After a year of living with COVID-19, I would like to reflect on the way we have responded to the pandemic and how it has impacted on the quality of care. While it may be easy to look back and find fault in how we responded, there are many positives and lessons that can be taken forward.
We must look at what has worked well as there are many bright spots. We can build on the positives for the delivery of safe quality services to people worldwide. I will highlight seven key quality challenges that face us in the future.
- The value of knowledge sharing
We learned of the need to change the way we gather and share knowledge. The rapid growth of knowledge has meant that the traditional ways we assess, publish, and share new knowledge must be changed. Traditionally knowledge is published behind paywalls and cannot be accessed, especially by those who need it. Fortunately, papers on COVID-19 have been free to view by most publishers. We now need to ask why this is not going to be the case for all knowledge, including knowledge about all the other health challenges that most of the world’s population who do not have COVID-19 face.
The World Health Organization (WHO) will also launch the COVID-19: Health Services Learning Hub (HLH) in the coming months. The HLH is a platform that will use innovative approaches to collate, document and synthesise emerging areas of learning on the maintenance of essential health services to support countries during the COVID-19 pandemic and beyond including the recovery and post-pandemic phase.
- The importance of the impact of social determinants
COVID-19 had an important role in exposing the social determinants of health to be a major factor in how people were affected. While this has been known and well-documented, people seemed surprised that the pandemic has targeted the poor and disposed, and the response with vaccines is likely to re-emphasise that social determinants are a key factor in determining safe and quality care. The acknowledgement of the social determinants will allow us to promote the cause of equity and justice in healthcare delivery, an often-neglected domain of quality.
- Preparedness is not for once in a generation pandemic and is a quality issue
A key lesson has been that we need to embrace the concept of preparedness and healthcare systems need to be able to learn and refine how the response to a health crisis needs to take place. Countries with a history of past pandemics responded better and this is not necessarily a resource issue. ISQua recognised the need to understand how to respond to a crisis and has a series of learning modules aimed at improving the knowledge base around preparedness and being prepared is not only to respond to the pandemic but also to maintain health services for the population.
- Mental health is as important as physical health
The prolonged pandemic has focused on preventing infection, but the interventions have had an impact on the mental health of the population. On reflection, the pandemic exposed an underlying issue in how we design our services and respond to crises. We now need to design quality responses to the mental wellbeing of populations. This means that our priorities must change, and a holistic approach must be taken.
- Health care is more than COVID-19 care – integration is essential
In upper-income countries, the silo working of health and social care was exposed and this is probably true in all other countries as well. It demonstrated that it is not only resources that count but the way we design healthcare systems into silos that have no communication or integration. COVID-19 demonstrated the need for integrated care and a total redesign of how care is to be delivered. It needs to be around the individual and family, co-produced and designed in a new way and not in the way we have done in the past.
- We need to rethink how we care for older adults
One of the successes of healthcare has been the increasing life expectancy of the population. However, healthcare has not responded with integrated care to manage people with chronic conditions and social care that provides safe havens for the older population. In many countries, the use of care homes for the elderly provided the perfect place for the infection to have a severe impact. As we look forward to the next phase, we must consider how to change our current approach to care.
- Healthcare workers need protection for their wellbeing
The WHO recognised the importance of healthcare safety, and this is not a new issue. We have ignored the mental wellbeing as well as physical wellbeing of the health care worker. A key positive is that we have learnt that we can make a difference and that the psychological safety of our workers is a priority. Many lessons of good practice are there to ensure we can build on this quality. The future must look at successes to learn and spread good practice.
To conclude, while the year has been challenging, the positives are that the priorities have been defined. As we look at the future there is an opportunity to stand back and to design a new way of working, not around disease but around health.
If we learn from each of the seven lessons, we can build a better future for the health of all.
Dr Peter Lachman,