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Social Distancing in Non-Clinical Hospital Areas During the Covid Crisis and Beyond

May 13, 2020

With so much focus on the NHS during the COVID-19 pandemic, could the need for social distancing help drive efficiency in space use? EventMAP’s Vernon Chapman discusses.

Hospitals, by their very nature, are used to dealing with people suffering with highly contagious and dangerous pathogens. However, the sheer scale of the Covid-19 SAR2 crisis has exposed concerns for the medical practitioners themselves. The focus of much media comment has been on Personal Protective Equipment (PPE) and the isolation of symptomatic patients from those who are asymptomatic. Across the NHS there are a range of spaces and working environments and it is just as essential to ensure that these are not overlooked. The focus, initially, was on ensuring that there has been sufficient capacity to support the growth in hospitalised patients along with protecting front line staff from infection. But what about those same staff when they are working in spaces which are not designed for those isolating with Covid-19?

The Twitter-sphere has been alive with professionals voicing this concern:

‘Our workspace (for around 8 doctors) is 3m x 2m. It also has no windows. If we catch Covid-19 it will be from there, not patients.’

'We do personal care and various other tasks that involve working in very close proximity to other staff. Your (sic) basically face to face at times’

‘My informant tells me, social distancing in hospital is a fiction… Many team members do handovers in a small office space without the use of masks.’

The 2017 Naylor Review on NHS Estates cited that 35% of hospital estate was non-patient floor space. Now this does encompass a wide variety of different space types – yet it also includes office space, training space and meeting rooms.

Many organisations have seen the value of home-working through the pandemic. Some have been forced to consider such practices for roles where they may have previously dismissed such as being impractical. This has been no different across the NHS – managers have been asked to support their staff to work from home wherever possible. This has been the case across many administrative functions, as well as some primary care and out-patient-facing roles. This enforced change has resulted in all areas considering the impact of the ‘new normal’ from a change in patient behaviours to a new, modernised approach to working with new technology. These new working practices will, as a result, impact on the current office spaces and considering whether these are actually necessary. Additionally, for those that are within their current roles travelling between locations within a Trust, this may mean that they have dedicated working space in several locations. Might it be worth considering alternatives?

What opportunities does this focus on the use of offices and non-clinical spaces have a potential to achieve?

Much emphasis has been rightly placed on freeing up the maximum possible inpatient and critical care capacity and freeing up the support needed to respond to these needs. This has certainly been the focus of media attention, and understandably so. EventMAP, as part of their work in hospitals and other NHS settings, see NHS staff work from inadequate facilities. So how can we all ensure that we support NHS staff to stay well at work?

One area that may bring value and result in positive sustainable change is a review of estate assets. The current crisis may provide an opportunity to review the way NHS Trusts manage their estate and adopt changes to the way people work and use these resources ¬– in ways that, before the pandemic, may have seemed impossible. There are cultural barriers that result in departments, even clinical ones, holding on to spaces despite others having a greater need. It is widely accepted that this crisis can act as a catalyst to change, allowing Trusts to understand how they use their space, and thereby ascertaining what the actual demand is. Analysing work practices to understand whether staff may benefit from adopting newer, smarter working initiatives, feeding into a comprehensive review of how Trusts use their non-clinical spaces and then adapt them to modernise with new modes of working.

The endeavour may be to consider how we support staff, and maximise staff availability whilst supporting our staff to stay well, particularly at a time when we are all looking to reduce the risk of infections to the wider workforce and patients. It will, however, then inform how the healthcare system reacts in any future such crisis. To illustrate, it is not uncommon to provide senior consultants with their own office space, yet for much of the day these offices may remain empty.

This and other scenarios could lead to other questions:

  1. Could spaces be modified allowing for them to be easily adapted in times of severe clinical need for alternative use?
  2. Can the occupants of certain spaces be accommodated in other ways, supported by technology and new processes and procedures?
  3. Do all staff currently enjoying their own allocated office really need this for them to perform their roles?
  4. Can some staff and specific roles that were originally seen as requiring ‘dedicated work spaces’ work more remotely, allowing them to utilise shared spaces?

Every crisis tests our systems. They provide us with opportunities to understand what we do well, and where we can improve. Maybe the Covid-19 crisis will provide a further push for the healthcare system to take stock of how all resources are best utilised. It may allow cultural barriers that have built up over many decades to be broken down. Might it afford the NHS the opportunity to reflect on the changing needs of its estate?

Since the year 2000 the world has received a few shocks that had potential to put all of the world’s healthcare systems under immense pressure – such as SARS Cov in 2002/2003, MERS Cov 2012 and Ebola from 2014-2016 and in 2018. All of these had the potential to become major international crises – and now SARS Cov-2 has become a realisation of all of those fears. Although we all hope it is the last such incident for a while, it would be short-sighted to think that we will have more incidents over the coming years. Could the current pandemic provide lessons as to how working practices should adapt to deal with any such event in the future?

EventMAP is currently involved in scenario planning and space modelling exercises with client organisations, most of whom are urgently assessing how to modify workplaces to make them safer in the current environment. Planning and space modelling uses client data, including information on any new constraints, such as different work modalities (homeworking, staggered shift patterns etc.), and constraints on space, such as reduced capacities. The modelling can create various scenario plans, allowing clients to then select and implement optimal space and usage plans without first committing to reductions in desk space and traffic flow systems through workspaces. This is allowing organisations to implement a scientifically tested, workable solution, without a need for trial and error and wasted expenditure.

Vernon Chapman

SENIOR CONSULTANT

Diamond

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