Public Health and Health Sector Crisis Leadership During Pandemics: A Review of the Medical and Business Literature

RN Reflections: Lessons Learned, Recommendations, and Pearls of Wisdom in Caring for the COVID-19 Population

BACKGROUND

In the early months of the COVID-19 pandemic, frontline nurses faced unprecedented challenges and were often excluded from decision-making, creating a critical research gap as their valuable insights were not captured, hindering the development of effective public health strategies.

OBJECTIVE

This study aimed to explore lessons learned, recommendations, and pearls of wisdom from frontline nurses who cared for COVID-19-positive patients in the United States during the early phases of the pandemic.

METHODS

The study employed a descriptive qualitative approach. Data were collected via virtual semi-structured interviews with 30 frontline nurses between July 2020 and November 2020. Analysis utilized reflexive thematic analysis by a 3-member coding team. Rigor was maintained through frequent team debriefing, reflexive discussions, the inclusion of multiple quotation exemplars, a national recruitment strategy, and an audit trail. Reporting followed the Consolidated Criteria for Reporting Qualitative Research checklist for qualitative research.

FINDINGS

Codes relating to nurses' lessons learned included leadership actions and visibility, innovations in patient care, teamwork and flexibility, and preparedness. Nurse recommendations encompassed soliciting nurses' voices, leadership competencies and enhancing emergency response preparedness, mental health support, and ensuring sufficient resources. Pearls of wisdom for future generations emphasized self-care, mindfulness, effective communication, and engagement with colleagues and family.

CONCLUSIONS

Effective pandemic preparedness must be managed as a systematic approach. Neglecting these actions risks repeating catastrophic mistakes in future health crises, compromising care quality and patient health outcomes. Improvements need to occur in nursing education, leadership training, and health care support for nurses.

A systematic literature review of the relationship between management and resilience in healthcare

BACKGROUND

Resilience in healthcare (RiH) is about the capacity to adapt to challenges and changes at different system levels, to maintain high quality care. Managers play a critical role in enabling, fostering and supporting RiH. Despite the wide range of management approaches, strategies, and interventions that have been put into practice and examined in the healthcare field, there remains a knowledge gap regarding managers' impact on resilience within healthcare organizations and what type of management strategies and approaches promote RiH.

AIM

This systematic review aimed to identify and synthesize research evidence concerning management strategies and RiH as well as to explore the relationship between, and impact of management approaches and strategies on promoting RiH.

DATA SOURCES

CINAHL, MEDLINE, Pubmed and Embase.

ELIGIBILITY CRITERIA

(1) primary qualitative, quantitative, and mixed-method research studies, published in English; and (2) (a) evaluated the relationship between management and RiH and/or explored management activities, strategies, approaches, and interventions promoting RiH, (b) in the context of healthcare settings.

SCREENING, DATA EXTRACTION AND SYNTHESIS

Study titles, abstracts (n = 2433), and full-texts were (n = 75) screened for inclusion by pairs of independent reviewers. Discrepancies were resolved via discussion. Data were extracted independently by pairs of reviewers using a predesigned data extraction form.

RESULTS

Sixteen studies were included in the review. The analysis resulted in seven themes: Development of relations; Trade-offs; Making room for adaptations; Innovative solutions; Contextual understanding and Collaborative learning.

CONCLUSION

Management strategies for RiH include the development of relations with workers, conducting sound trade-offs, make room for adaptations (e.g., absorptive, adaptive, and transformative strategies), to initiate, implement and being open to innovative solutions, developing a contextual understanding of their workplace, ensuring good communication between workers and leaders at the macro level, and to enable collaborative learning. Management strategies for RiH are likely to be context specific due to differences in work culture and access to resources. New ways of supporting RiH might be developed, using existing management strategies as the foundation to support resilience within healthcare organizations.

