Table 6 Theme 5 Maintaining and normalising a workforce

5. Maintaining and normalising a workforce

Movement of staff and limiting in-person contact

Q1 “Things like orientation where we have a dozen surgical JMOs appear on a day of change over, not having them all in the same room at the same time in face-to-face orientation, so we have had to implement the workflow and team structures around that. Things like the face-to-face education components, orientation components, hand over sessions, other meetings, other clinical meetings, basically all had to be done remotely” (P2)

Q2 “In a teaching hospital environment, it is not just about having meetings, but face-to-face education, engaging with the community, patient education sessions, effectively largely all cancelled” (P2)

Q3 “We're very susceptible because it's quite normal for medical staff to move across the areas of the hospital. Trying to restrict the movement of doctors was very critical, we were trying to work through models of maintaining doctors in particular areas, which then had its own sort of inefficiencies. There were additional handoffs (between teams), which were risky and it meant that there were longer length of stays and inefficiencies, and a loss of continuity of care for the patients” (P10)

Q4 “People didn't get it, so no social distancing, people were gathering without masks in the cafeteria, in the coffee area, their tea rooms. People would be in full PPE in any COVID areas and they go into a tea room and take it off and have a chat to their colleagues, because they all had to go for break, at the same time” [….] “Now we put the barriers in very early, how many people can be in a room, don't go and take your mask off, outside marquees for people to take breaks, and that we wanted people to sign in which they didn't, and still is an issue with tracking people and where they are” (P1)

Q5 “We had issues with the doctors always having to move in groups. All doctors would be in emergency at the same time, and so the risk is furloughing the whole entire medical group, similar in some respects to all the nurses having to go off on breaks at the same time and breaking those sorts of long-standing habits is incredibly challenging” [….] “Last year we believe that transmission also occurred because the ICU liaison nurses who had moved from ICU down into the wards as they normally do, and transmission occurred” (P1)

Q6 “We had to implement zoom, you know this online platform, how does that work, and I remember the first few meetings having to be on the phone to someone to walk them through how to have a face-to-face meeting” (P4)

Q7 “One of the key things I made a personal decision on was to go onsite every day, I could have said I’m an exec I can stay home” [….] “you actually have to have people on the ground, you have to have a presence and you have to have leadership. From my point of view because the COO and the program directors early on were across both sites, some days I would be the only high-level person on site. They can’t think oh everybody has abandoned them and everybody is just working from home, and that meant somebody was actually there to help escalate things and get it done for them and be like you guys just go and do your job care for the patients and we will sort out the rest” (P11)

Burden of contact tracing

Q8 “Certainly there were lots of community cases, but the transmission in ICU and on the fourth floor was tearoom driven” (P1)

Q9 “I've seen people getting quite antsy when they don't agree with a decision about a furlough or about you know what needs to happen, and I think we've just stuck together as a leadership group and you know the rules are the rules, and that is the decision and good luck with it” (P6)

Q10 “We had one incident, one of the first loads of furlough, and we lost quite a few theatre staff, and we were really concerned about our ability to continue, because obviously you can't run an obstetric unit without theatres. But we managed to get through that by cancelling all electives. And the theatres were only the skeleton staff we had left, just there for doing the caesareans, and we got through” (P6)

Q11 “All those furlough’s you think the world's falling apart around you, but the fortnight goes, and now it’s a week, and I think you learn to be more resilient as each one comes” [….] “And we did have an exposure in the nursery and I think we all held our breath for a little while, we didn’t get too many furloughed and we managed to work our way through it, and again I mean it is just sitting down and thinking logically about how you are going to manage this particular situation” (P6)

Q12 “This came on so quickly we just didn't have the staff, but that was recognized relatively early on and the organisation tried to support the infection control team as best they could. You have to have competent staff that's actually going to be helpful as well, you can throw 20 people at a department but if they actually can’t help it makes it difficult” (P11)

Q13 “We had people working really, really hard and intensely, but we had really poor systems, and then we had poor compliance with the systems” [….] “And at that stage I think we were still evolving our contact tracing processes and procedures” (P1)

Furlough challenges

Q14 “Now people are a lot more aware of it (furlough), I think people that did those big two weeks stints back in the early days, probably felt quite isolated and quite almost stigmatized from doing that. And now that sort of moved to well everyone almost got a turn, and I’ve missed out on my two weeks sitting at home” (P5)

Q15 “Everyone's just super tired you can see it walking around, I was talking to somebody about people going off and getting a COVID test because you can get paid COVID special leave, you do that and have a day off” (P5)

Q16 “We have a very low base of medical workforce, so availability of staff particularly in relation to furlough or sick leave was significant” [….] “We're still in a continual challenge at the moment, so it's not just maintaining your current level of staff we actually also have to get additional staff as well” (P10)