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Covid-19 workforce planning; prepare for the worst, hope for the best

PROFESSOR Leanne Boyd talks through eastern health's current workforce plan, which has been designed to respond to a rapid rise (and drop) in the demand for health services.

Disclaimer

The Challenge:

Setting up the hospital's workforce with enough clinicians who have appropriate experience and training to be able to respond to any spikes - and drops-  in healthcare demand (listen from 00:03:14).

The Solution:

  • Building the capability of the team so that clinicians can confidently work in areas they don't normally work in
  • Developing models of care the adapt the ratios of clinicians to patients
  • Employing registered undergraduate students of nursing to provide support in 'non-essential care' areas
  • Recruiting professionals who have recently left the workforce
  • Commencing 12-hour shifts to rapidly increase EFT in the organisation
  • Cancelling leave
  • Ensuring the unions and employees are involved in the planning (listen from 00:04:21)

The Impact:

Although Australia is yet to see a significant strain on the healthcare system like in other countries, Eastern Health is prepared to manage any spike in demand with their 'reserve' workforce. Staff members have taken advantage of the upskilling opportunities available and feel supported and ready to assist if/when needed (listen from 00:05:53).

Resources:

COVID Acute Wards - Model of care and clinical workflows

Eastern Health Service Delivery System for the COVID 19 Pandemic

Surge Planning ICU Upskilling during COVID-19 Pandemic

Prof George Braitberg

Professor leanne boyd

Professor Lee Boyd is Executive Director Learning and Teaching and Chief Nursing and Midwifery Officer at Eastern Health. She has a clinical background in critical care, over 25 years’ experience in health professional education and research. Previously, she worked at Cabrini Health in an executive role and at Monash University as Director of Academic Programs (Middle East) and Head of Department Community Emergency Health and Paramedic Practice. Lee is also a HEAL board director.

Lee holds post-graduate qualifications in Education and Critical Care from Monash University and a Masters in Tertiary Education Management from Melbourne University. Her PhD investigated health program evaluation models which reflects her interest in quality improvement. She is currently studying a Masters in Business Administration and supervises 6 PhD students. Lee is keen to facilitate a learning and research culture within healthcare organisations with a focus on safety and high quality care. She is a strong supporter of value-based care and patient engagement in care planning, systems design, education and research.

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Video transcript

Melanie Hay:

Welcome to another episode of the AICG Connecting Clinicians, COVID-19 Clinical Governance series. Each episode, we'll interview a clinician across Australasia to discuss a safety and quality challenge that COVID-19 has presented a solution they've implemented to address that challenge and the impact seen from these changes. Our clinicians have generously agreed to share any relevant materials that they might have developed in addressing this challenge. These resources will be available on our website alongside this interview. We'll form a COVID-19 repository of material for others to use. Today, we are welcoming Professor Lee Boyd, Executive Director of Learning and Teaching and Chief Nursing and Midwifery Officer at Eastern Health. Lee has a clinical background in critical care and over 25 years’ experience in health professional education and research. Lee will step us through the challenge, the solution, and the impact of COVID-19 workforce planning, which we've titled, "Prepare for the Worst, Hope for the Best." Thanks for joining us today, Lee.

Lee Boyd:

Thanks, Mel. I'm delighted to be involved. I think the AICG has a really vital role to play in collating and disseminating the information and our learnings from our experiences with COVID-19. It's developing so rapidly that we can't go through our normal processes that we do within healthcare. I think this is a great opportunity for us to learn from each other and it's a fabulous platform. Thank you for the opportunity.

(00:01:40) I'm going to talk today about the Eastern Health Pandemic Plan and where the workforce agility needs to align with that. Basically, we have six key deliverables in our plan. We have surge capacity plan and a COVID-19 model of care across a number of streams of key such as emergency, critical care, ambulatory care, mental health, all of those special key areas. We have to determine what's required for infrastructure and procurement. Because as you've heard I'm sure in the media, PPE is a major item and making sure that we can keep our staff safe and have the available equipment needed - having the right number of ventilators and things like that is an important part of our overarching plan. Workforce availability is a key component. That's something I'm going to focus on more today, but the other elements of our plan around maintaining our values throughout this crisis, workforce safety and well-being and making sure that our staff feel valued and heard throughout the changes that are occurring. That we minimize community transmission of COVID-19 for our staff, patients and visitors. That we maintain our critical non-COVID services because we can't forget that in amongst all these, there is still a large body of Australians that require our care. That's our overarching plan.