Implementing the pillars of value-based care: Leadership lessons from the CIUSSS Centre Ouest de l'Ile de Montreal

The Canadian healthcare landscape is characterized by its ambitious pursuit of innovation in response to challenges such as resource limitations and system restructuring. However, meaningful innovations cannot be sustained without leadership that empowers a patient-first integrated model of care. This article will explore the transformative changes of CIUSSS Centre Ouest de l'Île de Montréal directed to implanting the pillars of a value-based health system. We showcase our "Hospital-at-Home" program as an example to highlight the critical role of leadership in setting our vision of "Care Everywhere," empowering our healthcare workforce, and in ensuring successful implementation and sustainment. Our manuscript aims to provide insights into the leadership strategies that have underpinned these achievements, focusing on how these innovations have anticipated emerging healthcare demands, and highlighting a sustainable model for health leaders and policy-makers who are addressing similar challenges.

Developing a crisis leadership evaluation system for Chinese nursing staff during major infectious disease emergencies: a modified Delphi study

AIMS

To create a consensus on the nursing crisis leadership evaluation system during major infectious disease emergencies.

BACKGROUND

Crisis leadership is critical to prevent and mitigate an infectious disease infectious disease public health emergency during crisis time. However, there has been no crisis leadership evaluation system for nursing staff during major infectious diseases emergencies in China.

METHODS

We used a two-part modified Delphi method. Part 1 focused on creating a pool of indicators and developing an evaluation framework through a systematic literature review and a qualitative interview. Part 2 revised the indicators and built the final the evaluation system using two rounds of the Delphi surveys, following the Conducting and REporting of DElphi Studies (CREDES) guidance. Indicators were scored by a panel of experts based on the 5-point Likert scale. The weights of the indicators at each level were identified by analytical hierarchy process (AHP) methods.

RESULTS

A consensus was reached on a framework for assessing crisis leadership in nursing. Experts who met the inclusion criteria participated in round 1 (n = 23) and 2 (n = 19). The recovery rates for the two rounds of the Delphi survey were 92% and 82%. The authority coefficients (Cr) were 0.88 and 0.93, respectively, indicating the high reliability of the consultation results. The Kendall coefficients (W) of the two rounds were 0.106 and 0.150 (P < 0.001). The final consensus set comprised 6 primary indicators, 18 secondary indicators, and 38 tertiary indicators. The Weights of the six primary indicators allocated by AHP, namely loading the responsibility, heading the team, governing the situation, foreseeing the crisis, thriving on crisis, and insisting on the faith, were 0.3056, 0.2500, 0.1944, 0.1389, 0.0833, and 0.0278.

CONCLUSION

A consensus-based, contemporary set of nursing crisis leadership evaluation systems in the context of major infectious disease emergencies has been identified. Ongoing work is needed to further develop a highly reliable scale, determine the current state of nursing crisis leadership, construct a targeted training curriculum, and implement the program into practice that managers may wish to use to assess, select, and develop the next generation of nursing leaders.

A social identity approach to crisis leadership

This paper discusses the importance of a social identity approach to crisis leadership in the context of global crises such as the Covid-19 pandemic and emphasizes the interconnected relationships between leaders and followers. I highlight the role of leaders in fostering unity and shaping citizens' responses especially during crises. I discuss the nature of crises and the significant role of political leaders in guiding societal responses and suggest that crisis leadership extends beyond individual competencies and behaviours and involves a shift from individual to collective responses. With this, I introduce the social identity approach to leadership that views leadership as a social influence process and emphasizes the importance of creating a sense of 'we-ness' among followers. Following from that, crisis leadership involves leaders constructing defining features of collective identity and efficacy to address crises appropriately. However, the value of this approach depends on the careful definition of shared identity boundaries, consideration of diverse experiences within society, the evolving nature of crisis leadership over time and potential consequences of crisis leadership. The sustainability of identity leadership, the dynamics of intergroup and subgroup processes, and the complexities of various crises are identified as areas requiring further research.

