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What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

Community Hospitals (CH) made important contributions during the Covid-19 response, demonstrating flexibility, resilience and innovation. CH are local hospitals, often rural, with around 500 throughout the UK. 3 examples of quality improvement and innovation have been shared on the Community Hospitals Association (CHA) website:

*Improved communication between patients, families and staff via new technology to encourage motivation and progress rehabilitation

*Improved skills and confidence through locally designed, rapid, virtual training for redeployed staff optimising flexibility and care

*Optimised use of therapy time through implementing home assessments remotely

The CHA is exploring collaborations, partnerships and practice making innovation possible, across acute, community, NHS, voluntary sector, patients, staff, families.

Individual innovations do not often effect wider change. Systematic survey and analysis of positive changes is required. Findings would be disseminated throughout the CHA, CH and community services to support sustainable improvements in quality for the benefit of patients, staff, services and the wider NHS.

What does your project aim to achieve?

The CHA aims to describe, support and promote innovation developed during Covid-19 through shared learning across the network of CH in the UK.

In-depth examination of highlighted case studies will aid development of a protocol to map initiatives nationally.

Using the CHA database, we will survey Covid-19 related innovations and best practice systematically at organisational level. Data collection will be by interview using a standardised protocol or aligned online survey completion. Additional case studies may be completed following data collection.

Analysis using QI methodology on positive impact changes, methodology used, collaborations making them possible and identifying key learning will allow assessment of longer-term impact and the challenges of sustainability.

Learning will be shared across the network of Community Hospitals.

A sample will be re-surveyed after six months to see if previous changes have been embedded or altered and if innovation shared during the survey has effected new changes in practice.

How will the project be delivered?

The CHA is a membership organisation established in 1969 and is a unique voice for Community Hospitals and their services, staff, patients and communities.

The CHA has the resources of a well-established voluntary committee to fulfil this work.  The committee is multidisciplinary with wide professional backgrounds and a network of contacts. The CHA website www.communityhospitals.org.uk illustrates the range of activities of the committee and members, including the Awards Programme for Innovation and Best Practice, the Research Programme working with 5 Universities, guest blogs, news items, and a resource page with a special focus on Covid-19.

A steering group including CHA committee members, members and academic colleagues will oversee the project. A part time assistant will be employed to undertake the project with support from the committee using QI methodology.  A project board would steer the work of those undertaking the study.

The steering group will meet quarterly and the project team monthly.

How is your project going to share learning?

The CHA has an established commitment to sharing learning.  During the pandemic this has been done virtually.

Learning will be shared on-line/face to face via focused seminars. Previous events have been well supported by CH staff and voluntary organisations e.g. Leagues of Friends. A Q Special Interest Group for Community Hospitals would be developed.

The project team have an active research interest and have published extensively in the field of CH care and policy (see website). A report and academic paper will be part of the output of the project. Those featured in additional case studies would be asked to write guest blogs and work would be shared using posters, infographics, case studies, forums etc.

CHA is active on social media and will use this mode to share learning and links to activity on the website

Individual lifetime membership of the CHA is free and recruitment of new members continues.

How you can contribute

  • We would welcome input from others on evaluating learning that has taken place during Covid-19
  • We would welcome input and learning from others regarding sustainability of positive impact changes once the context has changed
  • We would be interested to hear from anyone who identifies synergy with their project in order to support and share

Plan timeline

30 Sep 2020 Case Study identification commences
30 Sep 2020 Co-design survey with providers and test feasibility of study
31 Jan 2021 Learning from case studies identified
14 Mar 2021 Project Researcher Role Description completed
31 Mar 2021 If bid for funding successful advertise for Project Researcher
31 Mar 2021 Protocols for survey and interviews designed
30 Apr 2021 Community Hospital Q Special Interest Group established
30 Apr 2021 Steering and Project Group membership confirmed and meeting dates scheduled
31 May 2021 Project Researcher engaged
30 Jun 2021 Design dissemination programme including sharing emerging findings throughout the study
30 Nov 2021 Surveys and interviews complete
31 May 2022 Data Analysis complete with case studies identified
31 May 2022 Interpret and validate findings with members and steering group
31 May 2022 Themes identified
30 Jun 2022 Resurvey sample to assess sustainability
30 Sep 2022 Analysis of data from resurvey
31 Oct 2022 Interpret and validate findings with members, steering group and SIG
31 Oct 2022 Review themes
30 Nov 2022 Design learning points and share case studies e.g. infographics
31 Dec 2022 Finalise and release report, articles and material for sharing

Project updates

  • 17 Oct 2021

    October Update:

    We are delighted to have had such excellent engagement from provider organisations across the UK, and we are reviewing the data from interviews so far. Strong themes have emerged, and are being reinforced by subsequent interviews.  We will be concluding interviews this month (October 2021).   We have sufficient data and we are conscious of the pressures on the NHS.

