Brief report Clinical academic leadership in COVID-19: a rapid leader: first published as 10.1136/leader-2020-000292 on 1 July 2020. Downloaded from response to sharing emerging insights in intensive care Nirandeep Rehill,1,2 Amanda Begley,1 Katie Mantell,1 C Michael Roberts1 1UCL Partners, London, UK ABSTRACT assume that role. UCLPartners is a partnership of 2 NIHR Applied Health Research Background The COVID-19 pandemic has raised a 23 National Health Service (NHS) trusts and 9 North Thames, London, UK wide range of challenges for health systems around the higher education institutions covering north central world and the National Health Service in England has and east London and parts of Essex, Hertfordshire Correspondence to Dr Amanda Begley, UCL been no exception. A significant proportion of infected and Bedfordshire. Governed by a partnership board Partners, London W1T 7HA, UK; cases require intensive care unit support and have a high and led by clinical academics supported by a corpo- amanda. begley@ uclpartners. mortality rate. In the early stages of the pandemic, there rate senior team, its purpose is to bring together com was neither an evidence base nor a clinical consensus on organisations to work collaboratively for the health and care of the population served. Received 18 May 2020 the optimal management of patients in this setting. Revised 9 June 2020 Interventions Responding to requests for assistance Accepted 11 June 2020 to address this evidence gap, UCLPartners, an Academic SHARING EMERGING INSIGHTS Health Science Partnership, working in collaboration with Through our partnership, we received intelligence other organisations including National Institute of Health that clinicians were concerned that the traditional Research Applied Research Collaboration North Thames, management of ARDS and other complications was developed a clinical academic team to synthesise clinical not having expected outcomes against this novel learning in real time. This was then disseminated using disease—and that emerging knowledge and experi- existing networks and social media to local, regional, ence needed to be shared to inform care. Our inde- national and international clinical teams. pendence and clinical academic connections put us Conclusion An Academic Health Science Partnership in a position to take up leadership responsibility to was able to respond quickly through adapting and rapidly fill this gap, allowing us to avoid the bureau- expediting traditional methods of evidence gathering, cratic processes embedded in central bodies. We supporting organisations to work collaboratively across illustrate our response in figure 1 and a description their networks and so meet an urgent clinical need to in this section of three related interventions. http://bmjleader.bmj.com/ the benefit of clinicians and patients. The Nightingale learning health system The London Nightingale was a ‘pop-up hospital’ INTRODUCTION designed to accommodate up to 3000 ICU patients As the COVID-19 pandemic gained a foothold in and was incorporated into the governance structure the UK, the pressure was acute—within 8 days in of a partner NHS trust. UCLPartners was to help late March 2020 hospital deaths from COVID rose ensure that clinical care would be informed by the 10- fold from 35 to 374 a day.1 Much of this pres- most recent evidence and best practice. We deployed sure was on intensive care units (ICU), receiving staff on site to establish an ‘internal learning system’, on September 25, 2021 by guest. Protected copyright. 5%2 of people infected with severe acute respi- involving daily review of clinical data and insights, ratory syndrome coronavirus 2 who developed a supported by a new role of Bedside Learning Coor- form of adult respiratory distress syndrome (ARDS) dinator. Learning was summarised into ‘bite- sized’ requiring ventilatory support. presentations given at daily staff briefings, at which Early reports revealed a mortality rate of c.50% clinical teams were able to raise questions requiring in that group.3 4 ICU clinicians were in urgent urgent response. need of guidance; however, guidelines rely heavily In parallel, UCLPartners established an ‘external on both research- based evidence and clinical learning system’ forming a team of clinical, consensus. The pandemic had erupted at such pace academic, programme management and commu- that neither were available for COVID-19. The nications experts. This system was both reactive— © Author(s) (or their system responded with the publication of interna- rapidly responding to front- line queries—and employer(s)) 2020. Re- use tional guidelines drawn from the evidence for the proactive in producing weekly highlights of permitted under CC BY- NC. No treatment of (non- COVID) viral