Leadership Challenges in Neonatal Services during the COVID-19 Pandemic

This study aimed to identify key challenges, barriers, personal experiences, coping mechanisms, and lessons learned by neonatal health care leaders during the COVID-19 pandemic, because they are not well documented.Voluntary, anonymous, online survey of leaders in perinatal care systems.A total of 154 leaders responded. The exact number of survey recipients could not be enumerated because the survey was sent via email distribution lists (listservs). The key challenges reported included managing patient and family-centered care, staffing shortages, education and training, resource allocation, communication, support systems, and maintaining trust in a time of uncertainty. Common self-care techniques included exercise, sleep, meditation, social support, and taking time off. Respondents highlighted lessons such as the critical importance of effective communication, flexibility, teamwork, resilience, and the prioritization of self-care for sustainable leadership.These findings underscore the need for structured crisis management strategies and proactive support systems to strengthen resilience in neonatal health care leaders, enhancing preparedness for future systemic crises. · Leaders in perinatal care faced significant challenges during the COVID-19 pandemic.. · Key challenges were managing patient/family-centered care, staffing shortages, communication, and trust.. · Structured crisis management strategies and proactive support systems for resilience are required..

Factors Associated with Healthcare Leaders' Perceived Self-Efficacy During Crises

GOAL

The COVID-19 pandemic exposed a lack of healthcare leadership preparedness for a widespread, persistent emergency. This study aimed to identify factors contributing to perceived leadership self-efficacy to better prepare leaders for future crises.

METHODS

The researcher conducted an online composite survey (n = 96) of factors affecting perceived leadership self-efficacy from an American College of Healthcare Executives group using a quantitative correlational design with multiple regression analysis. Results were examined through the lens of Kolb's experiential learning theory to determine recommended leadership training.

PRINCIPAL FINDINGS

The researcher found that the most significant factors contributing to perceived self-efficacy in leadership were years of experience and skill (β = .004). This was supported by a multiple regression model predicting leadership self-efficacy, F(6, 95) = 9.932, p < .001, and adjusted ΔR2 = .361. An overall moderate effect size supports the practical significance of these results. When given the opportunity to indicate what preparation would be most beneficial, healthcare leaders indicated a desire for more training in communication skills alongside tabletop drills to practice rapid assessment and response techniques.

PRACTICAL APPLICATIONS

As healthcare leaders continue to face unanticipated challenges, their self-perceived ability to handle crises competently is influenced by their years of experience and skill level. Of these two, skill level is practically addressable. Education and leadership development that incorporate evolving methods of training, such as tabletop drills, will improve critical skills, and thus, perceived self-efficacy during times of crisis.

Surviving a crisis: A multilevel model of leadership styles, employees' psychological capital and organizational resilience

Building on the emerging research on organizational resilience in crisis, we tested a model of transformational and directive leadership styles and their association with organizational resilience in a crisis via employees' psychological capital. Three hundred and one small and medium sized enterprises in Kenya provided usable survey data. The hypotheses were tested using multilevel structural equation modelling (MSEM) technique. The results show that both transformational and directive leadership styles were significant and positive predictors of organizational resilience through the mediating role of employees' psychological capital. From a practical perspective, as SMEs struggle to be resilient during crises, leaders should adopt effective leadership styles such as transformational and directive and also consider their employees' psychological experience of a crisis.

Trust: an essential component in nursing crisis leadership; a hybrid concept analysis

BACKGROUND

Given the increasing trend of disasters, terrorist attacks, pandemics and other crises, crisis leadership is crucial for nurses who lead others and for those working in such situations. There is a need to define and explore the concept of trust as a component of crisis leadership in nursing. This concept analysis aimed to explore the concept of trust in crisis leadership from a nursing perspective.

METHODS

A hybrid concept analysis was conducted. The method consisted of three phases: (I) a theoretical phase relying on a structured literature search, including 11 scientific publications; (II) a field-work phase, in which qualitative thematic analysis of interviews with 30 nurses who had been deployed and/or had led others during crises, was conducted and (III) a final analytic phase, where the results from these data collections were merged.

RESULTS

The analysis suggested that the fundamentals of trust included a perceived intention to do good, the capabilities of both the leader and the team and the perceived predictability of the leader's behaviour. Trust was found to be built on a perceived forward-looking direction, self-trust and the personal attributes of the leader, such as ethical conduct, the ability to predict the development of crises and an intention to take responsibility and be honest. The social attributes of the relationship between the leader and the team included the intention not to leave anyone behind, loyalty and fostering a sense of belonging among team members. The organisational attributes included a clear organisational structure and clarity of mandate.

