‘Necessity is the mother of invention’: Specialist palliative care service innovation and practice change in response to COVID-19. Results from a multi-national survey (CovPall)

  1. Lesley Dunleavy
  2. Nancy Preston
  3. Sabrina Bajwah
  4. Andy Bradshaw
  5. Rachel Cripps
  6. Lorna K Fraser
  7. Matthew Maddocks
  8. Mevhibe Hocaoglu
  9. Fliss EM Murtagh
  10. Adejoke Oluyase
  11. Katherine E Sleeman
  12. Irene Higginson
  13. Catherine Walshe
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Abstract

Background

Specialist palliative care services have a key role in a whole system response to COVID-19. There is a need to understand service response to share good practice and prepare for future care.

Aim

To map and understand specialist palliative care services innovations and practice changes in response to COVID-19 (CovPall).

Design

Online survey of specialist palliative care providers, disseminated via key stakeholders. Data collected on service characteristics, innovations and changes in response to COVID-19. Statistical analysis included frequencies, proportions and means, and free-text comments were analysed using a qualitative framework approach.

Setting/participants

Inpatient palliative care units, home nursing services, hospital and home palliative care teams from any country.

Results

458 respondents: 277 UK, 85 Europe (except UK), 95 World (except UK and Europe), 1 missing country. 54.8% provided care across 2+ settings; 47.4% hospital palliative care teams, 57% in-patient palliative care units, and 57% home palliative care teams. The crisis context meant services implemented rapid changes. Changes involved streamlining, extending and increasing outreach of services, using technology to facilitate communication, and implementing staff wellbeing innovations. Barriers included; fear and anxiety, duplication of effort, information overload, funding, and IT infrastructure issues. Enablers included; collaborative teamwork, pooling of staffing resources, staff flexibility, a pre-existing IT infrastructure and strong leadership.

Conclusions

Specialist palliative care services have been flexible, highly adaptive and have adopted a ‘frugal innovation’ model in response to COVID-19. In addition to financial support, greater collaboration is essential to minimise duplication of effort and optimise resource use.

ISRCTN16561225

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Key Statements

What is already known about the topic?

  • Specialist palliative care is part of a whole healthcare system response to COVID-19.

  • Services need to make practice changes in response to the global pandemic.

What this paper adds

  • Specialist palliative care services responded rapidly to COVID-19 in both planning for change and then adapting to needs and requirements.

  • Services often relied on ‘improvisation’, ‘quick fixes’ and ‘making do’ when responding to the COVID-19 crisis.

Implications for practice, theory or policy

  • In addition to financial support, greater collaboration is essential to build organisational resilience and drive forward innovation, by minimising duplication of effort and optimising resource use.

  • The effectiveness and sustainability of any changes made during the crisis needs further evaluation.

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