UK Healthcare Workers’ Experiences of Major System Change in Elective Surgery During the COVID-19 Pandemic: Reflections on Rapid Service Adaptation

Document Type : Original Article

Authors

1 Department of Targeted Intervention, University College London, London, UK

2 Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK

3 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

4 Institute of Epidemiology and Healthcare, University College London, London, UK

5 Department of Anthropology, University College London, London, UK

Abstract

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.

Keywords

Main Subjects


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Articles in Press, Corrected Proof
Available Online from 01 September 2021
  • Receive Date: 14 April 2021
  • Revise Date: 13 July 2021
  • Accept Date: 07 August 2021