Ben Chan is an emergency room doctor and assistant professor of global health at the University of Toronto. He was the inaugural chief executive officer of the Health Quality Councils of Saskatchewan and Ontario, and consults widely to the World Bank and foreign governments.
COVID-19 headlines are surely causing Canadians great anxiety. We are inundated with stories of rapid growth of new cases, looming shortages of ventilators and masks, infected health-care workers and inadequate social distancing.
During my first emergency department shift since the outbreak, I added to this dynamic by expressing alarm on social media at the lack of COVID-19 testing. Patients returning from abroad with breathing problems were not being tested. Our official numbers of cases were undercounted. Contacts of untested patients were not traced. Many other doctors also spoke out. Issues rose to the forefront. Leaders at all levels are now scrambling to respond.
Some may read this information and question our level of preparedness, the wisdom of our leaders and the capability of our health-care system.
But when we hear health-care workers raising concerns forcefully, we must not lose confidence in our institutions and our leadership. Transparency about these issues is a sign of our strength. Remember that COVID-19 spread in China after a doctor was punished for speaking out. Indeed, there are many strengths in our current system that are becoming more apparent, and that we can build upon.
Let’s view this crisis through the lens of a concept in quality management theory called resilience: the intrinsic ability of a system to adjust its functioning to keep operating, even after a major mishap. Our health-care system can be hit at any moment with natural disasters, terrorist attacks or pandemics. We can, and do, prepare, but we cannot predict every dire consequence.
According to the theory, resilient health-care systems must be nimble. Workers are trained to scour the landscape for problems. Management provides rapid responses. Teams anticipate worst-case scenarios. The official leaders – chief executive officers and politicians – suspend traditional hierarchy and designate the most qualified technical person to deal with each problem. Roles can be rearranged if needed. Mistakes occur but are corrected and not repeated.
What I’ve seen in the past week, returning to the front lines from my university office, has been remarkable. Doctors have quickly coalesced into chat groups to share concerns. Managers issue daily communiqués. Simple requests, such as fixing confusing wording on guidelines, are addressed within a day.
Rural hospitals are preparing to handle intensive care situations. Politicians defer to public health experts as appropriate. Clinical leaders are finding creative solutions, such as securing equipment from research labs, and repurposing chlamydia swabs for use in testing for the novel coronavirus, which causes COVID-19. I have not witnessed this level of co-operation and adaptability in my 30 years as a doctor.
To be clear, I am deeply fearful of what will hit us in two weeks’ time. To survive, we must not only analyze our missteps, but also reflect on what we’re doing well and how to do more of it.
Double-down on these principles of resilience: anticipate, monitor, learn, respond. Never hide urgent concerns. Stop turf wars between professions. Consider previously unthinkable solutions. After this pandemic is over, continue our progress in building good communication, responsiveness and ingenuity.
Canada: We have a crisis. We will speak out about problems, fix them and learn. And we are resilient.
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