CONCLUSIONS

Trust is an essential component of crisis leadership that depends on a leader's perceived intention to do good, predictability of the leader's behaviour and the capabilities of both the leader and the team. The development of trust relies on the personal attributes of the leader, the social relationship between the leader and the team and organisational attributes. Nurses appointed to lead others during a crisis need to understand the fundamentals of trust as part of leadership in highly demanding situations. Thus, it can be argued that being a leader in a crisis situation requires distinct personal and professional attributes and skills compared to those used to meet routine demands.

Essential competencies required of nurse managers in times of COVID-19: A scoping review

AIM

To identify the essential competencies required of nurse managers in healthcare services during the COVID-19 pandemic.

BACKGROUND

Nurse managers play a vital role in healthcare services organization, requiring a diverse set of competencies. The increasing occurrence of epidemics in recent decades underscores the importance of understanding these competencies in pivotal junctures. The challenges faced during the COVID-19 pandemic present valuable opportunities to recognize the competencies of nurse managers and guide their responsiveness in addressing future health crises.

METHODS

A scoping review following the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines was conducted. A comprehensive search was conducted across six databases (LILACS, BDENF, EMBASE, MEDLINE, SCOPUS, and Web of Science). Results were categorized according to the nurse manager competencies model by the American Organization for Nursing Leadership and were analyzed using the competing values framework model.

RESULTS

Out of 2033 potentially relevant sources identified, 17 studies met inclusion criteria. A total of 52 competencies were identified and categorized into four thematic categories: (1) the ability to collaborate in times of crisis; (2) maintaining control during a crisis; (3) adapting to changes caused by the crisis; and (4) preserving competitiveness through the crisis.

CONCLUSIONS

The findings highlight communication, decision-making, training, adaptability to change, and leadership as essential competencies required of nurse managers to address crises, such as pandemics.

IMPLICATIONS FOR NURSING POLICY

This body of knowledge can serve as a reference point to enhance the response of nurse managers in the face of future health crisis scenarios. Additionally, it can serve as a framework for healthcare organizations to develop or improve their crisis management training programs.

Lessons From Leading During a Pandemic: An Exploratory Study of Public Health Leadership Insights on Training, Preparation, and Experiences From the Field During COVID-19

CONTEXT

The public health workforce encountered challenges during the COVID-19 pandemic that exposed areas for improvement in preparation for future public health threats. Key among these is well-trained public health leaders equipped with an array of crisis leadership skills.

OBJECTIVES

To examine the training background, assess the perceived preparedness, and garner recommendations for training of the future public health workforce from public health leaders who navigated the COVID-19 pandemic.

DESIGN

This exploratory research gleaned information by utilizing an online questionnaire and interviews to provide lessons learned regarding improvements needed for public health leader preparedness.

SETTING

Three California public health departments representing urban, suburban, and rural populations.

PARTICIPANTS

Thirty public health leaders who were directly involved in public health work for ≥3 years in a leadership/management role and involved in COVID-19-related work for at least 6 months participated.

RESULTS

Questionnaire findings revealed gaps in crisis leadership, communication, and collaboration training. Interview results supported and expanded upon the quantitative findings, including the value of various competencies and recommendations to improve the preparedness of future public health leaders.

CONCLUSIONS

The findings suggested that although many of the skills needed are competencies for accredited public health training programs, effective leadership during public health emergencies may require additional training beyond what is generally provided. Recommendations include integrating study findings into public health training programs to address competency gaps, leveraging results to enhance leadership skills, and promoting collaboration between public health departments and academic institutions to develop evidence-informed crisis leadership training. These findings inform strategies to ensure the preparedness of the public health workforce for future crises.

Leadership for AI Transformation in Health Care Organization: Scoping Review

BACKGROUND

The leaders of health care organizations are grappling with rising expenses and surging demands for health services. In response, they are increasingly embracing artificial intelligence (AI) technologies to improve patient care delivery, alleviate operational burdens, and efficiently improve health care safety and quality.

OBJECTIVE

In this paper, we map the current literature and synthesize insights on the role of leadership in driving AI transformation within health care organizations.

