Table 2 Examples of the key changes over time evident in participant responses to the series of interviews across the 16-month study period

Senior executive

Quote 1 (April 2020): “So the biggest stressor for the staff on the floor has been about PPE and it has come because of people’s interconnectedness, so our executive very early on took the position that what DHHS say is the rules … and as you know, this is has been pretty conservative in terms of their PPE guidance, but [some] midwives know someone at [Hospital 1], knows someone at [Hospital 2], knows someone at [Hospital 3], … they are all wearing scrubs for their whole clinic, they are all wearing a surgical mask for all their clinic … so all of the first 2 weeks of April was all about PPE.

Quote 2 (September 2020): “I spent all of my holidays on email, managing anxiety primarily about PPE. People wanting to wear masks, wanting to wear scrubs, wanting strict visitation, but at that time that was not the recommendation from DHHS”

Quote 3 (June 2021): “What went well was that not needing to individualize your institution and the rules, “these are the rules, from the department” so that was a really good thing … I think what’s different now is that that information from the Department to the hospital to the staff is more rapid and systematic than it used to be, somewhat ad hoc.”

Needing to adapt and alter services - guideline development and changes

Needing to filter and translating information – PPE guidelines

Maternity unit manager

Quote 1 (April 2020): “My head of unit and myself have been very consistent in our messaging to our workforce, both nursing and medical, since late February. So we send out an email three times a week to our staff base where we collate information relevant to our staff base and put it into a single email because obviously people get information from everywhere, its information overload.”

Quote 2 (June 2021): “it’s been about making sure that the staff have the information they need because they are being inundated and the messaging within [Hospital] is very good and we are often ahead of the messaging that comes out from the department, so it’s been about filtering that. That takes a bit of time and it took a bit of getting used to as well and figuring out the best means of communication for the team because at the end of the day communication is key, so that’s probably been the hardest thing to figure out what works well and same thing doesn’t work, like if you have got an urgent message that’s different to your weekly wrap up emails or whatever happens to be and I think there is email fatigue, I think a lot of people have email fatigue at the moment and I think that’s hard when that’s the expectation and how you going to get your information out to your staff.”

Needing to filter and translating information – communication channels, what works best

OBGYN

Quote 1 (March 2020): “We are still waiting on workflows and clinical practice guidelines for staff and it’s increasing staff anxiety, so much like we’ve seen at a national level, politically, people actually want information and want transparency and I think that that would actually help a great deal in terms of staff anxiety and preparedness”.

Quote 2 (June 2021): “Initially we did a lot of simulation specifically to design the protocols and guidelines and everything for COVID and then donning and doffing and PPE and then as things progressed we didn’t really need to do that quite as much because people were familiar with that and then as we were coming out of lockdown, we started fit testing, so also people were getting a bit more education about PPE but also I think there was a lot more awareness of the new guidelines that had moved to actually recognition of COVID is airborne”

Needing to filter and translating information – guideline development and dissemination

The need to support people – facilitating education