Protection in a Pandemic - Supporting your staff

MedicaInsure
In the face of the coronavirus outbreak, the spotlight falls on the front line staff who are tasked with treating potentially tens of thousands of patients suffering various degrees of respiratory illness.

These staff are not being implored to stay safe in their own homes but must go out to do battle with COVID-19 on a daily basis. Few members of the general public will have given thought to what happens if these staff become ill, or how surgeries, hospitals, clinics, remote consulting offerings, 111, urgent health centres and other out of hours offerings will cope, whether with the unprecedented demand on services, or with the life changing advice offered by the Government on Monday, effectively asking all who can to work from home.

Behind the clinical staff in patient-facing roles there are numerous managerial, administrative, operational, financial and governance staff amongst others who help to keep our health services afloat. This article is intended for all our healthcare clients – dental and medical - and tries to offer some practical tips on managing employee-related issues specific to the issues thrown up by Covid-19 and the associated Government response. Due to the variety of our clients and the enormity of the task at hand this does not purport to be a ‘fix all’. Moreover, given the knowledge and sophistication of our clients, much of this will merely be revision. We hope that at the least it acts as a handy aide memoire.

Plan ahead

Easy to say when caught in an unexpected and fast moving crisis. However, this is crucial. Points include:

  • Consider appointing a COVID-19 ‘Champion’ and setting up a dedicated email address so that all employment concerns relating to the impact of the virus can be easily identified and filtered: staff will require lots of support in this area and the situation is incredibly fluid so expect a significant level of queries.
  • Send out daily updates containing any relevant key points from the daily PM updates so that staff are aware and informed; thereby feeling more in control and less likely to make mistakes.
  • Ideally 24 hour hotlines will be implemented to enable staff to urgently notify if they cannot work their shift, which can then prompt fast investigations into backup staff availability.
  • Operations managers should double check that all the details for clinicians are up to date on the systems and on hand, as more unexpected and last minute or extra shift cover will be required than usual.
  • Likewise, all clinical staff need to be provided – ideally by text / Whatsapp and email and post – with: 1: the contact details they must use when they are unable to come into work due to illness, 2: reiteration of the current strict advice in place that if they are showing any symptoms of a cold and they live alone they must self -isolate for 7 days and must not come to work. If they live in a household with other people and one of those household members develops symptoms, or they themselves develop symptoms, then they must self-isolate for 14 days and likewise must not come to work. 3. Advice that, in either case, the clinicians affected must advise the relevant personnel via the contact details mentioned in 1) above immediately in order that significant efforts can be made to arrange cover.
  • Operations staff should use all their data from past years, focussing in particular on spikes due to extremely cold weather or norovirus or flu outbreaks in their area to try to more accurately identify how many more staff they will require to foot the – even greater –demand. They should also communicate intra organisationally: every individual centre holds a wealth of information. Pooling information will help to minimise errors through sharing past lessons learnt and different methods of tackling staffing shortages. Urgent Health UK are an example of a forum offering support, and we work closely with them. Likewise, we can arrange webinars allowing discussion of  key risk areas if this would assist organisations with planning.
  • Start to draw up flexible staffing and patient assignment models to allocate key personnel to the most pressing patient needs. At all times try to ensure there will be a very experienced clinician available for supervision purposes. It is better to spread out the most experienced individuals across teams rather than try to ‘up skill’ the inexperienced, in whatever arena.
  • Ensure all staff, clinical and non-clinical, receive training NOW on psychological skills to deal with patients' anxiety and panic regarding diagnoses, and, if possible, recruit temporary mental health staff to be on hand to directly help these patients, thus releasing staff to focus on practically treating the disease.
  • Think about security measures – stories are spreading of patients’ families stealing hand gel and being uncooperative. Some families or individuals demanding tests may become violent so ensure there are adequate measures in place; deployment of the military organised by the government will assist in this regard.
  • Develop detailed rules on the use and management of protective equipment to reduce misuse and staff, family of staff and patient worry.

