Home not hospital

The world has changed significantly since my last editorial in January. COVID-19 and the resulting global lockdowns have impacted the lives of each of us in one way or another. Given these extraordinary times, I have invited Mr Rodney Mountain, ENT surgeon and Healthcare Designer at Ninewells hospital, Dundee, to reflect on how art, design and the creative industries have come together to help meet the challenges faced by Covid-19.

Dr Caroline Erolin

Editor

The covid-19 frontline and frontier

A teenage boy recently described the global Covid-19 pandemic as a ‘very unusual war’. A war, ‘the wrong way around’. Old and vulnerable people were dying on the frontline, young healthy people were instructed to stay at home, everyone was susceptible, and the enemy was unseen. How insightful, the whole world had rapidly turned upside down, home, work and play would never be the same again. Every Thursday evening, I am deeply moved by our neighbourhood ‘Clap for carers’. As an NHS surgeon working in Scotland I join in and clap loudly, in recognition of my fellow villagers who are the true Covid-19 frontline. Our homes have been our frontline, protecting the elderly and vulnerable people in our village. Home I believe is now the new healthcare frontier. The place where remote-monitoring technologies, patient-focussed learning, virtual communication methods and information sharing will empower people and transform care. Home, not Hospital.

Education during a crisis

Two broad stands of education and information sharing have emerged during Covid-19. Rapid training and education of our health and social care workforce has been vital. More importantly, the wider impact made through ‘Public Health’ messages, communicated through radio, TV, newspapers and the Internet. Public Health messages have varied significantly in content and consistency from country to country. One message is very clear to me, at times of real healthcare need, public health matters more than private health.

Place and relationships

Covid-19 has completely redefined place, has redefined relationships and the ways in which we communicate and collaborate between patients’ homes, community care centres and hospitals. Herein lie many opportunities for artists, designers and creative people to contribute to a post-covid future. The creation of home-based resources that redefine a new world of health and social care, a world where human communication is key. Phone calls, video consultations and drone deliveries are rapidly changing the relationship between hospital and home. As a consequence, more sustainable care pathways are already in place, less travelling will be needed and queues at hospital car parks will not be seen again. I live in hope.

Face-to-face and virtual

Healthcare services are broadly being defined in two different ways. Physical (face-to-face) or virtual (phone calls, video consultations, email and texting). My experience tells me that any future visit to see me in hospital should now only take place for two possible reasons. The need to be physically examined or treated, or the need to share a complex social, psychological or emotional conversation.

Creative collaboration

As we emerge from Covid-19 lockdown into a new world order, defined by queues, two-meter distancing, black and yellow striped tape and wayfinding arrows around our built environments, I pause to reflect. Art and design has made a significant contribution to the challenges faced by Covid-19, not just through the creativity that has taken place in peoples’ homes, but the creative collaborations between public, private and voluntary sectors that that have emerged as a consequence. As the following examples demonstrate, collaboration, not competition has been the new order of the day.

The covid-19 education and training challenge

On the 20th of March 2020, I attended an urgent meeting of trainers and educators who work for our local NHS Tayside Healthboard and University of Dundee Medical School. I clearly recall a boardroom style meeting, a chairperson, a printed agenda and 20 people communicating face-to-face across a room. A key theme emerged, ‘education and training’ of staff and citizens would be needed in confronting the care challenges faced by a rapidly evolving epidemic. This would be our first and last face-to-face meeting for a very, very long while! The need to provide Covid-19 training and education for hospitals and community-based teams caring for half a million people in a widespread geographical region was daunting. No more face to face meetings were allowed, no more agenda driven processes could take place, no more bureaucratic permissions were required, the simple task was to educate and re-skill a large number of staff in a short period of time.

We drew on the creative talents of our healthcare colleagues, medical artist and video makers and created a suite of training and education resources that could be accessed from home. A free, open access website formed a platform for new information, guidelines, infographics and video-based resources to be shared widely. Key areas of need were quickly identified – The clinical assessment and management of patients affected by Covid-19, Personal Protective Equipment (PPE) guidelines, how to physically ‘don and doff’, recognition of the deteriorating patient, critical care, palliative and end of life care to name a few. Professional video makers helped us create educational packages for our staff and patients. These video resources have been well received and highlight the value of audio-visual communication. Our Medical school clinical skills training facilities were reopened and used to train a large number of workers in a range of new skills required. Very few paper documents were produced, most of our information was shared on-line.

Our team used Zoom, Teams, WhatsApp and other virtual methods of communication. Our meetings were efficient, well attended and often very humorous. Room bookings became a thing of the past. The meeting room had become virtual. Months later I feel ‘Zoomed-out’ and in need of a handshake, a pat on the back or a physical hug. My mindset to travel has changed. From now on, I will rarely travel far to meetings and conferences. I plan to attend them in the comfort of my office or dare I say it, my home. Much of my work-life has moved home.

Scrubs, gowns and PPE

In April 2020, a PPE crisis loomed, supply chains had broken down and simple textile-based resources such as scrubs, gowns and masks were globally in short supply. In Tayside, we responded to this crisis by asking our community, citizens, local textile industries and the textile design team at the University of Dundee for help. Halley Stevensons - the makers of ‘Barbour jacket’ textiles, Keela – the makers of outdoor clothing, Don and Low – the makers of high-tech fabric, JD Wilkie – the makers of body armour all responded with help. Six hundred citizens volunteered to sew scrubs and face coverings at home. A team lead by Jane Keith from the Duncan of Jordanstone College of Art and Design created a ‘Scrub Hub’ within the University of Dundee Library. Sewing machines replaced student laptops and a new, collaborative model of working evolved at pace. Laura-Jane Logue, one of our Dundee Medical Art Masters students created a wonderful set of ‘Personas’, a ‘Community, University, Industry’ logo and wayfinding images that helped communicate our collective messages. Her artwork was done remotely from lockdown in her London home. Citizens in our region sewed 1000 scrubs and 10,000 face coverings in the space of two weeks. Home production had become a new industrial base, one that we plan to support in the long-term. We plan to challenge the current methods of public sector procurement and unsustainable global supply chains. Local, natural, re-usable will hopefully become a new public sector textile and garment mantra.

Medical illustration messages

These are a few of my take home messages for 2020 and beyond.

• Think of resources that are either ‘face-to-face’ or ‘virtual’.

• Meet and hold conferences both physically and virtually.

• Produce more audio-visual resources for patients and carers.

• Produce resources for all generations to access remotely.

Finally, a wee Scottish challenge to all of you. When asked to create visual information resources, please pause, place patients in the centre of your frame and step into their homes.

The ‘Hospital at Home’ is here.

Mr Rodney Mountain

ENT Surgeon and Healthcare Designer

Dundee

Scotland

Covid-19 Logo created by

Laura-Jane Logue