    Themes for interviews – we are now further developing these in order to identify the Case Studies and Bitesize Learning we want to progress for sharing.

    Reporting – it was great to receive positive feedback from QExchange regarding our September reporting against milestones and our revised budget – lots of change since the original submission. Our Lessons Learned Log has been invaluable for reporting. We now have information on the final report format for QExchange (SQUIRE new to us but we are really enjoying learning new things!) and we are scheduling developing it.

    Project progression – we are on track to complete the planned work on time. Some really great discussions and learning about theme development, communication plans etc.

    Sharing the learning – lots of thoughts and discussion about how we might produce a range of material that will be accessible but relevant to different parts of our audience from frontline staff to commissioners. This has had a positive knock on effect for the CHA as it has made us think about our image and how we engage more widely with different groups. It has also made us think about where we can get support and expertise. We really like the thought of using infographics for the Bitesize Learning (2 of us attended the recent Q sessions and loved participating but not sure we have the skills required) and may approach the Sketchnote SIG for support.

    Lessons Learned Log – this and our Risk Log have been invaluable. It has been really helpful to look back and see the things we were worried about that never happened (what if we have no one to interview!) and also the things that we did not anticipate. For us, in any project in the future, this would be one of the key things to set up.

    QExchange – the support from the team has been really impressive. The sessions provided have been really valuable.  We have benefited from one of the team attending all of the Action Learning Sets.

    Workload – we have had lots of discussions about the amount of work the project has involved especially as we are volunteers in our CHA roles and all have day jobs. Despite the time required we are all so enthusiastic about the work, are coming away with more knowledge and skills than we had when we started and are really excited to be getting to the stage of extracting and sharing the learning.  Thanks QExchange for giving us this opportunity.

  • 12 Sep 2021

    September 2021: Q Report against milestones

    Our Q Exchange project continues to progress positively. We have been providing monthly updates on the Q Exchange Community Hospitals project page. This month we are providing a short update on the progress made against the original project timeline and how the outline plan for Q resources.

    QI methodology has informed our project. we have applied this to our project, ensuring all risks and lessons learnt are logged at each monthly Project Team meeting.

    You will see that some actions have been added, postponed or changed as we have implemented the project, as a result of PDSA cycles and lessons learnt reflection. We have been delighted at the engagement in the project we have had from community hospitals across the UK.

    Project Plan Timeline

    Date/Planned action/Update
    30 Sept 2020
    Case study identification commences
    This started ready for the bid submission

    30 Sept 2020
    Co-design survey with providers and test feasibility of study
    Completed

    31 Jan 2021
    Learning from case studies identified
    Completed as per timescale

    14 March 2021
    Project Researcher role description completed
    Completed as per timescale

    31 March 2021
    Advertise for Project Researcher if bid funding successful
    Completed as per timescale

    31 March 2021
    Protocols for survey and interviews designed
    Interview protocol completed. Decision was made not to complete the survey protocol until we had gained learning from the interviews.

    A decision was then made at the Project Group 1.9.21 that due to positive engagement and richness of interview data a survey is not required.

    30th April 2021
    Q Community Hospital Special Interest Group established
    Live from 10 March 2021. We have 21 members and we continue to encourage people to join via CHA newsletter, website and social media posts. We have very positive engagement through social media and people interacting with the CHA. No meetings have taken place but we are planning a participative event in the autumn.

    30th April 2021
    Advisory Steering and Project Group membership confirmed and meeting dates scheduled. Specific Terms of Reference agreed for the groups and meetings have been taking place monthly for Project Group and three monthly for the Advisory Group.

    31 May 2021
    Project Researcher engaged
    Just Ideas engaged to support with the project.

    30 Jun 2021
    Design dissemination programme including sharing emerging findings throughout the study
    Stakeholder mapping completed. Draft dissemination programme designed, which is constantly being updated.

