HMC’s Nurses Providing Strategic Covid-19 Leadership in Qatar
A glimpse from several expatriate nurse leaders
Dealing with a new contagious disease has its challenges, and 2020 is a year that will have made an impact on everyone; especially for those in the healthcare system who have had to manage the unprecedented COVID-19 pandemic.
Much has been said before about the value and abundance of teamwork, that has been even more evident during this crisis. In a previous article, we featured several Qatari nurse leaders who have shown their amazing leadership capabilities and commitment to serve their country in this time of need. In this article, we wish to feature a selection of expatriate nurse leaders who have provided exemplary leadership and professionalism.
Mr. Ahmad Abujaber
A/Executive Director of Nursing, Hazm Mebaireek General Hospital
Mr. Ahmad Abujaber started his career as a staff nurse in Hamad General Hospital more than 17 years ago. Over two decades, he gained valuable experience and honed his skills, which led to his appointment as Acting Executive Director of Nursing at Hazm Mebaireek General Hospital (HMGH) in 2017. He was part of the team responsible for commissioning the hospital, which was officially opened in late 2018.
Ahmad’s extensive knowledge of the hospitals development and operations was immensely helpful in helping to transform HMGH into the second major COVID-19 facility, after the CDC. Ahmad, along with the other clinical leads, developed plans to change the function of the hospital to provide significant critical capacity from March 2020 onwards. They changed the hospital scope from having 8 ICU beds to 226 ICU beds, and from 102 general ward beds to 707 beds. This was a huge jump in capacity and the corresponding planning requirements concerning staffing, equipment and support services was massive, especially given the urgency.
The rapid expansion in capacity needed to service the growing demand for COVID-19 hospital care necessitated the large increase in nursing staff. From initially 500 nursing staff, Ahmad had to request around 800 additional nurses from across the corporation. Several of the new staff had no or little recent frontline experience, let alone dealing in a busy and often stressful critical care environment. Ahmad leads a team of 1300 staff, including all nursing designations as well as nursing aids and patient care assistants who provide valuable support services.
Ahmad noted how grateful he and his senior team were to the efforts of the nurse education team who worked hard to provide basic critical nursing and infection control skills training to the nurses assigned to COVID-19 facilities. He added that while the training provided in the simulation center was valuable, there is no substitute for practical experience. He established a rapid orientation program to help the new nurses get familiar with the unfamiliar environment and overcome the fear factor of looking after patients with a highly contagious virus. This was important especially in the initial stages, when the hours were very long and often physically and mentally exhausting.
Ahmad encouraged support from mental health colleagues, who provide psychological counselling for nurses waho had to deal with individual patient tragedies as well as concerns from their families at home. The HMGH staff needed psychological support especially following an accident where the field hospital tent collapsed during a freak weather storm, which saw several of colleagues and friends get hurt.
The introduction of the buddy system in the critical care units was very successful and popular among the team. By pairing a couple of newly assigned nurses with experienced critical care nurses on-site, they were able to reduce fear and anxiety among the new nurses helped to promote safety across the units. These challenging times have contributed to the development of highly experienced and capable ICU nurses who will be a credit to whichever unit they are redeployed to after the pandemic ends.
Ahmad and his team are responsible for managing the resources and designs of all nurse-led procedures. They provide clinical feedback to the multidisciplinary team on site and liaise with other facilities, especially when patients are relocated to facilities for less acute or convalescence care. Ahmad explained that there is a lot of behind the scenes work to manage the complex hospital operations and the team need to be agile and flexible when new information is presented that warrants a change in course. He added that every stage they work through, they gain valuable knowledge that help them manage the next stage they enter.
Ahmad reflected that the experience of the past few months, while often challenging and sometimes disconcerting, has taught them a lot about operational planning, people management and empathetic patient care. The experiences and skills gained will always remain with him and his team and is part of a valuable reservoir to draw from if the need arises in the future.
Mr. Majed Hijjeh
Assistant Executive Director of Nursing for Critical Care Services
Mr. Majed Hijjeh is the Assistant Executive Director of Nursing for Critical Care services at HMC. He is tasked with leading the corporate Critical Care service improvements and standardization of practice, based on international standards, across the corporation.
He became more involved in the COVID-19 efforts in February 2020 and one of the first tasks was to establish a dedicated screening service at Hamad International Airport following the Ministry, in accordance with the government’s Public Health’s mandate. He also helped establish HMC’s quarantine facilities, together with his colleague Ms. Nadya Al Anzi, ensuring the allocation of required manpower and medical devices. His efforts then focused on expansion of Critical Care service and supporting the clinical teams within ICUs as needed.