pneumonia and published literature alongside emerging qualitative commercial re- use. See rights 5 and permissions. Published ARDS, including surviving sepsis guidelines and insights from research underway on COVID-19. by BMJ. National Institute for Health and Care Excellence These highlights included short summaries designed guidance on critical care escalation.6 for pressured clinical teams and aimed to highlight To cite: Rehill N, Begley A, At such moments, there is a need for a different 3–5 key actionable insights. Mantell K, et al. BMJ Leader Published Online type of leadership where responsiveness, challenge Over 5 weeks, 13 questions were raised relating First: [please include Day to convention and support to clinical leaders are to clinical presentation (eg, coagulopathy, delirium), Month Year]. doi:10.1136/ key. UCLPartners, an Academic Health Science clinical management (eg, drug side-effects, Endo- leader-2020-000292 Partnership, was one organisation in a position to tracheal Tube blockages), infection control (eg, Rehill N, et al. BMJ Leader 2020;0:1–3. doi:10.1136/leader-2020-000292 1 Brief report teams within their regions. The resources were shared via email leader: first published as 10.1136/leader-2020-000292 on 1 July 2020. Downloaded from with more than 5000 contacts in the UK- wide ICS community, and were engaged with widely on Twitter (296 000 impressions; more than 7000 engagements) and Facebook (more than 1600 likes and shares). They were also distributed to more than 250 UK- wide COVID-19 leads on the ICS/Faculty of Intensive Care Management Whatsapp group, and shared with members of the UK Scientific Advisory Group for Emergencies committee. The emerging learning was spontaneously shared by clinicians across social media and WhatsApp groups, receiving hundreds of comments of thanks. The reach has been global: the WHO joined ICS webinars, and we were told Professor Don Berwick had welcomed the Figure 1 Overview of interventions within UCLPartners intensive care resources and would share them with ICUs in the USA. programme including target audience. AHSN, Academic Health Science Network. LEADERSHIP LEARNING Taking on the role of sharing emerging insights during COVID-19 Continuous Positive Airway Pressure) and staff well- being (eg, revealed some core elements of leadership, which may be appli- dehydration, shift patterns). cable to other situations requiring rapid learning. The Intensive Care Society (ICS) collaboration Responsiveness The ICS is the professional society representing clinicians When the pandemic first hit the NHS, clinicians and leaders working in intensive care in the UK. Early indications showed reported being overwhelmed by the unknowns of how to clinicians were struggling to manage a condition that did not respond. At a time when staff most needed to reach out to peers, appear to adhere to the principles of ARDS or previous viral to scan the literature, to digest official guidance, they were hit pneumonias and had much higher mortality. The society planned with unprecedented volumes of critically ill patients. to hold a series of webinars to collate emerging clinical experi- Within a week, we started producing daily outputs, followed ence and synthesise learning in close to real time. UCLPartners by weekly reports on emerging evidence; we were highly respon- was approached to provide academic support, via its partner sive to daily queries. National Institute of Health Research Applied Research Collab- To deliver this support we found ourselves, as highlighted by 7 oration North Thames, to synthesise the learning and to use its Sadler and Stewart, needing to ‘throw away [our] calendar, act communications expertise to present this in a format suitable with intense urgency, own the problem and form a crisis manage- for wider dissemination to front- line clinicians. Seven webinars ment team’. Rapid decision- making by the senior leadership http://bmjleader.bmj.com/ involving hundreds of participants were held across a range of team allowed UCLPartners to flex from its business as usual to topics, engaging clinicians from across the world. form a new team to address the problem within days of the ask. ICU collaborative Joining up leadership is key In recognition of the need to rapidly share learning, UCLPart- The challenge in a time of crisis is not lack of leadership but lack ners established a virtual learning platform to facilitate multidis- of joined- up leadership. Reflecting on the 2017 terrorist attacks ciplinary, multispecialty discussions, initially in partnership with in Manchester, UK, Lord Kerslake advised leaders to ‘consider London Academic Health Science Networks (AHSNs), followed how the differing cultures of all the organisations involved in a by expansion