    30 Nov 2021
    Surveys and interviews complete
    UPDATE- date collection progressing well with very positive engagement from organisations with community hospitals:

    ·        12 Interviews have taken place with 10 organisations across UK. This covers 75 community hospitals in those organisations.

    ·     11 further interviews have been agreed and are being planned.

    ·     1 organisation have staff wanting to participate but awaiting organisational approval.

    ·     Contacted a further 18 organisations

    Initial themes have been  reviewed which determined the interview protocol needed to be strengthened in some areas which has been completed in September 2021.

    New activity

    Oct 2021
    Commence the sharing of initial themes and case studies

    Initial themes shared with August 21 Advisory Group

    Date changed

    31 December 2021 Data Analysis complete with case studies identified

    Jan/Feb 2022 Interpret and validate findings with members and steering group and finalise report with other dissemination of findings

    Decision will be made whether a resurvey will take place, to assess sustainability in May 2022.

    May 2022
    Themes identified

    30 Jun 2022
    Resurvey sample to assess sustainability

    30 Sep 2022
    Analysis of data from resurvey

    Additional activities

    Date/Planned action/Update
    Commenced in June 21
    Develop and complete QI documented approach for the project – Completed 4.8.21

    Commenced in July 21
    Develop project evaluation plan and monitor agreed metrics every 2-3 months
    Completed with first monitoring report 1.9.21

    Commenced in June 21
    Develop and complete stakeholder mapping and a plan for dissemination of learning
    Stakeholder mapping completed in June, learning dissemination is planned and will be further developed through PDSA cycles

    Commenced in March 21

    Social media communication – Ongoing and gaining significant engagement

    Commenced in August 21
    Rebranding work Final draft of rebranding to enable increased engagement – Completed in September 21

    Outline plan for Q resources

    As the project has progressed, the Project Team have determined the importance of sharing the learning, as community hospitals have been very enthusiastic to engage and share their experiences and learning. This is reflected in the updated resource plan to spend resources on activities to enabling sharing across community hospitals.

    Plan                                             Year 1                                       Year 2
    Subcontracting                         15k committed                 3k planned Reduced to 1k
    Activities to enable dissemination and sharing, including design of materials
    5.8k                                    3.3k
    Running costs                           0.7k                                    0.7k
    Travel and subsistence           Not required now            0.5k
    Total                                           24.5k                                  5.5k

  • 15 Aug 2021

    We are amazed to find ourselves in August already.

    July has been busy.

    We have commenced working with Just Ideas – it has been great doing some joint interviews with them, learning together. They are now doing the majority of the interviews.

    We are really fortunate to have Heather Penwarden https://q.health.org.uk/community/directory/heatherpenwarden/   take over as chair of the Advisory Group. Heather has such a wealth of knowledge, experience and passion for Community Hospitals and we are looking forward to her leadership of this group.

    We have completed more interviews – the learning continues and each time we are humbled by the work that has been done across Community Hospitals during Covid-19.

    We have started to think about templates for sharing the learning and Q Community have been very supportive with members of different Special Interest Groups sharing their templates and knowledge.

    We were so fortunate to have  Emma Adams Generation Q Fellow attend our July Project Group – it was great to talk through our methodology, think about quality versus quantity and our evaluation. It also made us think about how we capture more explicitly the PDSA cycles we have completed.

    As expected engagement has dipped slightly due to the increase in Covid-19 and subsequent system pressures and school holidays.

    We have had some interesting discussions about how we can be as inclusive as possible of the broadest range of Community Hospitals models. We made it complex and then focused it back down on seeking engagement across a wide range of organisations based on geography, those that engage and as always personal connections. We will continue to review engagement as part of our Project Group meetings.

    We have sent out our Feedback Survey to the first 10 organisations interviewed – Google Forms posed a few challenges (yet more learning!) but we are hopeful of a good response rate.

    Looking back at our Learning Log has been helpful in seeing our journey so far – sometimes it is too easy to look at what is in front of you and not appreciate the learning so far.

    We have learnt more about the IHI Model for Improvement (Institute for Healthcare Improvement), Appreciative Inquiry and Experience-based co-design which all inform our study.

    The enthusiasm for the project continues –  what can we say – Community Hospitals are simply fantastic!

