Cape’s Hospital of Hope a case study of teamwork in the face of adversity

Many healthcare workers who were on the frontline of the pandemic associate the first wave of Covid-19 with anxiety, exhaustion and burnout.

But those who worked in the country’s largest Covid-19 field hospital at Cape Town International Convention Centre (CTICC) had a different experience. According to a study by the University of Cape Town (UCT) and the Western Cape health department, positive experiences such as teamwork and high level of staff support and flexibility in dealing with the ever-changing pandemic had resulted in job satisfaction and camaraderie among healthcare workers.

While the staff at that hospital, known as Hospital of Hope, initially held a great deal of fear due to the many unknowns of the evolving pandemic and the risk it posed to their lives, researchers found this gradually dissipated and was replaced by the unity of purpose, “to contribute to humanity and the country and do the right thing during a time of great need”.

Researchers said more than 80% of staff, including the Cuban doctors who were in SA to fight the pandemic, felt safe at work, while most felt they could access emotional support when they needed it. Over 80% felt appreciated and valued. The majority also responded that they were able to access assistance with solving problems when the need arose.

There was an expectation that it would be busier and more stressful than it actually was.

—  Study researcher

Only pharmacists found debriefing sessions less helpful compared to doctors and nurses. The debriefing sessions were found to be more helpful among the more experienced staff than the less experienced.

Not only did they largely escape Covid-19 infections, but most staff were “surprised by the positive nature of their experience, how much they enjoyed working there and how sad they were when it was over”, researchers reported.

“There was an expectation that it would be busier and more stressful than it actually was. Staff developed closer relationships with patients and their families than they had expected. And many responses emphasised the nature of interdisciplinary teamwork and connection, including words such as ‘family’ that were a recurring theme.”

One of the managers who took part in the study said that, despite all the stress and challenges relating to the pandemic response, there was room to be innovative.

“I’ve been more creative and productive than I was before ... there are aspects in my job that I forgot about that I’m rediscovering and enjoying a lot. Staff also felt more protected by PPE (protective personal equipment) than they expected.”

A nurse who was interviewed as part of the study said: “I was expecting some of us to contract the virus, but the government saw to it that we were protected.”

A call to respond to the pandemic during a time of need and a purpose to learn and grow personally and professionally were “an opportunity of a lifetime” for many healthcare workers. The unity of purpose inspired compassion, extreme diligence, hard work and great personal sacrifice.

Researchers said a culture of camaraderie and a “can-do” attitude was born, even among staff who were unfamiliar with each other and in some cases had no previous experience. “When it comes to saving lives and helping people ... people will go that extra mile regardless of who they are or where they come from,” said a senior clinician.

Another doctor said the passion to do the right thing for patients resulted in an overwhelming sense of “togetherness”. “Coming to work made me feel like a hero, knowing I’m coming to assist in this difficult time. Helping patients and doing my rounds in the wards came easy to me; it really woke up the spirit of ubuntu.”

When it comes to saving lives and helping people … people will go that extra mile regardless of who they are or where they come from.

—  A senior clinician at Hospital of Hope

Healthcare workers said they were also impressed by the levels of honesty and humility shown by senior managers. “This display of honesty and humility may have put people at ease and they were more willing to come up with innovative ideas and to contribute,” said one manager.

Researchers said despite many unknowns during the first wave, a sense of trust was quickly established between the different managers, despite not having worked together previously and the high stress levels of setting up a facility from scratch in a short time. “This trust appeared to have increased the level of collaboration and led to lower levels of disappointment and higher levels of forgiveness when expectations were not met, or mistakes were made.”

In a paper that is yet to be peer-reviewed, lead researcher and professor of primary healthcare Steve Reid and colleagues described staff experience at that hospital as “unique and unprecedented”, which produced significant learning for disease management outside a disaster situation.

“The staff largely volunteered out of a sense of wanting to contribute positively to mitigating the effects of the pandemic, despite the known risks. This has direct implications for recruitment procedures in routine services, suggesting that the fundamental motivations of applicants should be probed,” Reid noted.

“The low staff infection rate demonstrated what can be achieved through intelligent design and careful implementation to assure staff of their safety and support. The adaptability and responsiveness of the facility and its staff were largely a product of the unprecedented nature of the pandemic, but such approaches could benefit routine health services enormously,” researchers said.