Ras Laffan Hospital was officially opened by the Minister of Public Health on 23 April 2020, one of two new dedicated facilities outside Doha set up early on in the pandemic to care for the growing number of COVID-19 patients in Qatar. Ras Laffan and Mesaieed hospitals together provided an additional 400 beds for patients requiring medical care for COVID-19, including acute care capabilities, with the ability to expand capacity further should the need have arisen.
The opening of these hospitals was part of the government’s response to curbing the spread of COVID-19 and ensuring sick patients received the right care to try and minimize the effects of the coronavirus infection. The nursing teams were an essential part in enabling the hospitals to be set up and functional in record time. They were also instrumental in delivering the bulk of patients care throughout the hospitals operational period, until the last COVID-19 patients were discharged on 1 July.
This article shines a spotlight on some of the Qatari nurses who were instrumental in the success of the Ras Laffan facility, which was set up in record time. Commissioning the new facility from design to being fully functional in less than three weeks was an amazing achievement for the whole team. The new facility had over 600 staff, of which approximately 417 were nursing and support staff. The hospital’s clinical scope of service was to provide care for predominantly male, non-professional expatriate workers, including craft and manual workers who live in the industrial area. The patients included a mix of different ages and nationalities, some needing only ambulatory care while others needed critical care.
Ms. Saadiya Ahmed Al Hebail, Assistant Executive Director of Nursing, Ambulatory Care Center (ACC) & Nursing Lead in COVID-19 Ras Laffan Hospital
Ms. Saadiya Al Hebail had 13 years of experience, working as an operating theater nurse in Rumailah Hospital, where she rose to position of surgical services lead for the last six years of her placement there. The practical experience she gained and her interest surgical services made her an ideal candidate to take on a leading nursing role in the Ambulatory Care Center (ACC) when it first opened in 2017.
Saadiya has been the Assistant Executive Director of Nursing at ACC; she was closely involved in the commissioning of the facility and setting up the nursing teams and services there. Collaborating with the medical team during this time, Saadiya impressed Dr Khalid Al-Jalham, a Senior Consultant in Urology department and Director of ACC with her dedication and diligent work ethic. He therefore requested her to be part of the clinical team to help with the efforts to establish Ras Laffan hospital as a fully functional COVID-19 facility.
Saadiya commented that she experienced a bit of shock and trepidation when she first learned about the proposal for her to join the leadership team in a COVID-19 facility. But while she had the same initial fears about the virus that most healthcare personnel had in the early days of the pandemic, she quickly accepted the challenge. She was mindful that these were exceptional times that needed commitment from all healthcare professionals and she felt it was both a duty and an honor to use her nursing expertise to help her country and the patients.
At Ras Laffan, Saadiya was responsible for establishing optimal patient pathways and services, working closely with Dr Khalid and the rest of the management team to implement high service standards. Part of her remit included a wide range of operational planning efforts, such as arranging equipment requirements and all nursing related needs such as workforce planning, scope of practice and pathways development.
Patients who were transferred to Ras Laffan hospital typically came from other COVID-19 facilities after being triaged; such as the emergency department at HGH, HMGH, CDC and other inpatient facilities based on their clinical need. At the busiest time during the pandemic they had approximately 120 -150 patients admitted every day to this facility. The ability to process these patient volumes efficiently and effectively was a considerable task, especially given the limited manpower resources and time to set up functional teams and processes.
By conducting daily rounding sessions across all clinical areas within the hospital, Saadiya and the senior nursing team were able to have a clear overview of the patient population, their clinical and non-clinical needs and opportunities for service improvements. Her hands-on approach made it easier to deal with any issues in a more timely and efficient manner.
Ensuring staff and patient safety in a high-risk environment, with high numbers of confirmed COVID-19 positive cases, was both challenging but also rewarding and Saadiya stated that her priority was to implement and monitor the security measures for the safety of staff and patients.