Majed reiterated a common experience among other leaders, which was the need to manage the dangers of miscommunication, which occurred primarily when there were multiple or conflicting sources of information or multiple people from different locations involved in making decisions. Majed indicated they were able to manage this by proactively promoting strong communication between the teams. The fact that the SWICC team were providing more clear directives for all parties to follow was another aid to eliminate confusion and miscommunication and encouraging informed and efficient decision making.
Majed identified the underlying issue for many initial challenges was the lack of clarity of plans, which led to some individuals not taking ownership of their responsibilities, or people working in isolation. He worked on strengthening his team to work collaboratively towards a shared purpose. He expressed the value of having regular, clear and open communications between groups. He saw that many individuals responded very positively to being given responsibility for special projects; by allowing them to take charge of their task generally resulted in greater staff satisfaction and performance.
In the future, Majed would welcome a strong engagement with the community and more widespread efforts to educate them about key points concerning the virus, infection control measures and the benefit of complying with government plans, designed to help support the healthcare system.
Majed felt that the provision of care and support to frontline staff, and making sure they feel they are being listened to, was equally important for improving morale and patient outcomes.
Majed expressed his elation that the Critical Care Network team together were able to develop high quality and high functioning services for coronavirus patients. The team effort resulted in the expansion of Critical Care capacity to 400 beds in a very short period of time; and this effort is continuing with plans to further expand the capacity to 600 beds. He believes that this achievement was a key contributing factor in Qatar maintaining one of the lowest COVID-19 mortality rates in the world. This experience has led to many staff members adopting a ‘can-do’ and ‘will-do’ attitude which has been beneficial during the pandemic and will continue to support Qatar’s healthcare development efforts in the future.
Ms. Olivera Milanovic
Director of Nursing at Hamad General Hospital and Um Garn Isolation and Recovery Camp
Ms. Olivera Milanovic has been a Director of Nursing at Hamad General Hospital for several years. Her managerial abilities were at the forefront of her appointment to establish the Army camp on Salwa Road; which was one of the first isolation facilities for patients with mild or no COVID-19 symptoms. Once that site was up and running, she was asked to help establish the Bu Sidra isolation facility for professional expatriate COVID-19 patients.
In March 2020, demand for isolation facilities was growing rapidly and the decision was made by the Ministry of Public Health to erect new isolation and recovery facilities in the Umm Salal municipality, to handle the growing caseload of people who tested positive for coronavirus. The first temporary structure erected was the Umm Garn Isolation and Recovery Tent Complex on plot 1, followed by the purpose built facility on plot 2, which is still operational. Although the number of new cases is coming down, construction to build the final facility on plot 3 is ongoing to enable the government to be ready for any future eventuality.
The first newly constructed Um Garn Tent Complex was built on a greenfield site which necessitated the establishment of all new systems and protocols to ensure the building work delivered a practical solution. The goal was to build accommodation for more than 3700 people who had tested positive for COVID-19 but had few or no symptoms. While no critical care facilities were needed, however, the nursing teams were responsible for monitoring their guests’ general health and wellbeing. Together with the physician on-call, the nursing teams provided ongoing care for co-morbidities and had to ensure that appropriate medication was provided.
The commissioning team worked closely with Infection Control to develop special zones for the safety of staff and guests. The ‘red’ zone was the designated area for individuals with the coronavirus who needed to be isolated from their community. The ‘green’ zone was a designated areas for staff and partners to operate in relative safety.
Olivera explained that dealing with such a large and diverse group of men, mainly between the ages of 20 and 40, living in cramped conditions, required a sympathetic but also firm approach. The team arranged for amenity packs for every new arrival to provide them with basic essentials they would need during their stay. The provision of recreational opportunities, such as table tennis and other social games, prayer and relaxation areas were very important in offering wellbeing support.
Many of the guests who were brought to Um Garn were worried about their physical health as well as their employment status. Some were fearful of being deported and thought this facility was a holding station before they would be sent back to their home country. Olivera said that her nursing teams had to provide a lot of psychosocial support, and it was really useful that the multinational nursing workforce was able to communicate in different languages.
Olivera explained that the success of the first facility that was built was due to having a clear mandate for the scope of service to allow them to focus their planning efforts accordingly. This influenced the training and orientation given to staff assigned to the facility. While this was new territory and most of the team working on this project had never experienced a pandemic before, however, it was helpful that the leadership team had considerable management experience.
