When I qualified in August 2019 as a new consultant, I was confident that my training had put me in good stead to lead a team in acute medicine. Of course, there was no way to know that the expectation would be to lead far beyond my medical experience. To meet the demands of the COVID-19 pandemic, doctors from non-medical specialties were re-deployed at a day’s notice to work in A&E and acute medical departments, doing long shifts on a rota with no end-date. Even before my first COVID night shift started, I felt a mix of excitement and nerves. Excitement for the new challenge that awaited, but nervous about coronavirus and leading a completely new team with very different skillsets to my usual acute medical team. Some of these doctors had chosen careers in non-medical specialties or even non-medical careers, but all answered the same call to duty because of the pandemic. While there was a common sense of purpose in the team, working long hours in an unfamiliar environment (for some) and an unfamiliar disease for us all, was a stressful experience.
To prepare for the expected influx of COVID-19 patients, the hospital rota for junior doctors and consultants was revamped in a matter of days. In total, 58 consultants and 180 junior doctors formed five teams to provide 24-hour care on site. Doctors from all hospital departments, academia, doctors returning to work, frontline specialties and medical students worked together to cope with the COVID-19 surge. Additional to the stress of the uncertainty surrounding we were facing, the lack of food during night shifts and insufficient rest areas for the increased number of doctors made the COVID pandemic response more arduous.
As a new consultant in a trust with internationally renowned senior colleagues and set ways of doing things, I knew that instead of buckling under pressure I should instead rise up and acknowledge what I could control and improve for not only myself but my colleagues. I felt energised to improve wellbeing. I love food. It brings people together. I arranged for hot food delivery for the nightshift and repurposed an area that could be used as a rest facility. A senior colleague engaged a group of private donors to set up a fund for hot food for doctors in the hospital. Once the expectation was set and the resources created, it was a different kind of stress organising food for over 250 doctors daily in a time when most restaurants were closed! I reached out to various restaurants I knew in the area to consider re-opening for food delivery, which was still allowed. On one of the first days, a restaurant called to cancel last minute due to lack of staff – I went with a colleague to the Indian takeaway across the road and we helped the kitchen staff to pack the food they were preparing to take back to the hospital. At one point, I was learning to wrap a kebab roll in under ten seconds!
The value of rest between and during night shifts is well understood1,2. The existing system meant that doctors in both looking after COVID-19 positive patients and non-COVID-19 patients were sharing food areas, and no resting areas were provided. After discussions with the task force and the medical school, we co-opted medical school areas for separation of green and blue teams during breaks, provision of beds, changing rooms, shower areas and lockers. Being able to lie down in bed is important for brain functioning during night shift rest periods. We set up fifteen beds in tutorial rooms.
The provision of food and rest areas, two simple interventions, yielded one of the most dramatic morale boosting effects I have seen during my career. The hub became a place for doctors and medical students alike to sit together in a protected but informal setting to exchange ideas and discuss learning. Twice weekly I handed out tokens of appreciation, such as hand creams and chocolates, that were donated to the doctors. I asked the medical teams to give these to their nursing, portering and domestic colleagues. This helped the junior doctors to be leaders within their wards and improved team bonding.
I set up regular surveys to understand if staff satisfaction in different areas was improving. We incentivised survey responses by offering shopping vouchers donated from popular high street brands. We measured staff satisfaction with different aspects of welfare, as well as with other COVID-19 related measures in the hospital. As we were able to get real-time feedback, we were able to quickly address these concerns and repeat the surveys.
I volunteered to lead twice daily handover between day and night shifts. I saw it as an opportunity for workforce reallocation to ensure that all clinical areas were adequately staffed. This was of particular importance as 10-15% of staff were self-isolating or on sick leave at any point in the crisis. Handover also created an opportunity to make essential announcements as we moved towards a single, once-off-clerking system, as well as disseminate change in policy to keep in line with national or local guidelines. We were also able to troubleshoot any issues that arose and solve problems together.
These experiences have made me view my role as a consultant differently. A year ago, my focus was to complete my clinical training and improve my medical knowledge and clinical skills to deliver the best care possible for my patients. However, I now realise that being a consultant in the NHS gives me the opportunity and support to make a bigger difference – not just for my patients but also my colleagues as a compassionate leader. While clinical leadership is strongly encouraged, opportunities to grow in this domain are not in abundance. I feel I can develop my role further post-COVID to ensure that the wellbeing and morale of doctors is given the right attention.
References
1. McKenna H, Wilkes M. Optimising sleep for night shifts. BMJ 2018; 360. DOI:10.1136/bmj.j5637.
2. Horrocks N, Pounder R. Working the night shift: Preparation, survival and recovery – A guide for junior doctors. Clin. Med. J. R. Coll. Physicians London. 2006; 6: 61–7.
Dr Amir Jehangir
Dr Amir Jehangir is Consultant in Acute and General Medicine at The Royal Free Hospital London. He has specialist interests in venous thromboembolism and anticoagulation.
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.