Relocating an Acute Medical Ward following the Christchurch Earthquake

Summary

The magnitude 6.3 Christchurch earthquake struck the city at 12:51pm on Tuesday, 22 February
2011. Christchurch hospital (650 beds) was severely impacted. Three medical wards were
permanently closed. 33% acute medical capacity lost. The team of one of the closed wards was
given a task to set up and run acute medical ward at the different hospital within a week from the
day of the earthquake.

The Problem

To relocate an acute medical ward, including staff and equipment, during ongoing seismic activity
and potential danger to life. Strict time constraints. The ward the team was moving to lacked
proper infrastructure. Need to create new ways of working. Need to provide ongoing wellness
support to staff involved.

The Consequences

The team of nursing and support staff which is described in this case study were given the task to
relocate. At the time, this was a 27 bedded acute general medical ward. The team included Charge
Nurse Manager, thirty one nurses, ten healthcare assistants, and three clerical staff. The team had
to operate under tight time constraints and were expected to become fully operational with new
admissions within three days from relocation. The ward space the team moved into lacked proper
infrastructure. Many staff lost their houses, their life routine was disrupted. Many suffered from
psychological shock and have required ongoing wellness support.

Barriers / Obstacles

• Strict time constraints

• Lack of proper infrastructure in designated ward
• Lack of established medical support
• Physical distance from main hospital
• Designated ward was located in the older persons hospital not designed for acute medical
patients.
• No ED, ICU and minimal afterhours medical support
• Traumatised staff
• Lack of clinical protocols
Actions

Relocation of the team involved complex planning and intricate execution, compounded by
ongoing seismic activity. The process was supported and co-ordinated with senior hospital
management, logistics, IT team, orderlies, and the New Zealand Army. The senior management
support was detrimental to successful relocation of services. Following the relocation, the
sustained team performance was supported by the integration of four core RHC potentials:

Potential to respond:

• Supporting emerging behaviours

• Embedding workarounds
• Running upskilling sessions
• Implementing shared and collaborative leadership

Potential to monitor:

• Monitoring threats and identifying opportunities

• Early identification of stress and fatigue
• Timely and appropriate staff well-being support

Potential to anticipate:

• Identify any possible developments

• Staff debrief
• Identify any learning opportunities going forward

Potential to learn:

• Simulation scenarios
• One on one and group reflection
• Double loop learning

A process of ongoing realignment between WAI and WAD at team level played a very important
role in ensuring resilience performance.

What Worked?

Establishing clear communication across a team, and transparency, trust, and open engagement
assists in turning this process into a learning opportunity for a whole team. Collaboration,
innovation and engagement between team leaders and other team members contributes to an
overall team’s resilience.
What Didn’t Work?

• Physical distance between two hospitals and a need to transfer clinically unwell patients to
the main hospital.
• Need to use private radiology facilities in the older persons hospital resulted in increased
running costs.
• High level of personal stress among staff members and a constant need to monitor and
support wellbeing.

Outcome

Following a successful trial two remaining evacuated teams were moved to the same location.

Development and immediate implementation of innovative models of care. Direct acute medical
admissions from community into three relocated wards bypassing ED. New model of team-based
nursing. Collaborative leadership model across all three wards.

Team demonstrated remarkable ability to go beyond their original level of functioning and to grow
and thrive despite repeated and prolonged exposure to stressful experiences.

Lessons Learnt

Our experience has clearly demonstrated that to develop a potential for resilience the following
components must be included in team dynamics and performance:

• Development of situational awareness and anticipatory thinking.

• Creating psychologically safe environment.
• Implementation of scenario-based learning and promoting reflection practice.
• Supporting and promoting informal leadership within the team.
• Setting up robust shared leadership practices.
• Ongoing development and support of staff well-being by providing adequate resourcing.
• Early identification and management of burnout.
• Monitoring early signs of PTSD.

Questions

1. How would you establish and promote shared leadership in your team? (minimum
150 words)
2. What are key components in creating psychologically safe environment in your
team when facing an evolving crisis? (minimum 150 words)
3. Will applying existing policies and procedure during prolonged critical event
support or hinder resilient performance? (minimum 150 words)
 4. How would you look after your own well-being and build your personal resilience
during protracted crisis event? (minimum 150 words)
5. Describe efficient and people focussed ways to promote learning practices during
the crisis. (minimum 150 words)

References / Bibliography

McIntosh,J., Jacques, C., Mitrani-Reiser, J., Kirsch, T., Giovinazzi, S., Wilson, T., (2012) “The impact
of the 22nd February 2011 Earthquake on Christchurch Hospital”. New Zealand Society for
Earthquake Engineering (NZSEE) conference proceedings, Christchurch, New Zealand.

Richardson, S., Ardagh, M., (2013), “Innovations and lessons learned from the Canterbury
earthquakes”. Disaster prevention and Management, 22 (5), pp. 405-414.

West, M., Eckert, R., Steward, K.,Passmore, B (2014).,Developing Collective Leadership for
Healthcare. Kings Fund, London.

Ardagh, M., Deely, J.M (2018) “Rising from the rubble.” Canterbury University Press

Zhuravsky, L “When Disaster Strikes: Sustained Resilience Performance in an Acute Clinical

Setting” In: Hollnagel, E., Wears, B., Braithwaite,J., (Eds.) Delivering Resilient Health
Care, 2019, Routledge.

About the Author

Lev Zhuravsky, BA, PGCert Crit.Care, PGDip HealMgt, MHealSc (Health Management), PhD Cand.
University of Otago

Lev is an experienced health practitioner with expertise in critical care and trauma nursing,
hospital operations management, and disaster response.

Lev is researching the application of Resilience Engineering in a complex health care environment
and has particular expertise in building high performance and resilient teams based on principles
of RE and collaborative leadership.

He has published a number of papers and book chapters dealing with various aspects of resilience
and widely presented at numerous international conferences and congresses.

Lev is a Recipient of Christchurch Earthquakes Award.