TY - JOUR T1 - Lessons in cognitive unloading, skills mixing, flattened hierarchy and organisational agility from the Nightingale Hospital London during the first wave of the <em>SARS-CoV-2</em> pandemic JF - BMJ Open Quality JO - BMJ Open Qual DO - 10.1136/bmjoq-2021-001415 VL - 10 IS - 3 SP - e001415 AU - George Benjamin Collins AU - Nikhil Ahluwalia AU - Lynne Arrol AU - Natalie Forrest AU - Alan McGlennan AU - Ben O'Brien AU - Alastair Proudfoot AU - Matthew Trainer AU - Richard Schilling AU - Eamonn Sullivan AU - Mark Westwood AU - Andrew Wragg AU - Charles Knight Y1 - 2021/07/01 UR - http://bmjopenquality.bmj.com/content/10/3/e001415.abstract N2 - The Nightingale Hospital London (NHL) was the first of seven new UK National Health Service (NHS) hospitals designed to address the potential shortfall in critical care capacity caused by the rapidly escalating first wave of the SARS-CoV-2 pandemic. When scenes of hospitals at risk of saturation were being broadcast internationally, the initial NHL mandate was to deliver a large-scale intensive care unit (ICU) for up to 4000 ventilated patients to increase the capacity of London’s existing hospitals. Before this, ICU bed capacity in London and England was 839 and 3766, respectively.1 Healthcare projects of this pace, scale or complexity are usually overseen by experienced teams over many years, and within specifically designed environments and timetables.2 However, the NHL was constructed in an events centre, and started accepting patients within weeks of conception. The newly formed NHL leadership team was redeployed from different hospitals across London at a time of unprecedented national uncertainty, before disease-modifying COVID-19 therapies were approved and when staff in existing hospitals were preparing ICU expansions of their own.3This unique mandate resulted in the NHL being exposed to a level of potential risk and vulnerability to human error that healthcare services have worked to reduce in recent years.4 5 Fortunately, due to lockdown restrictions and ICU expansion in existing hospitals, only 54 patients were admitted to the NHL. Therefore, in comparison to forecasts, existing hospitals and its potential capacity, the overall contribution of the NHL to the ICU COVID-19 response in London was relatively small. Importantly, however, clinical outcomes were comparable to existing hospitals. NHL patient mortality was 48.1% compared with 47.7% nationally, and the requirements for, and duration of, organ support were also similar.6 Although its true potential was fortunately never reached, the NHL did fulfil its role in urgently providing … ER -