MUMC is one of the participating hospitals. Loraine Bodewes
What has changed in five hospitals in Limburg over the past year due to the COVID-19 pandemic? A lot, according to a study conducted by Maastricht University researchers Daan Westra and Bram Fleuren. Hospitals closed departments, introduced twelve-hour shifts, set up screening tents, and began to provide psychosocial support for struggling employees. But, even more importantly, how did these changes affect hospital employee health? And what are the takeaways for future healthcare crises? The Netherlands Organisation for Health Research and Development (ZonMw) gave the researchers half a million euros to find the answers to these questions.
In September 2020, Daan Westra and his colleagues in the department of Health Services Research started reading and analysing. The five participating hospitals in Limburg (Viecuri in Venlo, Laurentius Hospital in Roermond, St. Jans Gasthuis Weert, Zuyderland in Geleen and Heerlen, and the Maastricht University Medical Centre+) provided them with crisis team meeting notes containing lists of actions and decisions, evaluation reports, and internal blogs dating back to the beginning of the COVID-19 crisis in the Netherlands. They interviewed hospital employees, from purchasing officers to administrators. And they looked at relevant articles in local newspaper De Limburger and medical journals like Skipr and Zorgvisie.
The researchers did all this to find out which decisions the hospitals made during the first and second wave. They didn’t get to see everything, though. “For example, we didn’t receive the full minutes of the crisis management meetings”, says Westra, “but that was fine. We did get the list of decisions, which was the most important thing for us.” The result of their study is a list of two hundred changes, divided into “first wave” and “second wave”.
Westra: “It was all hands on deck from March last year onwards. Staff members employed in closed departments were put to work elsewhere in the hospital, like in the ICU. Medical students were stationed at the entrance to screen patients.” Employees also often worked more hours and performed more job duties. For example, nurse practitioners were authorised to prescribe medications, and nurses were given more access to medical files. To reduce the number of different employees working on the COVID wards per week (to lower the risk of infections), they worked sixty hours per week, followed by a week off. And employees experiencing mild symptoms were asked to come in anyway, as there was no one to cover for them.
Westra: “This healthcare crisis is forcing hospitals to make decisions that are not always the best decisions for the mental and physical health of their employees.” At the same time, hospitals are trying to do things to help their employees: providing support through a psychosocial team and peer support from direct colleagues, or taking care of practical matters, like childcare and grocery services for employees working long hours.
After the first wave, the hospitals unanimously agreed that routine care should not be suspended to the same extent again. This was one of the lessons learnt, says Westra. “Suspending routine care was difficult for employees. It made them feel like they were failing in their duty of care.” But in the second and third wave, the combination of COVID care and routine care is a source of worry to staff, according to Westra’s findings.
Another lesson learnt in the first wave is that communication needs to be different, more streamlined. “There was no balance between transparency and an abundance of information.” In the first few months, new information kept coming in, leading to changes in decisions. At the peak of the first wave, daily updates were shared through WhatsApp, emails came in several times a day, and messages were posted on the intranet several times a day as well. Friction also arose because crisis teams had to make decisions quickly, resulting in doctors and nurses feeling excluded from the decision-making process.
Sleep and fatigue
It stands to reason that the COVID situation affected people’s health and morale. But how, exactly? Bram Fleuren, assistant professor of Work and Social Psychology, is trying to answer this question together with two colleagues in his department. Employees of the participating hospitals – about 23 thousand in total – receive a questionnaire four times a year. It asks them to report on their work experiences, sleep and fatigue on a daily basis for a week, among other things. Fleuren: “This gives us a good idea of their sleep quality, energy levels and rate of recovery.” The researchers are also paying attention to personality traits. “For example, we’re looking at resilience, as we expect people who are more resilient to be less affected by the situation.” Ultimately, it’s all about “sustainable employability”, says Fleuren. “Will employees still be able to function well at work in the long term?”
They sent out the first questionnaire in mid-December. At the time, the number of cases and hospitalisations was quite high. Was it the right timing? Westra: “We felt like we were caught between a rock and a hard place. Should we really bother healthcare workers who were already having a hard time? On the other hand, we have a socially relevant goal here. We want to help hospitals make decisions in times of crisis, decisions that will cause their employees as little harm as possible.” According to Fleuren, these studies also contribute to the existing literature. “We want to provide information on ‘changing X will affect your employees in Y and Z ways’. That piece of the puzzle is still missing in this context.”
The first round of questionnaires, sent out before Christmas, received a thousand responses. Westra: “It may not seem like much, but it’s a good number for research purposes.” But does this hold true even if few employees of the worst-hit departments (IC, COVID) responded to the questionnaire, as Fleuren saw on the basis of the first wave of the study? “This group is underrepresented in our sample. Ultimately, the averages are not alarming, but this is probably because our sample also included people who didn’t feel as pressured by the situation.”
But, he says, this doesn’t mean that the data are useless. “Not at all. We’re interested in the relationships between COVID-related changes and hospital employee health. People who work in cleaning or the logistics department are just as much hospital staff as ICU doctors are. And we have follow-up data coming up. It’ll be interesting to see how the situation changes over time. For example, will we find differences between the pre-Christmas results and this summer’s results?”
Not to rank
Finally, did they find any differences between the participating hospitals? Did one hospital act faster and better than the other? Do employees of hospital A feel more affected by the pandemic than employees of hospital B? “We didn’t find any major differences between the hospitals. They all made more or less the same changes, like scaling up COVID care and creating a psychosocial team”, is all the researchers want to say on this topic. Fleuren: “We send each hospital a report of our main findings for their benefit. The aim of the study is not to publicly rank and compare the participating hospitals.”