  • 12 Jul 2021

    We have now completed 8 interviews and we continue to be overwhelmed by the enthusiasm for sharing the learning that has happened across Community Hospital during Covid.

    We have had an amazing workshop with Emma Gibbard (Q member and Research Impact Manager, University of Bath) on evaluation – it has really helped us to think through and refine outputs, stakeholders and metrics – in hindsight doing this earlier might have saved us time as it would have helped clarify our processes and scoping.

    Emma introduced us to Google Jamboard – the Project Group are now converts!

    We have done our first follow up interview in relation to a potential case study.

    We are identifying  potential case studies and nuggets of learning to be shared as well as emerging themes.

    We have engaged Just Ideas as Project Researchers and are really  excited about the experience and different perspective they will bring. You can find out more about them here: https://just-ideas.co.uk/

    We are adding in a questionnaire for the first 10 interviews to gain feedback on the interview process.

    We are continually adding to our learning log and thinking about how we share this widely.

    We are giving thought to our interim report for Q Exchange – so much to share and reflect upon.

    We are celebrating the experience and knowledge our Advisory Group and Project Group members bring by sharing a synopsis of their biographies on social media over July.

    As a Project Group we are learning lots about each other and developing new skills and knowledge.

    We remain as enthusiastic as ever and feel more privileged than ever to be able to take this project forward.

    If you want to find out more about the CHA follow this link to our website: http://www.communityhospitals.org.uk/

  • 12 Jul 2021

    We have now completed 8 interviews and we continue to be overwhelmed by the enthusiasm for sharing the learning that has happened across Community Hospital during Covid.

    We have had an amazing workshop with Emma Gibbard (Q member and Research Impact Manager, University of Bath) on evaluation – it has really helped us to think through and refine outputs, stakeholders and metrics – in hindsight doing this earlier might have saved us time as it would have helped clarify our processes and scoping.

    Emma introduced us to Google Jamboard – the Project Group are now converts!

    We have done our first follow up interview in relation to a potential case study.

    We are identifying  potential case studies and nuggets of learning to be shared as well as emerging themes.

    We have engaged Just Ideas as Project Researchers and are really  excited about the experience and different perspective they will bring. You can find out more about them here: https://just-ideas.co.uk/

    We are adding in a questionnaire for the first 10 interviews to gain feedback on the interview process.

    We are continually adding to our learning log and thinking about how we share this widely.

    We are giving thought to our interim report for Q Exchange – so much to share and reflect upon.

    We are celebrating the experience and knowledge our Advisory Group and Project Group members bring by sharing a synopsis of their biographies on social media over July.

    As a Project Group we are learning lots about each other and developing new skills and knowledge.

    We remain as enthusiastic as ever and feel more privileged than ever to be able to take this project forward.

    If you want to find out more about the CHA follow this link to our website: http://www.communityhospitals.org.uk/

  • 12 Jun 2021

    Once again we have had a busy few weeks.

    We have interviewed and offered the Project Researcher role. Just Ideas will bring a range of different skills and knowledge once in place.

    We have conducted another 2 interviews with a Community Hospital which is helping us to refine our processes. The richness of the data is confirming the value of doing this project. We have more planned across the coming weeks.

    We have potentially identified our first in depth case study.

    We continue to set up interviews with interested Trusts and have identified our next potential organisations to approach.

    We continue to be overwhelmed with the enthusiasm from organisations we are engaging with.

    We have completed our DIPA.

    We have held our first Advisory Group – the quality of membership is inspiring (and everyone we asked said yes!). It was a productive meeting with lots of questions, healthy challenge, sharing of wisdom and resources and advice on how we could improve the processes and project.

    Some project group members accessed the Q Evaluation Workshop which they found informative and inspirational.

    We have agreed our project hashtag – #QICommunityHospitals

    We are on or ahead of target with all our key milestones.

    We are thinking about and discussing our evaluation and dissemination strategies in greater detail.

    Our monthly Project Group Meetings continue and are as packed as ever.

    As a group we continue to be very excited about this work. As volunteers within the CHA I think it is fair to say that we had underestimated the amount of work we needed to do but with each step we are gaining new skills and knowledge, learning more about all things QI and forging new relationships while continuing to be inspired by the work done in Community Hospitals.

    We are so grateful for the opportunity to do this work.