Olivera credits the development of a strong team structure and culture, along with appropriate training and encouraging open communications channels, for helping achieve a good onsite safety records. She was immensely pleased that none of the staff contracted the virus at work.
Olivera reflected on the importance of team building, especially when staff are coming from different backgrounds with different experiences and professional qualifications. She supported her to team in organizing several staff activities to help keep up morale; for instance, during International Nurses Day, certificates of appreciation were handed out to nursing staff to recognize their efforts. As she is transitioning back to her main role, Olivera mentioned she will genuinely miss the team she has relied on over the past few months and come to respect. But she takes pride in the knowledge that whatever challenging healthcare situation may arise in the future, she is confident that the nursing team can handle this with professionalism and commitment.
Mr. Ashraf Al Hashlamon
Lebsayyer Field Hospital Nursing Supervisor
Mr. Ashraf Al Hashlamon has built up a lot of practical and leadership experience at Hamad General Hospital, one of the busiest hospitals in the Middle East. His expertise in dealing with complex systems, different professional disciplines and nationalities, made him an ideal candidate to help lead the nursing efforts in several of COVID-19 sites. His first appointment was to help commission the new Mesaieed Hospital in February 2020 where he supported Ms. Sawsan Seed - Acting Director of Nursing, Lebsayyer Field Hospital assigned to lead this new facility’s nursing efforts.
Ashraf was then posted in March to the Mekaines quarantine and isolation facility for craft and manual workers, which was operated by Qatar Red Crescent but with HMC clinical support. The Mekaines quarantine site was a very challenging but also rewarding experience for Ashraf and his colleague, Ms. Sawsan Saeed, who worked with him to help set up the nursing services.
The main challenge was due to the fact that the facility was not geared up to handle the large volume of people sent here to complete their isolation period. There was an urgent need to set up systems aligned to efficient patient / guest pathways. The teams has to register new arrivals, monitor any other health conditions, including conducting regular COVID-19 testing, ensure catering and other supporting services were available and finally to arrange the discharges. At the height of the pandemic, the facility accommodated 12,000 people, which was a massive organizational task.
The valuable experience and knowledge Ashraf gained in Mekaines led to his appointment to help open the Lebsayyer Field Hospital. The facility was set up in early April, initially as a quarantine site inside the military base located in Al Shahaniya. The Ministry of Defence and the Ministry of Public Health then decided to create a ‘step down’ facility for male patients who had been discharged from other COVID-19 hospitals but who were not yet fit to go home.
Ashraf worked closely with his Director of Nursing, Ms Sawsan Saeed, and the Medical Lead, Dr Abdulla Al-Naimi, to provide a high-functioning 504-bed facility, which relieved the pressure on the other hospitals. Patients generally stay between one to two weeks, after which they are tested again and, provided the test is negative, discharged home. Approximately 170 nurses and 24 doctors were assigned to this facility, which at the height of the infection crisis had nearly 500 patients.
One of the most important lessons Ashraf recounted was the need to establish clear structures and systems as early as possible and to communicate these to the whole team. He and Sawsan made it a point to orient every new nurse and doctor who joined the Lebsayyer team, which helped promote interprofessional communications and collaboration.
Ashraf felt it was important for staff get a clearer understanding of how to manage the risk of infection in order to deal with their fears, especially among those who were commuting home to their families at the end of each shift. Staff who lived with elderly or otherwise immunocompromised relatives were able to remain onsite in staff accommodation and Ashraf made use of this, as he wanted to keep his elderly parents safe.
Ashraf joined the nursing staff on patient rounds to demonstrate how confident he was of the safety protocols and to be positive role models to their staff. They helped establish special staff testing services that allowed them to get tested whenever they had a concern about potentially having been exposed to the coronavirus. The efforts contributed to the positive safety results, with none of the clinical staff getting infected. This led to greater operational performance levels and higher job satisfaction.
A concerted effort was made to keep patients happier and the nursing staff arranged for mobile phone donations for some of patients had none. They worked closely with charities and other partners to provide relief. For instance, together with Qatar Charity, Ashraf and his colleague helped provide a box of basic food items for each patient before they were discharged home. With the help of volunteers, though organizations such Qatar Olympic Society, they organized sporting activities such as volleyball and aerobics classes at night. These were popular among patients and staff and helped relieve stress. They also invited different clinicians to come and give health education talks to patients; for instance a dentist delivered a talk on the importance of oral hygiene.
