Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 UK Healthcare Workers’ Experiences of Major System Change in Elective Surgery During the COVID-19 Pandemic: Reflections on Rapid Service Adaptation 2072 2082 4118 10.34172/ijhpm.2021.101 EN Georgina Singleton Department of Targeted Intervention, University College London, London, UK Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK Anna Dowrick Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK Louisa Manby Institute of Epidemiology and Healthcare, University College London, London, UK Harrison Fillmore Department of Anthropology, University College London, London, UK Aron Syverson Institute of Epidemiology and Healthcare, University College London, London, UK Sasha Lewis-Jackson Department of Targeted Intervention, University College London, London, UK Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK Inayah Uddin Department of Targeted Intervention, University College London, London, UK Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK Kirsi Sumray Institute of Epidemiology and Healthcare, University College London, London, UK Elysse Bautista-González Institute of Epidemiology and Healthcare, University College London, London, UK Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK Ginger Johnson Department of Targeted Intervention, University College London, London, UK Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK 0000-0002-4728-3744 Cecilia Vindrola-Padros Department of Targeted Intervention, University College London, London, UK Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK Journal Article 2021 04 14 Background The coronavirus disease 2019 (COVID-19) pandemic disrupted the delivery of elective surgery in the United Kingdom. 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 United Kingdom, with the aim of developing lessons for future major systems change (MSC). Methods Using a rapid qualitative study design, we conducted 25 interviews with frontline surgical staff during the first wave of the pandemic. Framework analysis was used to organise and interpret findings. Results Staff 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. Conclusion Success 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 decisionmaking and competing guidance from national bodies. Involving staff in decisions about the organisation and delivery of MSC is essential for the sustainability of change processes.

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