Tackling the First COVID-19 Wave at the Cape Town Hospital of Hope: Why Was It Such a Positive Experience for Staff?
1. Introduction and Background
2.1. Study Design
2.2. Study Setting
2.3. Study Population
2.4. Qualitative and Quantitative Data Were Derived from Four Sources of Existing Records, Which Were Reviewed to Answer the Research Question
- A voluntary and anonymous exit survey was administered to all staff on leaving the facility as it was decommissioned, including quantitative and qualitative responses. The staff exit survey was developed by the researchers and made available online and all staff members were encouraged to complete it (Appendix A).
- Electronic records were used for care coordination and transfers between the acute hospitals and the HoH to describe the overall progression of the wave.
- Minutes of all management meetings held during the operational phase of the HoH, including a close-out meeting held at the end of the 10-week period during which managers and clinicians from the acute hospitals gave feedback to the HoH operational management team.
- The COVID-19 infection rates from occupational health records of all staff.
2.5. Ethical Considerations
3.1. Inputs: Design and Set-Up
“To be honest the first impression I had was this is not a do-able task and when you are faced with an undoable task you turn to people that have done undo-able tasks for you previously.”(Senior manager)
“I must say clearly that the reason we could do that was because we trusted that the system would have our back if something went wrong.”(Senior manager)
“I think when senior people put up their hands it kind of makes it easier to attract a team around them.”(Manager)
“We were all facing new thing nobody have experience in COVID, from professional nurse to nursing assistant, we were all the same. What a wonderful moment”(Senior nurse)
3.2. Process (Implementation)
“Having a largely ‘emergency medicine’ background, one often neglects holistic care and focus on a problem-orientated approach to clinical medicine. Working at the CTICC has been an interesting experience in this regard as on more than one occasion, we have seen significant focus on non-clinical components to health care which has invariably and often somewhat surprisingly led to some incredible recoveries.”(Senior clinician)
“I didn’t expect such a primary care family medicine leading orientation, but I think it is working incredibly well, there is no criticism at all but the way the care was managed and the family medicine approach I think is very different to the internal medicine approach.”(Senior clinician)
3.2.2. Unity of Purpose
“When it comes to saving lives and helping people… people will go that extra mile regardless of who they are or where they come from…”(Senior clinician)
“People from all the different angles… [those with] clinical experience, [those at a] managerial level, people that have got only administrative backgrounds, people with certain expertise… just going beyond what fits in their original scope…”(Manager)
“Leaving home coming to work made me feel like a hero knowing I’m coming to assist in this difficult time that the country is facing. Helping a patient whenever I was doing my rounds in the wards came easy to me it really woke up the spirit of Ubuntu.”(Clinician)
3.2.3. Teamwork and Communication
3.2.4. Staff Safety and Support
3.2.5. Responsiveness and Flexibility
3.3. Outcomes: Achieving the Overall HoH Aim
“So reflecting on that, I think we really hit the target bullseye when we were able to deliver on those patient experiences and giving a good patient experience and I think some of the best comments that came through is where people started talking about hope and just their interaction with the staff and being able to be accommodated in that space and where it was really in the peak of the pandemic.”(Manager)
3.3.1. High Job Satisfaction
“Despite all the stresses and challenges relating to the COVID response… During this COVID time, I’ve been more creative and productive than I was before then... there are aspects in my job that I… forgot about that I’m rediscovering and enjoying a lot,”(Manager)
“I was expecting to see some of us contracting the virus, but the government saw to it that we are protected.”(Nurse)
“I thought I would be affected too but because of the proper PPE I have no fear and I thank you for that,”(Clinician)
3.3.2. Professional Development
3.3.3. Personal Development
“I’ve learned a lot, I know things I’ve never known before, met the most wonderful people and I’ve never known what I want for myself but now I know what I want.”
“It was so much more than what I was expecting. In learning about the pandemic and growing as a person, finding my strengths.”
“There was a sense of hopelessness descending on the system and when the CTICC started accepting patients that sense of hopelessness or that dark cloud was certainly lifted”.
