Covid19: Proposals for administrators and oncologists to work from home

The covid crisis has disrupted the pattern of work that we are used to. As the oncologists are forced to quarantine, and we explore different hypofractionation methods to accelerate the pace of treatment, so far, a group hive has been able to generate some excellent suggestions. The virus outbreak, as a pandemic, has brought in a sudden transition. This is an essential guide for the administrators and the doctors at the frontline to fight the diseases (some suggestions are overlapping and have a commonality to them).

For hospital administrators:

  1. Get the infrastructure right. Zoom/Microsoft Teams/Google Hangouts (or something similar) is being rolled out- but it usually not the best solution. Specific niche verticals offer the video conferencing solutions and having sit through some of them for virtual tumour boards, I can testify that jitters, echoes and lags are a real problem. This will be exacerbated by the sudden pressures on the existing broadband networks. My suggestion is to keep it simple one to one video calls; keep it short and stick to emails (I recommend and use Fastmail). Don’t ignore the costs involved! It can scale up drastically!
  2. Take care of psychological distress. The IT teams are likely to be overwhelmed with support tickets as people would call or try to escalate the issues as they develop. A constant reassurance and transparency indicator would help. (A dashboard to indicate the availability of services/status of support tickets, etc.).
  3. On-Site, redundant solutions. Cloud computing is the rage, of course. However, I’d reserve it only for the backups and archiving.
  4. Allow flexibility in work processes- employees may have someone who needs tending/caring. Day schools get cancelled and would add to additional burden on individuals and families.
  5. The administrators need to set the priorities straight- how often they need to utilise the video resources; virtual meetings, and quickly cycling through agendas.
  6. Identify the end-users who are not adept at technology and different solutions. Hand holding may not always be possible; hence a playback of video conferencing needs to be provided as a “catch-up solution”.
  7. Employees managing critical solutions require extra resources and isolation to keep them away from getting infected. The RT Technologists, for example. Intensivists, Mechanical Ventilator operators, back up biomedical teams are part of the critical infrastructure, for example.

This calls for a radical overhaul of the entire infrastructure. As radiation oncologists, we would also be faced with the issues related to the management of side effects, triaging and identification of patients requiring testing for the coronavirus. How do we plan, decide and implement for those requiring the urgent implementation of plans- say for painful bone metastases?

Productivity is an abstract notion- the “end result” achieved. I have tried with the remote “contouring sessions”, but again, the lag and jitteriness are jarring.

For the oncologists:

  1. Virtual meetings require ground rules. The leaders have to ensure a clear agenda before everyone hops on video.
  2. It would be useful to check on everyone at the outset- on how they are coping up etc.
  3. Leaders have to trust individuals and subordinates to understand ground rules.
  4. Follow up every virtual meeting with email or preferably a Telegram group chat. Telegram allows native polls, and it would help to get immediate feedback loop to improve processes for the next meet up.
  5. Not everyone would feel “psychologically safe”, and the meetups require a leeway.
  6. Those trailing behind- being unable to contribute or not following up on emails/conversations, need to get the support accordingly.

I do see a positive trend going forward. I have always remained a votary for incorporating technology with the workplace, and I stay open to experimenting. However, I do realise that not everyone is on the same page when it comes to adoption of technology resources. I am anal about the video and audio codecs or even working on the best mic for sound clarity, but not everyone would see it the same way.

Therefore it is imperative to align the common interests towards achieving the productivity goals and establishing ground rules appropriately. Mobile healthcare has several fascinating dimensions, and this is one of them.