Trying to apply normal hospital standards in a field hospital was a complex exercise that needed both innovative and critical thinking; along with strong multidisciplinary and interprofessional communication. While Saadiya never permitted her team to compromise on safety, but she did encourage them to use ‘out of the box’ approaches to deal with various challenges.
When working in a high stress and challenging environment, a leader must have the ability to adapt to any dynamic situation and be flexible and have a ‘can do’ attitude. Moreover, a leader needs to lead by example and give the team the confidence that they can manage the tasks they have been set – and Saadiya had the full confidence and respect of her team and other colleagues.
Saadiya felt that that the most important skills to master a crisis are teamwork, communication skills, multi-professionalism and situational awareness. She also recognized how important it was to have an ability to recognize when your staff need professional and emotional support and then ensure they receive it. When dealing with a highly infectious virus and sick patients, the emotional stress can take its toll on the mental health and wellbeing of patients and staff. After experiencing a sentinel event, Saadiya and her team arranged for mental health professionals to deliver counselling onsite and the effects were hugely beneficial to all.
Compassionate patient care was very important to the nursing team and they would make it a point to ensure that those patients who had very little would receive at least basic hygiene and grooming essentials, often raising the funds themselves to cover the costs.
Saadiya said that her faith and prayers gave her the spiritual strength to cope with the challenges of working in such a high stress environment. She received a lot of support from her trusted team, who she knew she could rely on to carry out important tasks. Her family was also a huge help as their support and understanding made it easier to spend the long hours needed at work to get the job done.
Ms. Muna Othman Al-Hetmi, Acting Director of Nursing, Nurse Education
Ms. Muna Al-Hetmi started her career as a staff nurse at HMC in 2003, first working in the in the plastic surgery theater and then rising to the level of charge nurse in 2007. Around this time, she found her passion for education that led her to become a Nurse Educator. Following the completion of a master’s degree from Cardiff University in Nursing Professional Practice, Muna returned to HMC in 2017 and took over management of the nursing education needs for all operating theater nursing staff. She has been a part of the Corporate Nursing and Midwifery Education Department for the past several years.
On 19 April 2020, Muna was approached by Ms. Saadiya Al Hebail to help manage the staffing requirements in Ras Laffan hospital, which had just been designed as a new COVID-19 facility. The hospital was due to open on 21 April and Muna had just two days to help with the organization and briefing of a diverse group of nursing staff who had been deployed from various locations to Ras Laffan.
Initially she thought her role would be completed in within the designated two days and she would return to her regular tasks as a leading nurse educator. However, upon arrival at the new hospital site, Muna quickly realized that she was at the start of major task that she could and would not ignore. Many of the nursing staff who arrived had little frontline experience, having either worked in non-clinical capacities or joined HMC as one of the recent recruits. Nearly all staff had major concerns about handling COVID-19 patients and possible risks to themselves and their families.
So one of the first tasks that Muna and her colleagues did was to identify the nurses with sufficient experience and expertise to handle clinical tasks on their own. The remaining nurses were given additional training alongside being partnered with an experienced nurse able to guide them. This ‘buddy’ system had the benefit of enhancing patient safety while giving staff more confidence to work in an unfamiliar environment; the added advantage was the development of more skilled nurses that can operate efficiently in a crisis situation.
Muna also helped oversee infection control training for all staff and all the senior nurse leaders made it point to conduct regular checks to ensure that safety protocols were being adhered to. A self-confessed ‘COVID-19 infection control police’, Muna proudly stated that no member of staff contracted the disease from work.
A key aspect of the work was to set up effective infrastructure and communications channels and work with new teams who also had to navigate the challenging situation. In addition, they had to establish patient pathways and support the doctors and nurses find their way in an unfamiliar location so they could perform their duties.
To keep a team strong and motivated requires fostering good relations and supporting staff morale. The senior team would try occasionally to have breakfast together to help bring some normality into the daily routine and it was also a good opportunity to plan upcoming tasks.
