Setting up a new service in a COVID crisis; a challenging task at the outset of new

Imagine you are offered your very first consultant post in a new healthcare system of a new country. Imagine you start this job during unprecedented times at the start of the COVID-19 pandemic. Imagine you move to this new country alone, get locked down and placed in isolation for the first two weeks after arrival. Imagine during the first week you are asked if you want to take the lead for setting up the unit to combat the COVID-19 surge. How does it feel? The first familiar thing that comes to mind for a cardiothoracic surgeon is “palpitations”.

The COVID-19 pandemic and the immense demands it has placed on the healthcare system represents an unprecedented challenge to any country. I was newly appointed as a consultant cardiothoracic and transplant surgeon in Dublin in March 2020. Having never worked or lived in Ireland before, and starting in mid-March at the peak of the coronavirus lockdown, this was such an extraordinary move. Not only this, but I had to face being separated from my family as they remained in the UK. The travel ban abolished my original plan of weekend travel home and I ended up on my own for months. I was placed at the Mater hospital, which was designated as the main facility to care for COVID patients. This affected routine working, squeezing elective operating to the minimum. As part of surge planning, the cardiothoracic HDU was upgraded to an ICU to ensure that the hospital remained a sustainable facility to care for COVID-19 patients. In the very first week, I was asked to take the lead for this task. I had not yet seen the entire department, nor had I met my colleagues, so this was a big ask. With mixed feelings of excitement to lead this project whilst feeling a natural apprehension of being new in the environment, I happily said “yes”. My colleagues at The Mater are friendly and supportive, particularly Karen Redmond and Lars Nolke who were exceptionally good and guided me throughout. The day I said yes and had my first meeting with the ICU director, I was informed the same afternoon that I would need to be in isolation due to recent travel from the UK. My colleagues remained happy for me to continue leading the project whilst being off-site.

Leadership and management: There were several aspects requiring particular attention, including caring for the carers during COVID-19, looking after colleagues during the crisis, compassionate leadership, effective team working and supporting the ground staff to deliver high-quality care.

Structural modifications: It was not an easy task and involved a variety of actions that to structurally reconfigure the HDU to become an ICU along with the required equipment. The open bays (bed spaces) would need to be converted into isolation rooms by installing floor to ceiling glass fittings, a negative pressure ventilation system, monitors and new doors with a good seal.

Equipment and disposables: Inventory was created with the help of anaesthetic, nursing and pharmacy teams including ventilators, monitors, infusion pumps, medications and stocks of PPE. The management team was also eager and supportive, facilitating an easy purchasing process.

Staff up skilling: Another important element to consider was the up skilling of medical and nursing staff. This was a challenge and required particular attention. I have to praise all staff who were willing to take this challenge on board. As the cardiothoracic work was limited to urgent care, our junior doctors showed enthusiasm to have training to be able to run the new ICU under the supervision of the anaesthetic team. Similarly, nursing staff were also upskilled. With the help of the senior anaesthetic team, we ran a number of training sessions including virtual and face-to-face sessions, in addition to mock scenarios, particularly to address the monitoring of ventilators and cardiovascular support systems. The world had minimal knowledge of managing this deadly disease, but staff were ready to be in PPE for long exhausting hours.

The project was completed according to the plan and fortunately the hospital’s existing ICU and COVID beds sufficed. So, this new facility gave us the opportunity to do some semi-elective cardiothoracic work and even to reopen the cardiopulmonary transplant programme, making this development still worthwhile.

I learnt quite a lot from this project. Surgeons are de facto team leaders, yet surgical training focuses predominantly on technical skills. The importance of effective team leadership for achieving surgical excellence is widely accepted though behaviours that achieve this goal are less understood. Leadership is not just an inborn quality but a process and skill that can be learnt through desire. Recently, SCTS has run a leadership course but as NTN trainees you can also register yourself for modules like “Individual as a leader” and “preparing for leadership” through the deanery at your regional university. When it comes to consultant interviews, this makes an important contribution to the outcome. The junior doctors are the key to the future running of NHS services. One way to inspire these doctors, and thus to safeguard the future of the NHS, is via leadership management. This is not only essential for the future of the NHS, but may also be key to patient safety. n