METHODS

We conducted a comprehensive search across several databases, including MEDLINE (via Ovid), PsycINFO (via Ovid), CINAHL (via EBSCO), Business Source Premier (via EBSCO), and Canadian Business & Current Affairs (via ProQuest), spanning articles published from 2015 to June 2023 discussing AI transformation within the health care sector. Specifically, we focused on empirical studies with a particular emphasis on leadership. We used an inductive, thematic analysis approach to qualitatively map the evidence. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines.

RESULTS

A comprehensive review of 2813 unique abstracts led to the retrieval of 97 full-text articles, with 22 included for detailed assessment. Our literature mapping reveals that successful AI integration within healthcare organizations requires leadership engagement across technological, strategic, operational, and organizational domains. Leaders must demonstrate a blend of technical expertise, adaptive strategies, and strong interpersonal skills to navigate the dynamic healthcare landscape shaped by complex regulatory, technological, and organizational factors.

CONCLUSIONS

In conclusion, leading AI transformation in healthcare requires a multidimensional approach, with leadership across technological, strategic, operational, and organizational domains. Organizations should implement a comprehensive leadership development strategy, including targeted training and cross-functional collaboration, to equip leaders with the skills needed for AI integration. Additionally, when upskilling or recruiting AI talent, priority should be given to individuals with a strong mix of technical expertise, adaptive capacity, and interpersonal acumen, enabling them to navigate the unique complexities of the healthcare environment.

Public health leadership in the COVID-19 era: how does it fit? A scoping review

The COVID-19 pandemic has put a lot of pressure on all the world's health systems and public health leaders who have often found themselves unprepared to handle an emergency of this magnitude. This study aims to bring together published evidence on the qualities required to leaders to deal with a public health issue like the COVID-19 pandemic. This scoping literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A search of relevant articles was performed in the PubMed, Scopus and Web of Science databases. A total of 2499 records were screened, and 45 articles were included, from which 93 characteristics of effective leadership were extrapolated and grouped into 6 clusters. The qualities most frequently reported in the articles were human traits and emotional intelligence (46.7%) and communication skills such as transparency and reliability (48.9%). Responsiveness and preparedness (40%), management skills (33.3%) and team working (35.6%) are considered by a significant percentage of the articles as necessary for the construction of rapid and effective measures in response to the emergency. A considerable proportion of articles also highlighted the need for leaders capable of making evidence-based decisions and driving innovation (31.1%). Although identifying leaders who possess all the skills described in this study appears complex, determining the key characteristics of effective public health leadership in a crisis, such as the COVID-19 pandemic, is useful not only in selecting future leaders but also in implementing training and education programmes for the public health workforce.

Leadership to Accelerate Healthcare's Digital Transformation: Evidence From 33 Health Systems

GOAL

The COVID-19 pandemic, healthcare market disruptors, and new digital healthcare technologies have made a substantial impact on the delivery of healthcare services, highlighting the critical roles of leaders in hospitals and health systems. This study sought to understand the evolving roles of CEOs, CIOs, and other executive leaders in the postpandemic era and highlight the adaptability and strategic vision of executives in shaping the future of healthcare delivery.

METHODS

Between October 2022 and May 2023, 51 interviews were conducted with CEOs, CIOs, and other executives responsible for delivering technology solutions for 33 nonprofit health systems in the United States. They were asked to describe their backgrounds; how information solutions and technologies were viewed within their organizations' strategy, operations, and governance; and the key characteristics of executive leaders.

PRINCIPAL FINDINGS

The study has found that effective CEOs have an authentic belief in technology's role in achieving their organization's mission and that contemporary CIOs are strategic executive partners who align strategy with culture to improve care. This study examines how healthcare systems are creating digitally savvy executive leadership teams that operate in a new, integrated model that unites previously siloed functions.

PRACTICAL APPLICATIONS

Some healthcare CIOs are unprepared for current and future business challenges, and some CEOs are unsure how to leverage digital technologies and C-suite expertise to transform their organizations. This research provides insights into how the nation's health systems are building and sustaining leadership teams capable of adapting to the healthcare environment and accelerating organizational transformation.