  • 12 May 2021

    What a packed Project Group meeting we had last week – 90 minutes of review, reflection, planning and discussion.

    Interviews planned for our Project Researcher next week and questions drafted

    Pilot interview conducted, the process was reviewed and additions made to Participant Information and Interview Schedule. Reflected that telling their story was cathartic for those involved.

    First 10 organisations – we set ourselves a challenge to make contact with 10 organisations to test engagement and check our processes were correct and complete, positive engagement from all of them and they cover 3 of the 4 nations

    The Advisory Group is complete following confirmation of Emma Adams and Roy Lilley (CHA Patron) as Professional Advisors.  We now have an excellent mix of experts including the voice of the patient and League of Friends. We have been humbled by the willingness of others to support and share knowledge. Our first Advisory Group meeting is later this month.

    Our DPIA is underway.

    Our Highlight report is ready for the Project Board this week.

    We have had a really helpful discussion about QI methodology with Emma Adams and are working on this currently.

    We are in the early stages of planning our first Community Hospitals Special Interest Group Forum.

    We thought we were excited when we were awarded funding but as the weeks go by and the engagement and enthusiasm of participants and the project group grows we feel so privileged to be able to do this piece of work, ensure Community Hospitals are heard and the work they do valued and shared.

  • 24 Apr 2021

  • 11 Apr 2021

    It was so exciting to meet the Q Exchange Team and some of the other 29 Award Winners at the welcome event on 23.3.21

    The information on next steps and learning support was very welcome and we cannot wait to get the contracts signed and work fully underway.

    While waiting for the formalities to be concluded we have already been busy. We have updated our Information Governance policy, drafted all of our project documents, started our project group meetings, invited our Advisory Steering Group members to join (and they said yes!), drafted our participant information and identified our first pilot site. Our request for quote for a Project Researcher is out and we have already had some interest (details are on our website below)

    http://www.communityhospitals.org.uk/q-community.html

    Our Community Hospitals Special Interest Group is live

    https://q.health.org.uk/community/groups/community-hospitals/

    We have also learnt a lot:

    • Don’t underestimate the time the Q Exchange paperwork will take
    • Using the skills within your team to the utmost is helpful, having an experienced clinician with strong project management skills on our team is invaluable
    • Other people have been equally excited by our success and the project we will be undertaking and are happy to support – you just have to ask
    • The Q Exchange Team are incredibly supportive and the wider Q Community have a broad range of skills and knowledge they are happy to share
    • QI is such a good approach to sharing, learning and developing and sits neatly alongside the innovation and best practice values of the CHA
    • Sunday is not a good day to be trying to identify a tax number!

    If you want to know more about the Community Hospitals Association (CHA) head over to our website: http://www.communityhospitals.org.uk/index.html

Comments

  1. Evelyn,

    This is a great idea and I do hope that you take it forward. If you need any process visualizations done then please let me know as I'd love to help. Good luck with your idea.

    Tom

    1. Thank you Thomas. Very kind of you. Yes we would love to be in touch and take you up on that.

  2. This looks like a great idea. Have you thought about how you will entice groups/organisations to share their experiences - is there an established community of practice or culture in the community hospital network of doing this?

    1. Hi Tamar. Good question, thank you! Yes fortunately we have a very well developed network that continues to grow. Provider organisations and individual community hospitals share their experience continuously such as through our regular CHA members discussion forum by zoom, our guest blogs on our website, and our Innovations and Practice awards.  Also, as part of celebrating 50 years of the CHA, we are sharing good practice that organisations have offered us. A key feature is their response to Covid-19. We would love to extend our network further through this proposed study, learn about more examples of quality improvements and consider issues of sustainability.

  3. This sounds very interesting! Have you thought about how many case studies you will have? We will be aiming to recruit 8-10 sites for our study.

    1. Hi Michaela,

      Glad you think it is an interesting idea.

      We have a few already in the pipeline and hope to generate some more from our Innovation and Best Practice Award applications which close later this month.

      We also anticipate identifying some additional ones from the surveys as the project progresses.

      I suspect we will end up with a similar number.

      Evelyn

  4. Hi Evelyn and Helen, I wondered if you have thought of evaluating the innovations using the Sustainability in Quality Improvement framework / sustainable value - ie. impact on health outcomes for patients and populations alongside environmental, social and financial costs/impacts? It's described more fully at https://sustainablehealthcare.org.uk/susqi and I'd be really happy to discuss if you are interested.

