Power in our collective: how we build the future as one system and ‘one team’

The first in IFIC’s “Care during and beyond the COVID-19 Crisis – Building integrated care as the cornerstone of our new reality” webinar series took place on Wednesday, 8th April and was attended by 250 delegates representing 40 countries.

In this webinar series we will be offering an opportunity for our network to hear about the integrated care approaches implemented and considerations being made around the world to address people’s continued care and support needs beyond the immediate public health issues and crisis management. This webinar series is not intended to be about lessons learnt or to provide expert advice, but it is intended as a space to share observations, insights and thoughts. We will discuss various responses and reflect on new ways of working and ongoing learnings as the weeks progress.

While we are not able to represent all the contexts in the world, it is our intention to host webinars that include contributions from many regions and those in different time-zones. We understand that every country will often have very different challenges and responses and in these webinars we will draw in some other experiences from a wider range of regions and countries. If you do want to recommend a panellist for a future webinar, please do get in touch with us.

In these week’s webinar we were joined by eight panellists representing different countries and with different professional backgrounds. Each panellist was invited to give some observations based on their own experience and involvement in the COVID-19 responses in their regions. Here are some of their considerations, you can access the full webinar recording below.

In Singapore as 80% of the hospitals are publicly owned, the government quickly stepped into take quite a centralised approach to the response. Jason Yap from the University of Singapore said he has been impressed with how organisations and professions have been able to come together to provide a response, because everyone is working against a common danger. He commented that while decision-making had been centralised, organisations could decide how they implement decisions and he wondered how these efforts can be continued post crisis, where we have a unified vision of what we want for the whole community, it will become clear who is best placed to do it and competitive barriers should come down.

Anne Hendry, a geriatrician by background, turned our attention to the treatment of our older people and said we were at a defining moment in history. She said “we have two choices, we can continue to perpetuate some of our responses to ageism or we can be grounded now in an ‘every life matters’ and ‘nobody should be left behind’ response that needs to be proportionate and equitable”. Anne complimented the work of partners across Scotland and highlighted the importance of anticipatory care planning and hospital at home approaches. She also praised the work of the community and voluntary sector and how this was ensuring that older people remained at the heart of integrated care.

Robert Johnstone, patient advocate and IFIC Board member brought home some of the stark realities that COVID-19 is having on people and families with examples that included the refusal of treatment for a cancer patient and the isolation experienced by families supporting people with long term chronic illnesses and how difficult it is to manage care at this time. He emphasised how important it is to have a co-designed response and his hope to have a more intimate relationship with policy makers and be more involved in the planning of care services in the future.

Moving to Catalonia we heard from Albert Alonso who is working in Hospital Clinic Barcelona and he was able to tell us of the many innovations and improvements to ways of working he has experienced in recent weeks. He talked about the reorganisation of wards to increase ICU beds and the use of local hotels to increase the capacity for the treatment of COVID-19 patients. He told us of the adaptability of all clinicians to be redeployed to the care of those with the virus. Where previously he would have seen the struggles of professionals to adapt their ways of working for different care pathways, in this crisis situation people had adapted very well. He also highlighted how people from different backgrounds – clinicians, researchers, industry partners and engineers – have worked together to design and manufacture ventilators and how researchers have quickly responded to finding new ways to treat these patients. He also complemented the IT departments for providing the right level of support, where in the past ways to use IT to support integrated care approaches was often not so easy. On the negative side he said while they have used video calling and other technology to support patients and families, he felt that there could have been a more thoughtful and personalised response. He also noted that the continued silos between nursing homes and hospitals had been evident and there were times when different administrations could have worked harder to find agreements. Nonetheless, he believed that Covid-19 was a game changer that might take us to a different scenario of unprecedented wider collaboration.

Helmut Hildebrandt, based in Germany, also talked of the numerous innovations and support systems that have been created before and during the crisis. He talked of ‘Open Table’, a service perhaps akin to Meals on Wheels in other countries whereby those who formally led the service were now more vulnerable to COVID-19 and youth groups had taken up the mantle to continue the service. He talked too of the psychosocial support services that were vital to those in isolation and those feeling anxious and they had provided a video conference coaching service free of charge during the crisis. The organisation was also providing support to people to help boost their immune systems and providing refreshing ideas for how to keep active and well. Helmut importantly raised the issue of staff wellbeing and talked of the trauma that will be experienced by staff now and the time and support they will need to recover.

Bert Vrijhoef from the Netherlands was impressed by the level of collaboration that he has seen between researchers, both in health and social care but also with other disciplines. He hoped this spirit of collaboration will be seen beyond the crisis. Apart from all the innovations and the way that services were now being delivered, he was interested to see if the bottom-up initiatives including digital care for primary care services and telemonitoring to delivery of meals in times of physical isolation and the training, remobilizing and repurposing of the health and social care workforce with non-physicians taking over tasks that were previously only allowed to be undertaken by physicians, could be embedded in the care delivery models beyond COVID-19. “It will be interesting to see if this mixed bag of disruptive and incremental innovations and initiatives will translate into routine services as part of the emerging health and social care systems and even result in a new health eco system.”

Áine Carroll based in Dublin, Ireland brought our attention back to our humanist response. She asked “when you are in a crisis situation how do you make ethical decisions?”. She said “even if decisions are being made with the best of intentions they have consequences and the ethics of these consequences need to be considered.” It is important that people are enabled to make really sound decisions. To that end her team are creating a point of care decision-making tool using ethical frameworks that have been developed over recent years. There is a rapid review under way and they hope to have a prototype tool by the end of next week. “The tool will be co-designed, using a participatory action approach, and we are testing it in a variety of settings – in the hospital, in the community and in primary care.”

Finally we turned to Jodeme Goldhar in Toronto, Canada who provided us with an inspirational challenge to finish. She told us we needed an approach that is ‘one team’, and that has a co-designed shared purpose. She said the pandemic has shown us why working together as ‘one team’ has never been more important. She emphasized why a distributed leadership model across community, home care, hospital and primary care with patients has never been more important. She said that integration is in the DNA of the change we want to see around health and social care transformation. “We need to be ambassadors as to why a ‘one team’ approach is required. Sometimes we go to a command and control state but now what we need more than ever is the collaborative leadership approach and working together in a distributed way because there is a power in our collective, and how we build the future as one system and ‘one team’.”

We would like to take the opportunity to thank all our panelists for their contributions and our participants for their questions and comments. The questions we received during the webinar are being used to develop our forum topics in the COVID-19 Knowledge Exchange Platform.

Our next webinar will take place in the Asia Pacific time during the week commencing 20th April. If you would like to suggest panelists or topics for future webinars please contact us through Darren Curran or tweet us @IFICinfo using #integratedcare #COVID19.

On behalf of all the team at IFIC, we would like to recognise and congratulate the extraordinary efforts that are being made by individuals across the health and care sectors, the wider public sector, and within communities to provide care and support and continued services to those that are in need. We also sympathise and extend our good wishes to all those families that have been directly impacted by COVID-19.