{"id":48354,"date":"2020-08-20T18:49:03","date_gmt":"2020-08-20T17:49:03","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=48354"},"modified":"2020-08-25T13:53:11","modified_gmt":"2020-08-25T12:53:11","slug":"fostering-a-sense-of-safety-and-support-in-times-of-uncertainty","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/08\/20\/fostering-a-sense-of-safety-and-support-in-times-of-uncertainty\/","title":{"rendered":"Fostering a sense of safety and support in times of uncertainty"},"content":{"rendered":"<p class=\"standfirst\">Zach Ferraro and Evan Tannenbaum, residents in obstetrics and gynaecology, describe how their hospital has established new workflows that have allowed them to resume practice with something like normality<\/p>\n<p><!--more--><span style=\"font-weight: 400\">In mid-March we began hearing word that the seriousness of covid-19 would warrant near complete social and economic closures. Soon, concerts were cancelled, flights grounded, businesses forced to lock their doors, and international borders blockaded. Clinics and operating rooms were no exception to the altered workflow. Life was changing right before our eyes in a way that our generation of trainees had never seen before. <\/span><\/p>\n<p><span style=\"font-weight: 400\">As hospitals and clinics prepared to combat the virus, and social distancing measures continued, it was uncertain when some semblance of normalcy would return. This uncertainty was compounded with cancelled exams, workforce redeployments, and hospital protocols that seemed to change daily, as new research about the virus emerged. It was a tense time for everyone.<\/span><\/p>\n<p><span style=\"font-weight: 400\">People cope with uncertainty and stress differently; there\u2019s no question about that. From our view, team morale has benefited greatly from &#8220;checking in&#8221; on one another. A simple, \u201cHow are you?\u201d or, \u201cIs everything alright?\u201d really does wonders when asked frequently, acknowledges your concern, and comes from a genuine place. We are so fortunate to be blessed with friends, families, and colleagues who continually remind us that we\u2019re all in this together.<\/span><\/p>\n<p><span style=\"font-weight: 400\">While we are uncertain if these gestures have a direct, measurable impact on patient outcomes, one thing is clear: they work towards fostering a sense of trust and a feeling of relief between patients and physicians\u2014a small reminder that we are not alone.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">As residents in obstetrics and gynaecology (OB\/GYN), our widespread and collective efforts seek to ensure both the safety of healthcare providers and the delivery of competent and compassionate care for mothers and their newborns. The achievement of these goals is dependent on effective communication and teamwork, especially in these trying and uncertain times. <\/span><\/p>\n<p><span style=\"font-weight: 400\">A decision was made to relocate most of our workforce to labour and delivery. Senior residents agreed to take on more call to help reduce the workload of the team should any of our colleagues be forced to take time off due to signs, symptoms, or a diagnosis of covid-19. We received daily departmental updates about both the current census of COVID+ cases and persons under investigation, informing us of their clinical status. Weekly &#8220;code&#8221; simulations on the labour floor continue to help instil confidence, improve workflow efficiencies, and ensure proper donning and doffing of personal protective equipment (PPE). <\/span><\/p>\n<p><span style=\"font-weight: 400\">These skills were again reinforced at the hospital level. A dedicated departmental committee on covid-19 disseminates new information as it becomes available and informs us about changes to care pathway logistics and resource allocation. We all participate in frequent virtual update meetings and weekly <\/span><span style=\"font-weight: 400\">Zoom<\/span><span style=\"font-weight: 400\"> town halls as another way to check in with each other, share a concern, a laugh, and occasionally a lead on a new craft brewery with contactless delivery.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Our resident leaders, site chiefs, clinical staff, and administration have all fought tirelessly to secure necessary PPE and to ensure their proper use. Despite the extra precautions, we are still able to communicate and connect with patients and colleagues in a meaningful way. To us, that has been the most profound change (or lack thereof).