VHA’s Ongoing Response to COVID-19 from VHA’s Chief Nursing Executive

Kathryn Nichol, Vice President Quality, Best Practice, Research and Education and Chief Nursing Executive

Greetings. Let me introduce myself… My name is Kathryn Nichol and I am VHA’s VP of Quality, Best Practice, Research and Education and Chief Nursing Executive. In my role as Clinical Lead for the organization, I had the opportunity and challenge of a lifetime in leading VHA’s Incident Command Team responsible for our response to the COVID-19 pandemic. We launched our Incident Command Team on January 24th, put it on pause at the end of June and are ready to relaunch it if necessary. This dedicated team managed and closely monitored VHA’s ability to continue to provide excellent service, the impacts of COVID-19 on our clients and families and on our staff and service providers, personal protective equipment supply and distribution, ever-changing infection prevention and control guidelines and recommendations and of course communications both internally and externally. I can’t say enough about the hard work, dedication and compassion of this 24-member team and how much we all learned.

During Wave 1 of the COVID-19 pandemic, VHA and our Incident Command Team was truly focused on learning – learning everything we could about COVID-19 so we could safely provide home care to Ontarians. Evidence was being generated from the scientific community, experiences were being shared from other countries and stories were emerging from all corners of our public health system. From Day 1 we used the scientific advice of Public Health as our guiding star and when they changed their course, we changed ours. At the beginning changes came very quickly and we worked tirelessly to keep up. As the months passed and the COVID-19 learning curve wasn’t as steep, changes to our procedures were made at a more manageable pace. All the way through we were able to deliver vital services while focusing on keeping our staff and service providers and the clients and families we serve safe.

In the early days of the pandemic, we made the difficult decision to discontinue some non-essential services to make sure we could continue to provide critical supports and care. Like most organizations, many of our staff needed to take time away from work to care for their own families, including supporting virtual learning for children, and we shifted most of our office-based staff to working remotely from home. Throughout, we worked closely with community partner organizations to develop best practices and provide support, including much-needed assistance in long-term care facilities experiencing outbreaks. We also fully participated in local, regional and provincial pandemic discussions, helping to establish consensus guidelines including universal masking in home care and safe provision of care in schools for children with complex medical needs. In some cases we implemented best practices before they became formal guidelines and helped others to be early adopters as well. It was one of the steepest learning curves we have ever been on.

Between January and June we also learned a great deal from our staff and service providers about what it is like to provide home care during a global pandemic. With coffee shops and public libraries and community centres shutting down, where could home care workers go to rest and take shelter between visits? How is it possible to keep a mask dry when showering or bathing a client who needs a great deal of support? How do you ask screening questions before a visit with a client who can’t answer the phone and can’t answer the door?

Just as importantly, we also learned a great deal from our clients and families. How can my child with complex medical needs wear a mask if their respirations and secretions need to be continuously assessed? Should I continue with my service during the pandemic or put it on hold to reduce the number of people in my home? If I put my service on hold how will I cope? Where can I get support with technology if I want to take advantage of virtual care at home? These questions and many more helped to drive our learning and guide our practices.

Over the past few months, we have shifted from steep learning to using our learnings. When community-spread of COVID-19 slowed down in May and June we shifted from crisis management through an Incident Command Team to incorporating these important ongoing efforts and activities into our everyday business practices. We launched an organization-wide virtual care program with an awesome team of volunteers to assist clients who need some guidance with technology. We implemented a community hub personal protective equipment (PPE) distribution model where PPE kits are transported by volunteers to a central location that is convenient for our teams and the kits are distributed by front line supervisors. This method of distribution also provides a fantastic opportunity for supervisors to connect with their teams and provide much-needed information, reassurance and education. We created a special COVID-19 clinical on-call team to support teams working at night and on the weekend. And we developed new models of care in partnership with our funders that have led to dedicated staff working in congregate settings.

So have we stopped learning? Not even close. With September here, the number of cases rising, schools opening and flu season coming, our commitment to ongoing learning and using those learnings to develop safe and new ways of providing home care continues. We are looking forward to being able to provide in-home testing to clients who need it and cannot get to a testing centre. We are excited about expanding our virtual services to include remote monitoring and clinical consultation including “nurse to nurse and client/family” support. We are eager to work with schools and school boards to assist in having our school-based clients be able to attend classes and receive care safely. And we are energized by our Ontario Health Team partnerships and the innovative ways these Teams are supporting clients and families in their communities.

Will we be relaunching our Incident Command Team? I don’t know, but we are ready. One thing I do know, and have learned during this pandemic, is that home is the safest place to receive care. And I know that VHA remains committed to learning, innovating and providing the safest home care possible. I invite you to connect with us and share your stories, questions, ideas and feedback by contacting communications@vha.ca. We are all on this learning journey together.

Kathryn Nichol
VP, Quality, Best Practice, Research and Education
Chief Nursing Executive