Leadership: Bright Spots of Governmental Public Health Employee Reflections on the COVID-19 Response

The protracted nature of the COVID-19 pandemic demanded extraordinary efforts and innovation from public health agencies and their leaders. This is the first of 3 research briefs that highlight valuable experiences and opportunities that can be thought of as "bright spots" of the public health workforce's pandemic response. Using Public Health Workforce Interests and Needs Survey 2021 data, we qualitatively examined responses to an open-ended question about pandemic workforce experiences. Leadership was emphasized as a critical component of employees' experiences during the response, and 7 "leadership" subthemes were identified among 157 responses. Findings illustrate the importance of leaders prioritizing safe and supportive environments for employees. Respondents also highlighted the importance of leaders fostering teamwork alongside employees and advocating for and demonstrating appreciation for employees. In addition, effective leadership communication was reported to be motivational and alleviate uncertainty during crisis situations. Focusing on these leadership skills and competencies may aid the workforce during future emergency response events.

Healthcare Decision-Making in a Crisis: A Qualitative Systemic Review Protocol

Background. Throughout history, communities have faced outbreaks of infectious diseases and other natural and man-made disasters that pose significant threats to lives, public health, and business continuity. Many of these disasters are crises that require critical decisions to be made in a short, crucial time with limited information and unforeseen circumstances amidst panic, fear, and shock. The COVID-19 pandemic is a recent example, with public leaders responding to and formulating strategies to attenuate the relentless waves of transmission and surges in resource demands. The pandemic underscored the importance of understanding how healthcare leaders make decisions in-crisis and what factors healthcare leaders prioritize in their decision-making process. Methods/Design. PubMed(NLM), Embase(Ovid), Scopus(Elsevier), Business Source(EBSCOhost), and ProQuest will be searched for primary qualitative studies published in English to explore the multi-faceted decision-making processes of healthcare leaders during a public health crisis. A meta-ethnographic approach will synthesize insights into healthcare leaders' experiences and perspectives and generate a conceptual theory of decision-making in crisis. Discussion. Understanding how healthcare leaders make critical decisions during public health crises takes advantage of the lessons learned to inform how future health crises are managed. (This systematic review is registered in PROSPERO: CRD42023475382).

Applying Biblical Wisdom to Trying Times: 10 Leadership Lessons for Nurses

ABSTRACT

In the post-COVID era, examining nursing and pastoral leadership experiences with biblical examples offers helpful perspectives on how to lead in times of crisis and adversity. Reflecting on men and women of the Bible who led during crisis can encourage nurses to view our ministries through God's lens and motivate us to become stronger leaders.

"What We're Doing Now…Is More Than Water Cooler": Perspectives of Primary Care Leaders on Leading Through (and Beyond) COVID-19

BACKGROUND

COVID-19 presented numerous challenges to primary care, but little formal research has explored the experience of practice leaders and their strategies for managing teams as the crisis unfolded.

OBJECTIVE

Describe the experience of leaders in US primary care delivery organizations, and their strategies for leading teams during COVID-19 and beyond.

DESIGN

Qualitative study using semi-structured interviews performed between 9/15/2020 and 8/31/2021.

PARTICIPANTS

Purposive sample of 17 clinical leaders in a range of US primary care organizations.

APPROACH

An iterative grounded review of interview transcripts was performed, followed by immersion/crystallization analysis.

KEY RESULTS

Early in the pandemic, practice leaders reported facing rapid change and the need for constant decision-making, amidst an environment of stress, fear, and uncertainty, but this was buffered by a strong sense of purpose. Later, leaders noted the emergence of layered crises, and evolving challenges including fatigue, burnout, and strained relationships within their organizations and with the communities they serve. Leaders described four interrelated strategies for supporting their teams: (1) Being intentionally present, physically and emotionally; (2) Frequent and transparent communication; (3) Deepening and broadening relationships; (4) Increasing adaptive decision-making, alternating between formal hierarchical and flexible participatory processes. These strategies were influenced by individual leaders' perceived autonomy, which was impacted by the leader's specific role, and organizational size, complexity, and funding model.

