3 July 2020
Different. In 2014 I was mainly working with WHO’s infection prevention and control (IPC) and quality teams and with colleagues in WHO’s office in Sierra Leone, the Ministry of Health and Family Welfare and CDC. At the time, Sierra Leone, like many countries, had limited approaches to IPC and no program at any level of their health system. We worked together, under the leadership of the ministry, to identify and better understand the gaps. Following this, a national, sustainable and multifaceted program was implemented. Strong leadership from the ministry and a visionary champion in the form of the Chief Nurse influence me to this day. In the last few years, I have transferred my expertise and experience to other related fields, to strengthen collaborations and tie up what are often vertical agendas. So in 2020 I find myself supporting WHO’s Water Sanitation and Hygiene (WASH) team, with a focus on WASH in health care facilities. This is of course very relevant to todays situation and the prevention of many diseases and has dignity at its core. I still work with the WHO Quality Team and have been recently working on a project to skill-up those who clean health care facilities, often a very neglected part of the health workforce. So, it’s different and certainly country missions are much more curtailed, but if I think back to the work we did in Sierra Leone, which essentially was about working collaboratively to ensure guidelines are implemented, then some parallels are plain to see.
Because human factors is all about how we work, and all the things that influence that, including teamwork, leadership, the pressure people work under, the environment and equipment, to name but a few, it’s hugely relevant to COVID-19. If I can give one small but important example, there has been a lot of talk about hand hygiene by politicians, health leaders and even celebrities. A supportive environment in which health workers practice, including ease of access to the resources for hand hygiene, is necessary but this alone is not sufficient to influence behavior. Neither are messages saying ‘wash your hands often’ by leaders. The process of care, the actual flow of work is complex and influences behaviour, as does training, feedback, culture and knowledgeable leaders. In one respect, human factors thinking is about understanding how and why health workers do the right thing at the right time. This should be at the heart of health policy, guidance and implementation if we’re to be safe from COVID-19. I think partnerships could help to build interesting stories around where things have gone right in this pandemic, so we can better understand why and learn from this.
Yes, and I would like some of the learning to not just be about technical aspects, like use of PPE, but to centre on the impact that some of these preventative measures have had on the mental health and well being of people receiving health care. I’m thinking particularly about physical distancing and visitor restrictions to health and social care. We know that the pandemic has led to problems accessing essential health services in many countries and this has affected older people in particular. And even in caring settings, a recent UN Policy Brief talks about older people being harmed through neglect or mistreatment as a result of health system responses to COVID-19. These are patient safety issues and we need to look carefully at how we can stop this harm, including the psychological harm that visitor restrictions brought.
These human rights and ethical issues are being talked about at the highest level of global health and I welcome this. I would like to see more of a transparent, joined up focus on ethics and rights when we devise preventative policies and I would also like to see policies implemented in a proportionate way, with IPC professionals making sure there is a balance between protecting populations and the mental wellbeing of people with infectious diseases.
Anyone working in global health knows that right now COVID-19 seems to have changed just about everything. Politicians are acutely interested in the spread of infectious disease and their prevention and control. People in all countries are afraid, not just of the virus and of dying, but of things like poverty given the wider global situation. As we move forward, we need to not blink. Preventing and controlling the spread of infection is important to stop people being harmed whether we have a pandemic or not. I recall some of my early work as an IPC manager in Oxford with Dr Dick Mayon-White and many older and wiser colleagues, and I remember their warnings that a pandemic was just around the corner. Their message was how we should be prepared but also be confident leaders and be ready to remind and reassure colleagues and the public that the principles of safe practice, when applied, will protect populations from infectious threats, whatever they might be. Twenty years later, it’s important not to lose sight of this. So while everything seems to have changed, the principles of preventing and controlling infection are the same.
If I had to choose one episode it would probably be when I found myself leading on the evaluation of what was called WHO’s First Global Patient Safety Challenge in the Americas. This involved me, representing WHO HQ, building relationships with colleagues in PAHO (WHO’s American Office), the WHO Country Office in Costa Rica, and the leaders and staff of the national children’s hospital. It was a collaboration that inspired me and helped me see first-hand how it’s possible to work across all levels of the health system to improve health care quality. It also demonstrated the power of leadership and culture on safety.
Julie is a global health consultant, co-founder and director at S3 Global. She is also an Honorary Advisor for THET and has been helping to shape our COVID-19 response.
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