    1. Thanks Frances, some really interesting work on this site.

      We will be exploring it fully.

       

      Evelyn

    2. Thank you.  I have had a look at the website and some of your published papers.  Thanks for directing us to this.  Very helpful. Yes we will be in touch.

  5. Guest

    Trish Jay 1 year ago

    We have heard from many community hospitals about their contribution and developing services during the coronavirus pandemic. It is important to collate this nationally in order to continue to promote and support care closer to home where it is possible.

    1. Thanks Trish, Community Hospitals make a vital contribution but often get lost between acute and primary care. This work would shine a spotlight on them but also promote innovative practice closer to home which is in line with health and social care agendas, supports environmental sustainability and we know that patients and communities value them as shown by the Birmingham research: https://www.journalslibrary.nihr.ac.uk/hsdr/hsdr07010#/abstract

       

      Evelyn

  6. I sent this to you directly...

    We have looked at staff wellbeing and job confidence in several settings. Our measures are described on https://r-outcomes.com.

    A csae study of their use in care homes is at https://bmjopenquality.bmj.com/content/8/2/e000621.

    I will be glad to help further.

    1. Thank you for sharing, as Helen said really interesting.

       

      Evelyn

    2. Thank you very much Tim. I found your website to be really helpful, and I have put a link to it from our CHA website http://www.communityhospitals.org.uk/coronavirus.html

      Thank you very much for your offer of help. Yes, lets keep in touch.

       

       

  7. Hi Evelyn and Helen

    I wonder if you've connected with the Beneficial Changes network being co-ordinated by NHS England and NHS Improvement that has 16 different workstreams capturing and analysing changes and improvements that have emerged through COVID-19 https://future.nhs.uk/BeneficialChangesCOVID19/grouphome  and you can contact the programme team on england.improvementsupporthubpmo@nhs.net. Matthew Winn, National Director of Community Health Services and CEO of Cambridgeshire Community Services NHS Trust is leading the community services workstream.  It might be useful to see what's already been shared to inform your work?

    1. Thanks Karen for directing us there, I have located the page and will follow up.

       

      Evelyn

    2. Karen  Thank you so much. This will be well worth following up. We are grateful to you.

  8. Great idea folks - this recent guidance on capturing organisational learning and sustaining change from the Chartered Institute of Ergonomics and Human Factors and NHS Education for Scotland may be useful:

    https://learn.nes.nhs.scot/33851/human-factors/organisational-learning

    Good luck

    1. Thank you, just had a quick look and it seems like a great resource.

       

      Evelyn

  9. Guest

    Ruth Rankine 1 year ago

    Hi, can I point you this briefing from Confed community network which highlights case studies (not Covid related but still relevant)

    https://www.nhsconfed.org/networks/community-network/neighbourhood-integration-project

    1. Really helpful Ruth, thank you

       

      Evelyn

  10. We are working in Rugby and want to restore our local hospital to provide more services.  I know communities really value their hospitals and the quality they deliver.

    So keep up the good work on this. Small is Beautiful

    1. We would certainly agree Keith

       

      Evelyn

  11. Guest

    Helen Ballam 1 year ago

    I think it’s a really good idea. I have found the meetings really useful to establish contacts, share practice and learn from others. We have undergone rapid change with more to come. If the rumour around increase in district general hospitals is true, community hospitals will rise in popularity again.

    1. Thanks Helen, it is great to hear from those in Community Hopsitals that this work adds value.

       

      Evelyn

  12. This is a great idea which captures the spirit of learning, sharing and building new services arising from COVID-19. You've expressed a really clear plan for carrying out the work, and have a great network to build on. If you would like more collaborators from the Q community, can I suggest you have a look at the online groups and consider posting a link to your ideas there? There is one specifically on community services, but there may also be others where you could potentially find useful connections. Best wishes, Emma

    1. Dear Emma

      Thank you so much for your comments.  We have now linked to one of the groups as you suggest. Fantastic to have support from you.  We are so impressed with the flexibility of community hospital staff and services during Covid-19 - we think it will be a fascinating study on adaptability, resilience and quality improvement.  I would love to follow this up with you if at all possible and connect further. Thank you.

       

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