Will there be a second wave of the coronavirus? And if it hits, what are some of the lessons learned from the first outbreak? In his blog, Hans Schoo, member of the Board of Directors of Rijnstate hospital, shares how he experienced the initial outbreak and how he prepares for a potential second wave.


Intensive period

The initial outbreak of the coronavirus marked the beginning of an intensive period. Hospitals pulled out all the stops to properly manage the COVID-related care. This was in a period in which fairly little was known about the virus. It looked as if this initial blow was followed by a moment of calm, but looks can be deceiving. All who had worked so tirelessly during those first few months immediately had to pick up the pace again, restarting – where relevant – regular care and catching up on care which had to be put on hold.

We at Rijnstate have had over four hundred COVID-19 patients in our care. We would compare the situation with running a marathon without knowing its length. The initial outbreak in the Netherlands happened in the province of Brabant, which gave us, in the slightly more northern province of Gelderland, some extra time to scale down the regular care and prepare the hospital and staff for the arrival of many, seriously ill patients. In record time, we expanded our number of ICU beds from 12 to 28, established a crisis organisation with a policy team and operational teams, and facilitated psychosocial support for our employees. The scale of the crisis organisation and the long duration of this situation was something we had never experienced before. No ready-made approach existed to deal with such a situation, with patients requiring weeks of treatment, while managing the steady, seemingly unending inflow of patients.

Information technology

Digitalisation has absolutely gained momentum during this crisis. The rapid expansion of ICU capacity, providing physicians working in isolated rooms with the means to be able to communicate with their colleagues; these are just some examples of matters which needed to be achieved in a short period of time. In some situations, there wasn't even a choice to make; it was either remote care, or no care at all.

The COVID crisis affected all members of our society, including our suppliers. Good cooperation is always important, and even more so in situations such as this one. During these times, we have been able to move quickly with ChipSoft, the supplier of our EHR. Sometimes because they accelerated the realisation of our requests. Other times because they took the initiative in providing certain functionalities, allowing us to expedite the process of implementing strategical decisions made earlier, before the crisis. As such, we weren't forced to quickly make temporary decisions, at the risk of regretting them later. Think of video calls, or ChipSoft's Care Portal. Solutions first, and then we'll talk. At the very least this means that, digitally, we are much better equipped for a potential second wave of the virus, without compromising on our digital strategy. We will, however, need to reassess this strategy, as it appears that parts of it can be, and were, realised quicker than we anticipated when drafting our digital strategy.

Digital systems were used to exchange information throughout the country. I believe we have collectively learned a lot about the problems associated with this method. What responsibilities lie with the authorities ? How does it impact our work processes? How did we manage data governance? And what technologies do we use?

The crisis also showed that digital tools – such as video consultation, digital questionnaires, remote monitoring – are part of our work and care processes. Targeted decisions from the past few years helped us to innovate rapidly. We now need to remain focused and use this experience as a lesson for the future.

Logistical challenges

Now that we seem to have overcome the first COVID-19 wave, it's time that we turn our attention back to regular care, while following the measures that apply. Restarting regular care proves to be much more complex than scaling it down. The risk of contamination means that we have to restrict access to the hospital. We are faced with enormous logistical challenges. How can you guarantee a distance of 1.5 meter between the people in the waiting room of a doctor's office, for instance? This is just one of dozens, if not hundreds of situations and settings we continually think about. Currently, all hospital spaces are reorganised in accordance with the guidelines, but I expect us to be able to better put to use the data and routing information from our EHR and use strategic capacity management to achieve more efficient results. After all, to measure is to know.

Lessons learned and second wave

Of course we hope there won't be a second wave, but in the case of one, Rijnstate will be prepared and will continue to strive for the best possible care for all our patients. We aim to strike a better balance between COVID-related care and regular care. On top of that, we will definitely continue to focus on providing acute care.

Hans Schoo, Board of Directors