Protecting your employees physically

The physical health of your employees, arguably above all other sectors at the moment, is paramount:

  • Send reminders to all patients that they should not be attending practices for example unless in an emergency. Put physical signs up at the entrance to the premises reiterating this.
  • Where possible call patients on the day before their appointment to check they are still symptom free if they are attending for a physio appointment for example.
  • Keep track of protective equipment availability. We appreciate that there is currently a large shortage but ensure that where you have control over orders and supplies, your figures are correct and that staff know where to collect their equipment such as masks, and how to fit them.
  • Aside from the points suggested in the ‘Planning’ section, reiterate the importance of hand-washing and of disposing of used tissues etc.  Advocate protective face masks where people are working in particularly vulnerable situations.
  • Consider putting up tape so that where patients are collecting prescriptions or attending appointments you ensure that they are standing at an appropriate distance away from your staff. Where practical, see if patients can wait outside or in their cars before being called in (judgement needs to be used here as you do not want an increase in complaints from the public)
  • Where clinically appropriate enforce telephone or video consultation services and investigate the possibility of sending prescriptions in the post.
  • If some of your staff can transfer clinical practice to the home – perhaps acupuncturists or physios – ensure they have adequate insurance in place and remind them that they must call the patient ahead to check they are symptom free and keep the workspace meticulously clean.
  • If someone becomes unwell in the workplace with symptoms of coronavirus, they should:
    • get at least two metres (seven feet) away from other people
    • go to a room or area behind a closed door
    • avoid touching anything
    • cough or sneeze into a tissue and put it in a bin, or if they do not have tissues, cough and sneeze into the crook of their elbow
    • use a separate bathroom from others, if possible.

The unwell person should use their own mobile phone to call either 111 for NHS advice or 999 if they’re seriously ill or injured or their life is at risk. They should tell the operator:

  • their symptoms
  • if they have travelled within the last 14 days, which country they've returned from.

If someone who has coronavirus comes to work, contact the Public Health England health protection team. Anyone who has had coronavirus, self-isolated for two weeks, and then tested negative for the virus is safe to return to work.
 

Protecting your employees emotionally

Irrespective of the fact that your staff are used to dealing with death and illness on a regular basis, they are not immune from the panic and fear which is sweeping the nation as we face remarkable levels of restriction on our activities and doubt over sources of income. Don’t forget that your staff could share a household with someone who is heavily impacted by the closures of entertainment venues or international borders. To exacerbate the situation, usual social sources of relief and relaxation are not available to wind down from the challenges of the day or night shift: even yoga studios are shutting. Poor sleep, anxiety, depression and outbursts of anger and worry as well as feelings of isolation will be commonplace. Therefore, keep in contact and always remember that your duty as an employer does not lessen just because some of your staff are at home.

We suggest:

  • Consider establishing remote, weekly team ‘coffee mornings’ for the –predominantly non-clinical - staff who are working at home.
  • Make use of video conferencing systems such as Zoom for essential meetings so that individuals at home feel less isolated.
  • Managers make an effort to ‘check in’ with staff; this is very different to ‘checking up’ on staff and ensures that employees feel connected and supported. 
  • Lots of tips on home-working are circulating on the internet and in the news including advice on taking breaks, establishing a routine, getting exercise and setting up an effective working space. Send round advice tailored to your staff: Lockton will be happy to assist with this.
  • Remind doctors that we are here if they simply want someone to talk to about the strains of the environment they are working in. The BMA also has a helpline.
  • Learn from the Second Xiangya Hospital of Central South University in Wuhan Province, China in the following  areas:
    • Make psychological counsellors available to all front line staff where possible and especially in hospitals bearing the brunt of the ITU care to listen to concerns;
    • Provide a place for rest where staff can temporarily isolate themselves from their family;
    • Guarantee food and daily living supplies for those working in hospitals, and help staff to video their routines in hospital to share with families and alleviate family members' concerns.
    • Focus on promoting leisure activities and proper training on how to relax to help staff reduce stress.

Closure of practices of clinic

If you are forced to close for a short time then you still need to pay your employees. The only exception is if your employees’ contracts state otherwise or an alternative agreement has been reached.

Sick Pay

The Statutory Sick Pay (SSP) regulations have been amended so that an employee is ‘deemed’ incapacitated, and therefore able to claim SSP from day one if they are following the new official self-isolation guidance. It is good practice to provide contractual sick pay in these situations.

If the is self-isolation is only precautionary then, if practical, we would advise allowing them to work from home so that they can be paid as normal.  

Where employees refuse to come to work then spend some time discussing their concerns and see if they can be resolved. An option could be to offer flexible working but this may not be possible if the employee is a clinician. Another solution would be for the employee takes some of their annual leave entitlement. If those options do not work, the employee needs to be gently reminded that they could face disciplinary action and that SSP will sadly not be available.

As the pandemic spreads, so the advice will change. We will endeavour to update our clients with risk management information and are, as ever, always available to discuss any concerns to support our clients allowing them to focus on delivering their crucial services. 

Please do not hesitate to get in contact using the details below. 

Flora McCabe
Head of Healthcare Claims

t: +442079332516
e: flora.mccabe@uk.lockton.com

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