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In May 2020 South Africa started to deal with the upsurge in Covid19 cases and healthcare facilities began facing the enormity of the task ahead. On the suggestion of Dr Rob Campbell, CEO of Nurture Health, the Lean Institute Africa coordinated a Lean Healthcare Crowdsourcing group.

The group was designed to pool knowledge and share countermeasures for problems being faced by managers in the healthcare sector. It was a supportive environment for learning during a time when many hospital managers and leaders were overwhelmed by “unchartered waters”. Dr Campbell introduced the concept of the group following a webinar about beginning to ‘map’ such waters, and you can watch the recording of this here.

The group met every two weeks from 12h30 to 13h30, during the height of the Covid19 epidemic in South Africa. The conversations tackled issues faced by the various facilities.

Those discussed included PPE challenges, mitigating staff risks inside and outside of facilities, managing Covid admissions and reflecting on lessons from our Covid responses.

Tshepo Thobejane, Lean Institute Africa Lean Facilitator, recently spoke with Len Deacon, Group CEO of SA Homecare who was a regular member of the crowdsourcing group. Tshepo and Len discussed how the Lean Healthcare Crowdsourcing group supported the participating organisations, and specifically SA Homecare, during the Covid19 epidemic.

Before the Lean Healthcare Crowdsourcing group began meeting, Len had previously heard of lean and had a top-line understanding of it. He knew that theoretically it could be applied in healthcare, but hadn’t been exposed to the reality of it. He said that it was through the group that he came to see lean showcased in healthcare, and the CEO of Nurture Health, Dr Rob Campbell, who was an integral member of the group, “clearly articulated a lot of the value that Lean can have in Healthcare facilities in particular.”

Len shared how the group opened up the lean healthcare possibilities to him and his business: “If you asked me before the crowdsourcing lean interaction, I would have had a conception that lean could be applied to healthcare, but I wouldn’t have had a tangible way of actually feeling it. If I look at it now, after this group, I’ve actually seen ways that lean can be applied and some practical examples of how to do that. Prior to this group, it would have been a head thing, after being in the group, it’s a practical thing…and I’ve actually implemented some of it in my own business…[and the shared] learnings were impactful for the business”

Tshepo: What was the most valuable lesson/learning from participating in the Healthcare Crowdsourcing group?

Len: “There were two.

  1. One can develop mitigating factors and actions to deal with the fear of being helpless and the fear of Covid, not knowing what it was.
  2. The ability to create structures to deal operationally with Covid, and the Covid consequences in the environment in which we were operating.

“It was about creating coping skills while dealing with the unknown…and in some practical ways. There was the PPE thing that Rob Campbell looked at and he developed a process in terms of levels of PPE required for different clients. I was able to adapt that to my environment. We were treating patients who were not Covid, and they were frail, and at that stage we were not treating Covid patients, but it was through this process that we got to a position where we were able to understand that we could treat Covid patients at home, provided we had the necessary PPE protection for our staff and for our patients. That was quite a big ‘Aha’ moment for us.”

Another learning for Len and his team was the power in making things visible:

“We created a one page standard operating procedure – and everybody knew exactly what they needed to wear, what they needed to have, depending on the level of patient they were treating. That was very helpful, including for people who might not be completely literate.

“We created different zones. We used videos for ‘donning and doffing PPE’ – words with which I was then not particular familiar!  It was Rob Campbell who helped us source the videos made for the NHS. Every single member of our structure watched those videos to make sure that everybody understood how to put on their PPE, and how to take off their PPE. So ‘donning and doffing’ became actions everyone could do, not just words.

“This created a safe standard for the employees to protect themselves and their patients from Covid.”

Tshepo: What impact and benefit did your organisation derive from participating in the Healthcare Crowdsourcing group?

Len: “We created structures and forums where staff could interact. I had a separate weekly check-in with each of my leadership teams. We also had a weekly ‘leadership group’ check-in, and regional meetings. We thus developed forums where people could talk about issues and raise them with no fear of repercussions; it was clear we were all learning, and none of us knew the answers. We were all learning at the same time. People started supporting each other, at a time when people were unsure of what to expect and what to do.

“I remember at one stage a lot of our staff were fearful of treating Covid patients. Eventually we actually communicated with each one of our staff individually and gave them the choice to either treat or not to treat Covid patients. And we had an overwhelming majority that felt safe to treat Covid patients with the protection and communication established. It was a voluntary thing. We did not force anybody to treat a Covid patient.”

Tshepo: What questions/challenges do you believe can be better managed and answered through a Healthcare Crowdsourcing group?

Len: “One of the things I found most valuable was just checking in and hearing how other people were dealing with their challenges, and having the opportunity to say ‘I have this challenge, how would you deal with it?’ Being able to bounce questions was very valuable. If you look at Covid, my own view is we are going to have a second wave. We should continue to support one another through this time.

“Furthermore, we haven’t dealt with the mental health situation with our people – distancing, and not being able to interact physically with people has an implication. Even now, we can go out and meet with people, but there is still a reservedness in terms of affection. That’s going to have an impact on mental health. South Africans want to connect. Not being able to is going to have an impact. Death is another thing. We haven’t yet seen the impact of dealing with death.

“And the fatigue. At one stage, I had four or five zoom meetings a day, but eventually it gets tiring. It’s not the same as when you’re sitting in a normal meeting.”

Tshepo: “Looking at the SA Healthcare system as a whole, what are some of the issues that a crowdsourcing forum could help with?”

Len: “There is a lot of potential for this kind of forum in the public sector. In terms of flattening the structure – in all the businesses that were represented, it was clear that we all flattened our communication structures, our levels structures, it was almost a direct communication between senior leadership and the people on the ground. And in a very open environment. I think in the public sector this could have a major positive impact where you get workers, managers, senior managers and executives reducing and flattening the levels in the organisation and having honest communication to deal with the issues. Many of the solutions we looked at came from people on the ground, not from the leadership.

“In our own business the flat structures allowed us to hear and respond to things of crucial concern to our front line staff. For instance, where our staff were visiting patients in their own homes there was a need for an area where our staff could safely and discretely don and doff PPE. This was done by creating so-called red zones, demarcated areas, in the patients’ homes. Entering from outside, our staff member could then give safe care to both the patient and themselves.

“Rob used so-called ‘town hall meetings,’ where people from all levels of the organisation came together to communicate and brainstorm. If we could have this in public facilities it could have a major impact on processes, on efficiencies and health outcomes at the end of the day. That is, after all, why we are here.”