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Understanding how a healthcare organisation responds to a public health crisis: the Bradford Covid-19 cohort study


Background to study

The growing spread of coronavirus globally represents a huge challenge for health services, and how organisations manage their staff and services at this time will be crucial. Much of what we know about how organisations cope at times of extreme challenge is gathered retrospectively, and very little is known about exactly how different levels within an organisation communicate and support each other to flex and adapt in the face of adversity.

This study will use an emergent theory called resilient healthcare, which views safety as the capacity of a system to adapt and respond to changing demands. In this approach, safety is characterised less by ‘learning from failure’, and more by ‘learning from success’, identifying how services support staff to provide safe care, even when under extreme duress.

This study aims to capture the real-time experience of staff across all levels and settings within Bradford Teaching Hospitals NHS Foundation Trust. As a longitudinal, multi-level study of how a healthcare organisation manages during a public health crisis, it would represent the first of its kind in the world. Most importantly, however, it would provide a rich case study that can be used within Bradford for future planning of such crises, and likely afford a range of generalisable conclusions that would greatly add to our understanding of how to support multi-level health system resilience.

Brief methods

Approximately 10-15 staff members from across the organisation will be asked to digitally record their brief spoken thoughts (up to 5 minutes) at the end of each day or clinical shift, over a period of two months. The frequency of these recordings would be up to the individual staff member, with a minimum of twice per week (unless on leave) and a maximum of once per day across the study period. We will make available a dictaphone for these recordings, or staff can use their mobile phones. We would collect recordings on an ongoing basis throughout the study period, at the convenience of the staff. Staff will be allocated a pseudonym to use at the beginning of each of their recordings to identify themselves.

The framing for these recordings would be the four ‘cornerstones’ of resilient systems, namely:

i) responding: What have you been concerned about today? What have been the biggest challenges you have faced? How did you respond to them? What stopped you or supported you to respond?

ii) monitoring: What issues might you and the service face tomorrow and in the coming days? How will you know if you are doing better or worse on these issues?

iii) anticipating: What are you doing to plan for the problems you might face tomorrow and in the coming days? What is supporting or hindering you in your efforts to plan?

iv) learning: What have you learned, and how do you feel?

Once the study period is complete, these recordings will be transcribed and analysed, with a view to developing a multi-level case study that explores how Bradford flexed and adapted in the face of this public health crisis.

All transcribed recordings will be anonymised, and all data stored confidentially in line with data protection requirements. No individual will be identifiable in any future publications.