and Minority Ethnic (BAME) HCWs. Most HCWs felt encouraged to promote vaccination to their patients and the majority said they would advocate vaccination or engage in conversations about vaccination with others when relevant. ConclusionIn order to improve HCWs trust and confidence in the UKs COVID-19 vaccination programme, there needs to be clarity about what is known and not known about the vaccines and transparency around the evidence-base supporting government decisions on vaccine rollout. Effort is also needed to dispel the spread of vaccine-related misinformation online and to address specific concerns, particularly among BAME and junior level HCWs. Strengths and limitations of this studyO_LIThis is the first qualitative study to understand the factors influencing healthcare workers (HCWs) attitudes towards COVID-19 vaccination in the UK C_LIO_LIThis study integrated interview and policy data and captured HCWs perceptions and attitudes in real-time as the vaccination programme was being rolled out in the UK C_LIO_LIOur interview study sample was limited in its representation of junior level HCWs and areas of the UK C_LIO_LIThis research may have been impacted by selection bias as those with stronger views on vaccination may have been more likely to participate in the study C_LI
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ObjectivesTo report frontline healthcare workers (HCWs) experiences with personal protective equipment (PPE) during the COVID-19 pandemic in the UK. To understand HCWs fears and concerns surrounding PPE, their experiences following its guidance and how these affected their perceived ability to deliver care during the COVID-19 pandemic. MethodsA rapid qualitative appraisal study combining three sources of data: semi-structured in-depth telephone interviews with frontline HCWs (n=46), media reports (n=39 newspaper articles and 145,000 social media posts) and government PPE policies (n=25). HCWs interviewed were from secondary care, primary care and specialist community clinics. Media and policy data were from across the UK. ResultsA major concern was running out of PPE, putting HCWs and patients at risk of infection. Following national-level guidance was often not feasible when there were shortages, leading to re-use and improvisation of PPE. Frequently changing guidelines generated confusion and distrust. PPE was reserved for high-risk secondary care settings and this translated into HCWs outside these settings feeling inadequately protected. Participants were concerned about inequitable access to PPE for community, lower seniority, female and ethnic minority HCWs. Participants continued delivering care despite the physical discomfort, practical problems and communication barriers associated with PPE use. ConclusionThis study found that frontline HCWs persisted in caring for their patients despite multiple challenges including inappropriate provision of PPE, inadequate training and inconsistent guidance. In order to effectively care for patients during the COVID-19 pandemic, frontline HCWs need appropriate provision of PPE, training in its use, as well as comprehensive and consistent guidance. These needs must be addressed in order to protect the health and well-being of the most valuable healthcare resource in the COVID-19 pandemic: our HCWs. O_TEXTBOXWhat is already known?- PPE is an important component of infection prevention and control to protect HCWs delivering care on the frontline of an infectious disease outbreak. - Frontline HCWs have reported challenges delivering care in PPE during the COVID-19 pandemic. - Research understanding how HCWs responded to these challenges are lacking. What are the new findings?- HCWs faced multiple challenges delivering care including inadequate provision of PPE, inconsistent guidance and lack of training in its use. - HCWs persisted delivering care despite the negative physical effects, practical problems, lack of protected time for breaks and communication barriers associated with wearing PPE. - In the face of training, guidance and procurement gaps, HCWs improvised by developing their own informal communication channels to share information, they trained each other and bought their own PPE. - HCWs reported inequalities accessing PPE based on the healthcare sector, gender, level of seniority and ethnicity. What do the new findings imply?- To feel safe and confident caring for patients, frontline HCWs need to be provided with appropriate size, quality and level of PPE, as well as training in its use. - PPE guidance should be consistent, clearly communicated, and reflect the most up-to-date evidence-base for the safest level of PPE. - Regular breaks for staff working in full PPE should be prioritised even in contexts of understaffing and PPE shortages as these are key aspects of well-being. C_TEXTBOX
