Overcoming challenges in implementing measures across multiple centers of a chain of hospitals to combat COVID-19 pandemic.

PURPOSE: Coronavirus outbreak was first reported towards the end of 2019 and has now been declared a pandemic by the World Health Organization. Post declaration, India announced lockdown and various guidelines were issued by Health authorities worldwide for the organizations to function in this emergency aeon. Different organizations strategized differently to respond to COVID 19 pandemic. The aim was to implement COVID 19 guidelines across all the centres of a chain of Eye hospitals in India in short span of time overcoming the challenges.
METHODS: A SMART strategy was confabulated within the team. There were numerous challenges like lack of time, rapidly changing guidelines, no travelling scenarios, training and educating the staff in huge numbers, rapidly evolving situation, change management, need of increased vigilance, and language barrier at certain centres, sustaining quality assurance and motivating the staff in stressful times. The challenges were surpassed using a power packed strategy, dedicated efforts and team work grasping the available tools and technology from a single location. This template can serve us and other hospitals to respond in a better way for similar future challenges.
RESULTS: The COVID 19 protocols were implemented across all the centres successfully. The entire Quality assurance system drifted to online platform and education and awareness methods took the digital thread. Teamwork synergized with the aforementioned things and we came out with flying colours achieving the goals in short span of time overcoming all the barriers.
CONCLUSION: Difficult times bring challenges and challenges teach us the innovative ways to convert them into opportunities. A well planned strategy, best utilization of available resources, team work and continuous monitoring can bring the best outcomes forward.

Change is hard at first, messy in the middle and gorgeous at the end - Robin Sharma

Emerging pandemics show that how crucial it is to take right actions at right time and to teach and educate the staff on implementation of the same in order to curb infection, sustain routine operations and quality in an organization ensuring patient and staff safety.

Where great innovative ideas and strategies to excel were lurching on paper of different organizations to welcome 2020, an unwelcomed pandemic hit human lives across India like a robust wave of disaster. On 30th January 2020, the WHO declared the Chinese outbreak of COVID-19 to be a Public Health Emergency of international Concern posing a high risk globally.[12] During this crisis, the healthcare industry could not take respite and with its dignified human resources who shined as armored Corona Fighters, it continued to serve the nation in this ornery battle ground.

Globally, Ophthalmologists face an ageing population which appears to be at increased risk of severe COVID-19 infection and mortality.[345] Undergoing multiple investigations, it is common that patients have prolonged stay in clinics to complete the whole examination.[6] All these factors potentially increase the risk of cross-infection in ophthalmology than other clinical disciplines.

Our chain of eye hospitals adhered to our Vision, Mission, Values and Quality Policy without any slumber focusing on enhancing patient and staff safety and infection control overcoming various challenges coming on the way while implementing the protocols/guidelines and measures to combat this intrusive pandemic across all our centers countrywide.

Methods

The challenges [Table 1] and the journey we took overcoming these challenges is elicited here.

Table 1

List of challenges faced during implementation of measures during COVID-19 pandemic

List of challenges
Deluge of information
Adaptation
Implementation in short span of time
Rapid changing guidelines
Command and control
Integration and Co-ordination
Change management
Language barrier
Lesser scope of travelling
Increased need of vigilance
Lack of motivation

The challenges were surpassed using SMART strategy, dedicated efforts and team work grasping the available tools and technology from a single location.

CODE GREY was announced at all the centers with onset of the disaster. Various measures were implemented taking reference from national and international guidelines.[6789] The measures were divided into following categories[7]

Basic preventive measures to be followed at all times[1011]

Measures specific to workplaces/offices

Measures to be taken on occurrence of case(s)

Disinfection procedures to be implemented in case of occurrence of suspect/confirmed case.[1213]

Where the world was slowly and steadily drifting towards the virtual era, we promptly swerved to technology and digital platform to make the toughest things happen. Though socially distanced, we stood together headstrong like a team and gave the best of our efforts in implementing the changes to drift towards the New Normal.[1415] Our staff individually stepped forward like a pro with an unsurpassable attitude.

For implementation of new policies and measures to combat COVID 19, the Quality team took the initiative to train the staff across all the centers using digital platform. Change management was the roaring challenge and we managed to make the staff members adapt to the online training sessions through effective communication and addressing their problems with multiple solutions. Making them tech-savvy was an accomplishment which will lay its fruits in future as well, hence embarking a new long term investment. Language barrier was a challenge with our southern centers. The Centre Heads did not hesitate to go the extra mile to educate their team members in best possible ways using local language. With the onset of our virtual trainings, we introduced an animated character, named “Qualexa” as our virtual Quality expert to make the dry subject glamorous. We used visual tools and interesting competitions for the staff like “CORONA Fighters’ tool”, “Mask wear challenge”, “Poster competition”, “BMW-Let’s jump” etc., to educate, aware and motivate them.

The committee meetings took an online track. The papers turned into work sheets on laptops. Post-sharing the protocols and Post training sessions, the Centre heads with their respective teams kept their noses to grindstone to achieve the best outcomes. The Centre teams went into overdrive and made sure that all the measures are being reproduced at their centers. The enthusiasm depicted by the teams made us sail the boat. Despite of the negativities around our team always looked for the silver lining.

Our Biomedical Engineering Team did not compromise on equipment maintenance and functioning during pandemic when the centers were functional for limited number of days. The HVAC system in OTs were monitored and operationalized during the gaps in order to prevent any culture growth and infection which made us primed for any emergency surgeries during lockdown.[161718]

Tools like Infection control checklists, Hand Hygiene audit checklists, and regular review meetings were used to verify the implementation process and continuous monitoring.[1920] Queries were handled on calls and if required re-trainings were done.

Results

‘ Necessity is the mother of invention’ and the famous American Basketball Player, Mr. John Wooden quoted a resplendent thread of words-‘The main ingredient of stardom is the rest of the team’.

Here these quotes reflect the entire picture of how we achieved success in accomplishment of our rapid targets listed above in this pandemic in the cacophony of challenges. The measures were not easy to implement, execute and sustain in such a short span of time. It took the blood, toil and sweat of our team to do the same on large scale with uniformity and consistency. Our agility was the key in coming out with flying colors in the current grey shades of time. It was not one man’s army, it was the formidable efforts of our teams countrywide which made us fight against this pandemic vehemently.

In second quarter of the year i.e., from April’20 to June’20, more than 2000 staff members have been trained using digital tools, more than 50 webinars/online training sessions have been conducted by the quality team excluding the training programs conducted locally at the center by the Centre heads and Quality coordinators, more than 60 man-hours have been spent on training sessions.

This pandemic could not stop us from making further improvements in quality systems. We achieved NABH accreditation/certification goal of total 20 centers of our group, naming it as T20 achievement. We initiated QMIS monthly meetings for pilot centers, Introduced 5S Japanese concept in our system and conducted webinars on quality improvement techniques and methods.

Discussion

Challenges and opportunities move hand in hand. It depends on how we strategically utilize the available resources in the best possible ways to bring out the desired outcomes. The technology succored our team to continue the training and implementation processes. The innovations were the building blocks. The teamwork acted like mitochondria, powerhouse of the entire journey.

Conclusion

Overcoming challenges and preparing the Centre teams across India against the pandemic was a strenuous task which was accomplished with diligent efforts of our teams and use of technology unrivalled. We cherished the success and converted our failures into achievements. This status quo has to be addressed in continuation without taking a breath. Still we have to be in the same momentum and keep following the measures stringently. Sustenance is the foreseen challenge which we have to overrule. Together we did and we will make a difference.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.