Muna was mindful of the larger group of nurses who also needed support and the occasional morale boost. One of the ways this was achieved was through organizing a special surprise breakfast for the nursing staff. Muna and her team contacted a large MacDonald’s chain in Al Khor and asked if they would sponsor a breakfast for the nurses. The MacDonald’s management team were happy to support this initiative and delivered the breakfast meals to a very appreciative group. The experience highlighted how small gestures can have such a high, positive impact on the team.
This caring attitude also extended to the patients. When realizing that some patients were not eating the meals provided, Muna made it a point to find out why. Once she realized that many patients were used to eating rice as part of most of their meals and were not keen on the alternative hospital food, she contacted the catering team to arrange for rice to be served twice a day. This solution was warmly welcomed by many patients and it is these kinds of gestures that contribute to good patient care and improved recovery outcomes.
Muna said they all worked incredibly hard as a team and that she has seen first-hand that with commitment, dedication and effort, everything is achievable. This realization, along with the support from family and senior leaders, had given her the confidence that Qatar can manage to deliver a high standard of healthcare to all patients in a crisis.
Ms. Fatma Al-Komah, Director of Nursing for Workforce & Staff Support
As the Director of Nursing in Al-Khor hospital and a member of the corporate workforce panning team, Ms. Fatma Al-Komah has responsibility for all staffing related tasks. Her role requires her to work very closely with different facilities within HMC to identity their staffing needs and help ensure they have the appropriate nursing skills mix to carry out their assigned scope of work.
As part of her role to support corporate COVID-19 planning, she collaborated closely with the operational teams responsible for nursing services in Al-Khor, Hazm Mebaireek General Hospital and the Umm Garn isolation and recovery camps. She also supported the team in Ras Laffan Hospital when it was designated as a COVID-19 facility and supported the clinical leadership team with redeploying nursing staff from other locations to this one.
In order to service the rapidly growing needs of the new COVID-19 sites, the workforce planning team has to redeploy nurses from existing locations to where they were needed most. At the height of the pandemic, the team redeployed around 2600 nursing staff to support the COVID-19 efforts, this included Registered Nurses, Patient Care Assistants and nurse mangers. Al-Khor Hospital also contributed to this effort and Fatma arranged to transfer 173 nurses to other locations during the height of the pandemic.
As not enough existing nurses were available to meet the huge demand from the numerous new sites, a special plan was devised to hire new qualified nurses and patient care assistant from a pool of professionals who were already living in Qatar. Together with the Rapid Recruitment team from Human Resources Department, Fatma and her colleagues managed to interview, validate and arrange for temporary contracts of more than 1000 new recruits in record time.
What added complexity to this task was that a number of these nurses had no recent frontline experience and very few had experience in dealing with such a contagious virus. The workforce planning team therefore had to work with the nursing education and infection control teams to develop relevant training and upskilling courses that would enable them to be assigned in a new role without undue risk to themselves or their patients.
Fatma explained how delighted she was when the last recovered COVID-19 patients were discharged from Ras Laffan on 1 July, as this indicated that COVID-19 patient caseload was finally decreasing. She was looking forward to supporting the hospital’s new scope of work to provide general hospital care to people living in the north of Qatar.
Fatma said that she gained so much practical experience over the past months and is looking forward to using this knowledge to help the development of future nursing workforce plans. A key realization for her over the recent months was the need to develop a practical plan to promote the right skills mix in our organization. This is important at the best of times but especially so during a crisis situation when teams have to rely on limited resources.
Fatma feels much more confident now in her personal abilities as well as collectively in the organization’s strategic planning abilities to master major challenges in the future. She has learned valuable lessons, including improved critical decision-making skills, negotiation skills and being flexible to deal with the unexpected at any time. While it was extremely hard work, Fatma was also proud of what she and her colleagues have achieved as a team, a corporation and a nation.
Nursing Team Supporting Ras Laffan Hospital during COVID-19
Nursing Team in Ras Laffan Hospital
Nursing Team from Al-Khor Hospital – Joining the national fight against COVID-19
