Dr H – Positive leadership experience

Dr H is a hospital consultant with some formal leadership responsibilities. During the pandemic, he faced some very busy times with emergencies and COVID-19 admissions, as well as difficulties, such as practicing in the absence of evidence. But there were some positives too. The experience, while very different from normal, was not as bad as he expected.

For Dr H, there was an easing of day-to-day pressures – a strange paradox in that, for a period of time, things weren’t easier but the usual challenges of day-to-day practice, such as training, service needs, leadership roles, service development, meeting targets, were reduced. Activity was down, lengths of stay in hospital improved and doctors were able to give more of their focus to clinical work. At times, there were some doctors who didn’t have a lot to do.

Dr H said, ‘Everything stopped. All meetings stopped. A lot of the other activities and other things that would normally put pressure on your time and efforts were not there. So a lot of doctors were able to just purely focus on inpatient care.’

There was a feeling that doctors had more time to put into their activity. ‘We found that actually we had time to do the things that we would like to do properly. I guess that you don't normally get in normal work. Towards the tail end [of the spring peak], people were quite happy with that way of working and felt actually, "Could we not just keep this way of going on with things?"

Having said that, at the beginning of the pandemic, there was huge amounts of guidance and advice to digest. Dr H described, ‘My email inbox is overloaded anyway, but during COVID I think it just went crazy… It was almost impossible to keep up and make any sense of it all. Early on I just gave up trying to keep up with things because there was so much stuff flying around…. Every Royal College, every national body had their guidance and everything was very slightly different from what everyone else was saying.’

Another challenge was lack of evidence around how to handle the coronavirus pandemic, for example effective treatments. ‘A lot of our practice is based on experience of doing something or on evidence showing that this is the right thing to do. There was literally nothing to use as a comparative for this. Things obviously changed quite often and often quite suddenly…we had to be quite ready to adapt to that and change the way we were doing things.’

In some ways doctors found using their clinical judgements helpful, as they had to use their instincts and experience. Dr H said, ’we've had to make changes really just based on what we feel is the right thing to do. That's not always a bad thing.

‘I think there is probably a little bit more leeway now to say, "Well, we're not sure if this is proven or demonstrated or evidence-based but it certainly feels like the right thing to do, so let's give it a try.”

Another challenge he faced was working out who needed a risk assessment. ‘For the managers trying to pick out who needed risk assessing wasn't a straightforward thing to do.’

At the peak, there was increased multi-specialty working in COVID-19 and non-COVID-19 areas, which had happened pre-pandemic, but was heightened. Each inpatient ward team had input from every specialty, a regular daily review of patients. There was a collective sense of working as one big team, rather than in their own departments, which was ‘refreshing and quite a positive experience.’

Dr H wants to continue this way of working as there appeared to be better patient outcomes. Although with different patient populations and higher activity this might not be possible.

He was impressed with how doctors early in their careers responded ‘very well’ and really contributed to how the consultants coped – it was ‘striking.’ He noted, ‘They really threw themselves into it, I think maybe because there was no other option. I think they showed a lot of initiative, they went over and above.’

‘They came up with ideas and suggestions for how we can improve things. I know a lot of them, obviously, had extended periods in those placements because the rotations didn't happen as planned. So I think they just got on with it. But I think I'm very impressed with how they overall managed.’

Overall, Dr H described how he couldn’t use the word enjoy, but that he found the experience of working in the early stages of the pandemic rewarding. ‘Being able to have a role in managing what was quite a major challenge and helping to contribute to that effort…it's something I'm certainly keen to continue.’