10 days to build a Covid-19 hospital: the digital challenge
Harrogate Convention Centre: Rapidly reconfigured as NHS Nightingale Hospital Yorkshire and the Humber (Image: Alamy)
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10 days to build a Covid-19 hospital: the digital challenge

James Lawrence — September 2020

At the peak of the Covid-19 pandemic in England, the country’s National Health Service established seven temporary, large-scale hospitals for critical care — in less than two weeks. We talk to Cindy Fedell, head of tech at Bradford Teaching Hospitals and Airedale Hospital, who was tasked with creating an IT operation in support of the ‘instant’ hospital in the Yorkshire and the Humber NHS region.

On the evening of Sunday 29 March, Cindy Fedell, the chief digital and information officer of Bradford Teaching Hospitals and Airedale Hospital NHS Foundation Trusts, received an urgent message from her boss. It confirmed a rumour she’d been hearing for a few days: she was to be the CIO of the Yorkshire and the Humber NHS Nightingale Hospital, one of seven critical care hospitals being set up urgently by the UK government in response to the escalating Covid-19 pandemic, amid fears that the nation’s health service would be unable to cope with the unprecedented surge in demand.

Cindy Fedell, executive chief digital and information officer, Bradford Teaching Hospitals and Airedale Hospital NHS Foundation Trusts
The problem was, this hospital didn’t yet exist — but Fedell, and all those involved in its creation, knew it might only be a matter of days before the UK literally ran out of intensive care hospital beds, forcing medical teams to make difficult decisions about how to care appropriately for patients. The challenge could not have been tougher, and the stakes could not have been higher.

Yet, just 10 days later, the hospital was primed to receive up to 500 patients.
Agile in action

First thing on the Monday morning after that message from her manager, Cindy Fedell found herself at the Convention Centre in the town of Harrogate (which had been identified as the most suitable site to be transformed into the new hospital), consulting with fellow digital leaders from the nearby Harrogate District and Leeds Teaching hospitals.

“We realised that the first things we needed were a network and software, as there was literally nothing,” she says. That meant using as much technology and support as possible from the nearby Harrogate hospital, and leveraging existing supplier relationships with the region’s hospitals to expedite the procurement process.

In order to make these kinds of decisions as rapidly and effectively as possible, while goalposts were constantly shifting, Fedell and everyone around her knew that agile methodologies were the only way to go during what was, effectively, a 10-day sprint on a massive scale. “It was a true example of agile in action,” she says. “We had a stand-up every morning and every evening, and all design decisions were either made there or vetted there.”

Some people needed a little time to adapt to this pace of decision-making. “You did notice whenever somebody new came along, it would take them about a day to get their head around the fact that we weren’t doing a lengthy process — we were going to decide right there and then,” she says. “I remember talking to someone who came in midstream and said they needed to consult with someone before acting. I replied, ‘No, we need to make that decision right now.’”

As well as setting the tone in this way, having the right people in place and operating outside of the usual hierarchies was also critical, she adds. “When I looked around at our stand-ups, they were all really good people. They were all senior enough that they had the experience to know what a good decision looked like, and could make it — and then had the authority to carry it out. It was the stand-up [team] that was empowered to make the decisions. For example, I would be clear: ‘This is what I’m putting in; this is what it will and won’t do.’ When the stand-up agreed that, everything was left to us to action and tighten up as we went along. It was a really rapid process.”

Being co-located with other empowered colleagues was also a huge benefit, says Fedell. “We were all in one big room. There was a digital table, an operations table, a nursing table, and so on — so you just went and found somebody to talk to if you needed something. And people came to us. We were next to the catering, so we had a lot of visitors!”
The lessons learnt

Fortunately, at the time of publication (late-September 2020), this Nightingale hospital has not yet been needed for Covid-19 patients; it is currently doubling as a radiology diagnostic clinic. But it remains on standby, should there be a major resurgence of Covid-19 cases in the region.

Meanwhile, Fedell is proud of what can be achieved when flattened teams, with a diverse range of skills, pull together with a shared purpose and a genuine sense of urgency. “If I look back at what we did,” she reflects, “even if I’d been given a year or two, we would have made the same decisions. So, going forwards, let’s get more ambitious — we know we can — and not worry so much anymore about organizational boundaries and whose job something is. Let’s just do this.”

Read more: Four digital leaders from the UK’s NHS on the pivotal role tech is playing in hospitals against the coronavirus

First published September 2020
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