key: cord-0833697-qhiulzdm authors: Staines, Anthony; Amalberti, René; Berwick, Donald M; Braithwaite, Jeffrey; Lachman, Peter; Vincent, Charles A title: COVID-19: Patient Safety and Quality Improvement Skills to Deploy during the Surge date: 2020-05-13 journal: Int J Qual Health Care DOI: 10.1093/intqhc/mzaa050 sha: 1f32e66d5c16cd697479c04cf39a46dde576f32f doc_id: 833697 cord_uid: qhiulzdm nan Key words: Quality Improvement, Patient Safety, Pandemic, COVID-19 Competing interests: Authors report no conflicts of interest relevant to this article. Word count: 1680 words The COVID-19 pandemic has suddenly challenged many healthcare systems. To respond to the crisis, these systems have had to reorganize instantly, with little time to reflect on the roles to assign to their Patient Safety (PS) and Quality Improvement (QI) experts. In many cases, staff who had a background in clinical care was called to support wards and critical care. Others were deemed "non-essential" and sent back to work from home, while their programs were placed in hibernation mode. This has meant that many QI and PS experts with skills to offer in their field have ended up carrying out tasks unrelated to the current crisis. We believe that the skillset of patient safety and quality improvement personnel is essential for the successful implementation of the changes required to achieve the desired outcomes. An understanding of systems theory and the complexity of healthcare systems, human factors and reliability theories, and change methodologies is key to the success of any transformation program. Here, we suggest a five-step strategy and actions through which PS and QI staff can meaningfully contribute during a pandemic by employing their core skills to support patients, staff, and organizations. Strengthen the system by assessing readiness, gathering evidence, setting up training, promoting staff safety, and bolstering peer support. 2. Engage with citizens, patients, and their families so that the solutions are jointly achieved and owned by both the healthcare providers and the people who receive care, and in particular the citizens who are required to undertake preventive interventions. 3. Work to improve care, through actions such as the separation of flows, flash workshops on teamwork, and the development of clinical decision support. 4. Reduce harm by proactively managing risk to both COVID-19 and non COVID-19 patients. 5. Boost and expand the learning system, to capture improvement opportunities, adjust very rapidly, and develop resilience. This is crucial as little is known about COVID-19 and its impacts on patients, staff, and institutions. Identify an appropriate readiness checklist and assess the situation. Various organizations, such as the World Health Organization (WHO) are offering readiness assessment checklists. [1] Carrying out the assessment allows quick identification of areas to improve as well as of solutions, although it is important for such assessments not to unduly simplify the complexities of readiness. . Checklists provide a guide, not a complete solution. Gather experience and evidence, filter, summarize and brief. At the beginning of a pandemic, very little is known about the disease, its specific behavior, treatment, impact and evolution. Gathering experience requires access to an international network, for which QI people are often uniquely placed through their international connections and affiliations with international societies offering web-based resources. Strengthen the capacities of the learning system. Emphasize the importance of capturing crisis-related incidents, risks and improvement opportunities, and innovations, as well as learning from things going right [7] . Facilitate that capture by coaching clinicians or providing bedside learning coordinators, as conceived by the London NHS Nightingale surge hospital. [8] Its coordinators' role is to gather ideas and data from the bedside, feed them back to a daily learning forum and input data on incidents and harm into the Electronic Incident Reporting System. The coordinator also provides a route through which to inform bedside clinicians reliably about operational changes and to share new learning. Contribute to problem solving and solution generation. Contribute to analyzing the needs brought up by the pandemic, through process mapping, designing and redesigning care delivery processes, and rapid implementation programs. Support solving PPE shortages. Promote a culture of safety, resilience, and learning. This is a central part of the routine work [2] . During a crisis, bolstering a culture of learning, not pointing fingers, being solutions oriented and learning from what goes well as well as from incidents is more important than ever. Be a motivator, a role model in resilience; promote adaptability and flexibility on the front line. Conduct rapid tests of the implementation of new findings from the literature. Contribute to data analysis, representation, and interpretation of variation. This can include modeling the outbreak, setting up and updating a pandemic dashboard, and creating run charts and control charts to identify and analyze variation. Support and help interpret tests of change. Coping with a pandemic primarily requires skills in virology, serology and intensive care, and other infection related disciplines. However, in parallel with the management of infection, health services worldwide are engaged in a massive and rapid process of organizational change, to which QI and PS people can contribute considerable expertise, know-how and know-why. They can help assess and develop preparedness, gather evidence and experience, advise and support leadership, remind everyone that there is no patient safety without staff safety, leverage organizational learning, and connect with experts and patient partners. These activities will help enable compassion, safety and respect to emerge from the midst of the turbulence. In the coming months, QI and PS resourcefulness will also be invaluable to help manage the impact on other patients whose treatment is delayed, interrupted or cancelled, in terms of both the immediate disruption and the ensuing process of further organizational change to repair our damaged health services and the many affected patients and families, both with and without COVID-19. U N C O R R E C T E D M A N U S C R I P T World Health Organization Regional Office for Europe. Hospital Readiness Checklist for COVID-19 COVID-19: Peer Support and Crisis Communication Strategies to Promote Institutional Resilience Promoting patient safety at time of COVID-19 Re-thinking word choice during this pandemic Changes in medical errors after implementation of a handoff program COVID-19 Related Resources for Pressure Injury Prevention COVID-19 and Lessons from the UK Overcoming COVID-19: What can human factors and ergonomics offer