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">While the halls and rooms of labour and delivery remain largely unchanged\u2014with the exception of newly required PPE, new signage, and the occasional COVID+ (or &#8220;under investigation&#8221;) patients\u2014the floor still has the same <\/span><i><span style=\"font-weight: 400\">Groundhog Day <\/span><\/i><span style=\"font-weight: 400\">ambiance: will the patient in 6 deliver or are we heading for C-section? In triage (labour assessment), have the patient\u2019s water broken? Which patient should take priority? And, so on. <\/span><\/p>\n<p><span style=\"font-weight: 400\">Does this <\/span><span style=\"font-weight: 400\">routine <\/span><span style=\"font-weight: 400\">mean we are winning the fight against covid-19? Perhaps the absence of significant palpable change is a testament to the emotional and physical sacrifices of those that work to update every single aspect of patient flow and the provision of care in the era of covid-19. Whether it be spending an extra minute with a family to answer their questions related to covid-19 or heading to the OR for an emergency cesarean in full PPE, we are prepared. We are ready. It is starting to feel &#8220;normal.&#8221;\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Witnessing the variety of initiatives underway seeking to inspire change and foster hope is truly a privilege: photo diaries that praise the <\/span><a href=\"https:\/\/twitter.com\/GrayMoonen\/status\/1244634997593640963\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400\">unsung heroes of healthcare<\/span><\/a><span style=\"font-weight: 400\">; the senior colleague who reminds us that it is &#8220;okay&#8221; to <\/span><a href=\"https:\/\/cmajblogs.com\/month-2\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400\">not have all the answers<\/span><\/a><span style=\"font-weight: 400\">; and the establishment of the <\/span><a href=\"https:\/\/www.covidwi.com\/?pgid=k9hlpi29-37b506c6-ce99-457a-9628-9811902f9514\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400\">COVID-19 Women\u2019s Initiative<\/span><\/a><span style=\"font-weight: 400\">, an innovative public health platform that provides real time maps of reproductive health services available to women. For these efforts, and the many, many more, we are here to say, thank you. We thank those who work to make the growing pains associated with our new reality a little bit easier to bear. Because of you, we can continue caring for our patients safely, effectively, and with the same standard of compassion and humility to which we are accustomed.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In the words of Canadian physician Sir William Osler: \u201cthe best preparation for tomorrow is to do today\u2019s work extremely well.\u201d His words resonate now more than ever before as we fight\u2014one day at a time\u2014against covid-19 together. In a high stakes area of medicine where acuity is omnipresent, we think we are doing today\u2019s work extremely well.<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/08\/ZF.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-48356\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/08\/ZF.jpg\" alt=\"\" width=\"133\" height=\"166\" \/><\/a>Zach Ferraro<\/strong><\/span><span style=\"font-weight: 400\"> is a first year OB\/GYN resident at the University of Toronto and former CIHR research fellow in human development and child health. <a href=\"https:\/\/twitter.com\/DrFerraro\" target=\"_blank\" rel=\"noopener noreferrer\">@DrFerraro<\/a>\u00a0<\/span><\/em><\/p>\n<p><span style=\"font-weight: 400\"><strong>Conflicts of Interest:<\/strong> none declared.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><em><strong><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/08\/ET.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-48357\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/08\/ET.jpg\" alt=\"\" width=\"133\" height=\"155\" \/><\/a>Evan Tannenbaum<\/strong><span style=\"font-weight: 400\">\u00a0is a fifth year OB\/GYN resident at the University of Toronto. <a href=\"https:\/\/twitter.com\/TannenbaumEvan\" target=\"_blank\" rel=\"noopener noreferrer\">@TannenbaumEvan<\/a><\/span><\/em><\/p>\n<p><span style=\"font-weight: 400\"><strong>Conflicts of Interest:<\/strong> none declared.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Zach Ferraro and Evan Tannenbaum, residents in obstetrics and gynaecology, describe how their hospital has established new workflows that have allowed them to resume practice with something like normality [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/08\/20\/fostering-a-sense-of-safety-and-support-in-times-of-uncertainty\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":48375,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263],"tags":[],"class_list":["post-48354","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-global-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - 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