“They experienced it as a time of hope and not a time of despair and I think that was remarkable. Looking back and knowing that we could have contributed in that way to someone’s experience in that time of fear and anxiety and uncertainty, I think was remarkable and that is something personally that one can really reflect on.”(Senior manager)
3.3.5. Implications for the Routine Delivery of Healthcare
“Whatever we were doing, we were going to make mistakes… I was going to make mistakes and it was okay, but if I see it as a learning curve it’s going to take away that negative thinking of making a mistake and being hard on myself, but rather trying to see it as it is a learning curve: I must learn from it and then move forward.”(Manager)
“… if we can focus that attention just as we did with this pandemic on something like preventative medicine and health promotion, if some of that effort and focus goes into something like this, then I think we will really see an overhaul of our health system. So, the first thing is to be able to clearly identify what are really the health demands and then secondly, being able to respond to that focusing resources, focusing attention, putting people together to really make a difference in those spaces.”
“So, to almost get rid of all the clutter. I think the clutter is taking up so much time and really distracting us from what is important, and we have really seen now that what is important is where the health system and the communities meet and what is important in the community in the health sector or from a health perspective must also be what is important for us as a health department and we got this right during this pandemic.”(Manager)
- Even outside of pandemic situations, health institutions should move away from the siloed approach of operating independently to a modus operandi of “supporting the greater platform” and adapting rapidly to the changing needs of the healthcare system as a whole;
- Clinical managers should be allowed a greater level of freedom, flexibility and adaptability in how they run their institutions to alleviate the slower decision-making process and bureaucracy present in the current hierarchical structure of government health departments;
- The fundamental motivations of applicants during recruitment processes should be probed to ascertain their level of commitment;
- A working environment should be created that supports camaraderie among healthcare workers, as well as relationships between healthcare workers and patients;
- A person-centered approach to healthcare should be adopted throughout the health system, from primary healthcare centers and local clinics up to tertiary-level institutions.
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
|COVID-19||Coronavirus disease 2019|
|CTICC||Cape Town International Convention Centre|
|HoH||Hospital of Hope|
|MERS||Middle East respiratory syndrome|
|PPE||Protective Personnel Equipment|
|PALPRAC||Association of Palliative Care Practitioners of South Africa|
|SARS||Severe acute respiratory syndrome|
|WHO||World Health Organization|
- Introduction: Please can you tell me the story of your involvement in the HoH
- Why did you decide to join the HoH staff?
- How would you describe your experience overall? And how did your staff experience it?
- In what ways did the experience of working at the HoH differ from your expectations?
- What were the best things about working there?
- What was the most significant thing that you learnt?
- What were the worst aspects of the work? [What would you not want to repeat?]
- Why do you think your/your staff’s experience at the HoH was ? [as it was—use participant’s language]
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|Non-healthcare workers *||93||95||98|
|HoH staffing category||Clinical operational manager (nursing, allied health)||5|
|Facility management (operational phase)||3|
|Facility management (commissioning phase)||3|
|External Metro Health Services management||1|
|Variable||CTICC HoH||Comparable Hospital (Source: Western Cape Department of Health)|
|Total number of staff on 31 July 2020||673||795|
|Total staff COVID-19 positive between 8 June and 14 August 2020||16||64|
|Health professionals who tested COVID-19 positive||16||41|
|Non-professional staff who tested COVID-19 positive||0||23|
|Total staff positivity rate||2.4%||8.1%|
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Reid, S.; Nana, M.; Abrahams, T.; Hussey, N.; Okun-Netter, R.; Ras, T.; von Pressentin, K. Tackling the First COVID-19 Wave at the Cape Town Hospital of Hope: Why Was It Such a Positive Experience for Staff? Healthcare 2023, 11, 981. https://doi.org/10.3390/healthcare11070981
Reid S, Nana M, Abrahams T, Hussey N, Okun-Netter R, Ras T, von Pressentin K. Tackling the First COVID-19 Wave at the Cape Town Hospital of Hope: Why Was It Such a Positive Experience for Staff? Healthcare. 2023; 11(7):981. https://doi.org/10.3390/healthcare11070981Chicago/Turabian Style
Reid, Steve, Mitan Nana, Theo Abrahams, Nadia Hussey, Ronit Okun-Netter, Tasleem Ras, and Klaus von Pressentin. 2023. "Tackling the First COVID-19 Wave at the Cape Town Hospital of Hope: Why Was It Such a Positive Experience for Staff?" Healthcare 11, no. 7: 981. https://doi.org/10.3390/healthcare11070981