Leadership and Management During High Uncertainty and Crises

Question 1

First Wave

Answer 1

Other emergency
Fewer people came
Bed occupancy halved
Time in department halved
Much more efficient care

Planned care
referrals from primary care fell by 2/3
Hospital activity halved

Covid: large spike in unavailable staff
Need to know how many beds are available and will be taken up: 450 beds based on worst-case scenario (half of capacity)
Oxygen
PPE: warehouse storage, training staff
Psychologists and psychologists: Staff
Testing centre set up with University and
Research studies to develop treatment programmes
Set up a task force to create enough capacity
Set up different areas
Additional wards added

Question 2

Second Wave

Answer 2

Covid
Almost twice as many people to care for
Expanded critical care beds
Redeployed staff
Very hard on the mental health of staff

Emergency dept
Lengths in the emergency department grew to almost 12hrs
Were able to use additional beds that were made free for the first wave of COVID

Planned Care:
Slow recovery in referrals
Referrals grew faster than activity
Long waiting lists

Question 3

Third Wave

Answer 3

covid
Emergency Dept
There were fewer beds in the emergency department (covid) so increased waiting time

Planned
Referrals grew faster than activity
Long waiting lists

Question 4

Lessons Learnt

Answer 4

Learn from the past and adapt to the present
Set direction
Constantly look ahead:
Usually look 2/3 years ahead (extra beds for backlog)
When to make a decision
Empower the front lines
Delegate
Reduce bureaucracy
Look after staff
Communicate constantly
Request and offer help
Be discerning about which requests and offers to pursue
Figure out what would help and what companies to partner with
Be discerning on how to engage with national decision-makers
Exercise judgment in applying national guidance to a local area
Embed innovation
Plan for resilience
Have to also adapt to new scenarios
Large hospitals vs smaller hospitals in one larKeep building an excellent organisation

Question 5

IfM Approach

Answer 5

Levels
Institutional
Operational units
Individuals

Question 6

Initial Findings

Answer 6

Organisational legitimisation to enable the initiation and rapid implementation of the collaboration
IfM was known to the hospital and had a good reputation
Pro Vice-Chancellor was formally of IfM

Availability of slack resources to rapidly deliver project outcomes
Many people available

Roles and capabilities of boundary-spanning individuals
Experience spanning hospital leadership and clinical work
Understanding the other side is important: hospital workers were very patient and employee-centric

Compatibility of institutional logics
Shared focus and values

Question 7

Limitations

Answer 7

Limited generalisability
Incomplete data