(00:03:14) A primary challenge in the workforce space is that we need to be able to significantly increase our staffing to cope with in-service demands. If our number of patients increases significantly, we're going to need to be able to flex up incredibly quickly. We're going to need to be able to provide a workforce that has experience outside their normal experiences. For example, if you haven't worked in critical care, you might feel very uncomfortable providing support in order to care for patients that are as sick as these patients tend to be, and require the interventions that they require such as advanced ventilatory support and things like that. That is one challenge, but in another area, we've got other challenges and that some of our staff are underworked and that they don't have the demand because we've closed down large portions of our service.

(00:04:21) Moving to a solution, we need to be able to flex up quickly and to be able to flex down again. How are we going to do that? We're doing some type of biography building within our teams so that we can coach nurses and doctors in areas that they're not historically used to working. We've developed models of care where different numbers will apply. For example, an ICU nurse, at the moment, would have one patient to one ICU nurse. In a surge scenario, it may be one ICU nurse plus three other registered nurses with additional training to support them for a group of patients. That would be a very different model of care. We're looking at employing RUSONs which are registered undergraduate students of nursing and engaging them in providing non-essential or vital care and support those nursing teams. We're looking at recruiting professionals that have recently left the workplace, looking at things like 12-hour shifts if we need to which rapidly increases EFT in an organisation. Cancelling leave, all of these things are part of our workforce plan. The most important thing is to make sure that the unions are involved in our conversation, that our staff are involved and feel prepared for whatever contingency occurs.

(00:05:53) If we move on then to our impacts and what happened with all of this planning, I think that we've been in a really privileged situation in Australia and that we've had time. We've had the privilege of time. We now have plans so that if I have a workforce that is depleted because people are sick, people are caring for family members, they can't attend work for a number of reasons, then I've got this reserve body of workforce that can come in and provide care if needed. I think that we have had amazing buy-in from our staff and our health professionals to really upskill rapidly. We've done a number of courses, the Department of Health have provided amazing opportunities for nurses and doctors to focus their learnings, at the moment, on respiratory care. A lot of our people are taking advantage of these so that they're able to contribute.

Look, I think, we're now prepared for whatever COVID-19 is going to throw at us. I hope that's the case. Our workforce, I think, are feeling ready and more supportive. I think that Australia is in a really good place. My final thought on this is that Winston Churchill once said during the war, "Never to waste a good crisis." I don't mean that facetiously, but I do believe that from this experience, there are going to be amazing learnings that we can share with each other. We can share internationally and we can take into our post-COVID world. I think that we've been incredibly innovative. I think we're delivering care in ways that we've never done it before. I think that this work that we've done in increasing agility in workforce is going to enable us to respond to emergencies in a totally different way in the future. I would suggest that we make sure that we don't lose these winnings, that we take the work that we've done. We build on it and we use it in the future.

Melanie Hay:

Thank you, Lee. That's fantastic. Thanks so much for joining us today and for sharing the challenge, the solution, and also the impact that you've seen at Eastern Health. We'd also just like to sincerely thank you at this point in time for all of the hard work that you've done and for that of your staff and your team at Eastern Health.

Lee Boyd:

Yeah. It's been an amazing collaborative journey. I will say that the professions and the disciplines have worked together so well throughout this process.

Melanie Hay:

We'll continue over the coming weeks to bring a series of clinicians across the country and New Zealand to share their Clinical Governance COVID-19 challenges with you. If you'd like to become involved in this series, then we'd love to hear from you. The faster we can share the great work that's taking place, both here and in New Zealand, the better. Please drop us an email at info@aicg.edu.au. Until next time, stay safe and Kia Kaha.