Undeniably, the early months of the pandemic brought significant challenges, and a devastating loss of life. It was also a time when people experienced the health care system working effectively to deliver change at pace.

Teams continue to work in rapid and unprecedented ways now. But as we move further away from the those first few months, with a second lockdown coming into force and a challenging winter looming, it can feel hard to grasp onto the things that were energising during that initial period.

Between May and August, the Q team heard from over 700 people working in health and care across the UK and Ireland as part of our Rapid Learning and Improvement during COVID-19 workshop series. The workshops provided a much-needed space for people to pause, reflect and connect with others in this turbulent year. Despite the challenges and stresses, participants shared positive and motivating experiences of collaboration, staff involvement, innovation and learning.

Here I summarise the collective knowledge and reflections gathered during those workshops, and how experiences changed over the months. I focus on four areas where progress has been made, and highlight questions to ask ourselves to build on this progress.

More joined up working, collaboration and shared purpose

The crisis started with the feeling of ‘all being in it together’. We heard how COVID-19 brought necessity and urgency, and united people with a clear common goal.

[There is an] overwhelming single imperative to work together

We heard that barriers were broken down across organisations and systems, new collaborations across the health care system were built rapidly, and there was better joined-up working across services.

By the late summer, it felt like some of those newfound relationships and sense of togetherness had started to weaken. Silos were re-emerging, and the shared purpose created in the early weeks of the pandemic was gradually giving way to separate professional and organisational priorities again.

Building from here

In the future, participants wanted to see health and social care truly collaborating, with joined up planning and unity across the system.

• How can we maintain the shared sense of purpose?
• How can we identify and build on the bonds that began to form, and mitigate the risk of silos re-emerging?

Staff involvement and team-working to deliver change

People experienced increased autonomy, local decision making, and a more permissive culture during the height of the first wave of the pandemic. They experienced more dispersed leadership, with power given to frontline teams to make changes.

Staff engagement has been a key factor is what has delivered success and we absolutely need to build that in the future

Through this they recognised and reflected on the power structures typically at play. They saw that people at all levels are well placed to make changes – not just those in senior positions.

It was clear that enabling leadership – where leaders are supported to ‘give up’ power and focus on providing the conditions for teams to explore solutions together – was highly valued.

Building from here

Recognising that autonomy, less top-down imposition and more voices in the room where decisions were made helped innovation to flourish, participants wanted to see this continue. They wanted to be given the power and opportunities to create solutions.

• How can we build on these experiences to support more innovation?
• How can leaders be equipped to give up power?
• What can we learn about empowering and enabling teams to deliver improvements in care?

Greater emphasis on innovation over risk management

Participants experienced the removal of ‘red tape’ in the immediate aftermath of COVID-19. The process to get approval and sign off became much less bureaucratic. Decisions were made more quickly, with fewer layers of management involved.

[A key risk is that] we revert back to heavy-handed structures and systems which once again restrict activity, flexibility and innovation

People spoke about how this was enabled by a changed interpretation of governance processes – moving from a risk averse approach to supporting changes at pace. Participants felt they had agency to act and were thinking more creatively.

Many people spoke of a ‘test and learn’ ethos, with less thinking and more doing.

Building from here

Now that we know that rapid change is possible, participants did not want to revert back to previous ways of working – and expressed concerns this may happen by default.

• How can we support and encourage people to innovate, and learn by doing?
• What conversations need to be had, with whom, about managing risk in ways that enable innovation to flourish?

Having a reflective, evaluative learning culture

The pace of change during the pandemic raised questions about how the health care system supports learning. We heard how people were placing greater value in evaluation and learning – with participants acknowledging the importance of capturing, using and sharing learning across networks to improve services.

In our team we have been looking to create moments of reflection and surface personal learning

Despite the lack of time and space for reflection, participants recognised the importance of taking a whole-team approach to learning.

Building from here

Participants wanted to maintain their focus on learning and reflection – losing this now would feel like a missed opportunity.

• How can we champion structured approaches to learning (especially learning from failure), so it becomes an integral way of working?
• How can we maintain the importance of reflection, learning and sharing across teams and wider networks?

Looking to the future

It was incredible to hear just how much workshop participants had learnt from the experience of COVID-19. In the face of adversity, they shared positive changes that went beyond service change to fundamentally different ways of working together. We know that sustaining some of these changes will be challenging as the pandemic continues.

While finding time can feel hard, the workshop series showed the value of giving ourselves the space to pause, think, and reflect even in the midst of rapid change.

As we look ahead – to the coming months as COVID infections rise again, and well beyond to the future health care system we want to build – I hope that taking the time to explore just some of the questions raised here can help us to keep hold of and harness that positive progress.

Tools and resources from the workshop series

Look back at the tools and resources that were used in the workshop series:

• Principles for learning as a team or system during COVID-19
• Practical learning from the Q team to help you run virtual workshops
• Using tools from futures and foresight to manage uncertainty and plan for the future

This blog complements other work by the Q community and the Health Foundation exploring and supporting rapid improvement and service change as a result as COVID-19. Take a look at the long read on Understanding and sustaining the health care service shifts accelerated by COVID-19, browse our interactive infographic on the rapid implementation of video consultations, and keep an eye out for the soon-to-be-published results of Q’s survey to understand the role of improvement during the pandemic.