CONCLUSIONS

As the burnout and workforce crises have accelerated, the identified strategies can be useful to leaders to support teams and build organizational resilience in primary care moving forward.

The role of the Field Epidemiology Training Program in the public health emergency response: Sudan armed conflict 2023

Background

On April 15, 2023, the armed conflict between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) started in Khartoum state, Sudan. This conflict was complicated by the preexisting complicated epidemiological situation and fragile health system in Sudan. This study endeavors to illuminate the pivotal role essayed by the Sudan FETP (SFETP) in enhancing the nation's public health response, particularly amidst the tumultuous backdrop of armed conflicts that have left their indelible mark on the region.

Methods

Employing a blend of quantitative and qualitative methodologies, we investigated the SFETP's contributions to the public health response during the initial 4 months of the conflict (April-July 2023). Sixty-four SFETP residents and graduates were invited to participate, and data were gathered through semi-structured questionnaires.

Results

A total of 44 (69%) SFETP residents and graduates were included in this study. Out of 38 SFETPs present in the states, 32 have considerably contributed to the crisis response at state and locality levels. Three-quarters of them have played key leadership, planning, and management roles. In essence, 38% (n = 12) of them have contributed to public health surveillance, particularly in data management, reports, Early Warning Alert and Response System (EWAR) establishment, and epidemic investigation. SFETPs have made special contributions to crisis response at the community level. The involved SFETPs supported WASH interventions (n = 4), and almost one-third of them strengthened risk communication and community engagement (n = 9). Despite their physical presence at the subnational level, 27% of graduates were not deployed to the crisis emergency response. Notably, throughout this time, half of the total SFETPs were formally retained during this response.

Conclusion

The study highlighted the importance of FETP engagement and support during public health crises. SFETP residents and graduates played diverse roles in the various levels of public health emergency response to the crisis. However. Strategies to improve the deployment and retention of FETP residents are necessary to ensure their availability during crises. Overall, FETP has proven to be an asset in public health crisis management in Sudan.

Professional quality of life, psychological well-being, and work engagement of healthcare professionals in two Greek hospitals during COVID-19: A cross-sectional study

BACKGROUND

During the COVID-19 pandemic, the mental health of healthcare professionals has emerged as an issue of great concern.

OBJECTIVE

To investigate the levels of professional quality of life, psychological well-being, and work engagement among healthcare professionals in two Greek hospitals during the COVID-19 pandemic.

METHODS

A cross-sectional study was conducted in December 2021 in two public hospitals in Greece. To assess the levels of professional quality of life, psychological well-being, and work engagement, respondents completed the Professional Quality of Life Scale Version 5 (ProQOL-V), the Psychological Well-being (PWB) scale, and the Utrecht Work Engagement Scale (UWES-17).

RESULTS

A total of 150 questionnaires were distributed, and 102 were returned (response rate: 68%). It was found that as burnout levels increased, the levels of work engagement decreased (rho = -0.36, p-value < 0.01). Higher levels of compassion satisfaction were associated with higher work engagement (rho = 0.48, p-value < 0.01). Multivariable analysis revealed that healthcare personnel's contact with patients or service users exposed to or who have experienced traumatic events was associated with less positive relationships with others (and, consequently, lower levels of psychological well-being) (p-value = 0.035).

CONCLUSIONS

Healthcare professionals in the two public hospitals in Greece, experienced moderate levels of compassion satisfaction, burnout, and secondary traumatic stress during the COVID-19 pandemic. Their psychological well-being was also found to be moderate, and their levels of work engagement were moderate to high. Supporting the physical and psychological well-being of healthcare professionals is essential for their ability to provide high-quality care in times of crisis, such as during the COVID-19 pandemic.

Assessing health care leadership and management for resilience and performance during crisis: The HERO-36

BACKGROUND

Whereas organizational literature has provided much insight into the conceptual and theoretical underpinnings of organizational leadership and management during emergencies, measures to operationalize related effective practices during crises remain sparse.

PURPOSE

To address this need, we developed the Healthcare Emergency Response Optimization survey, which set out to examine the leadership and management practices in health care organizations that support resilience and performance during crisis.

METHODOLOGY

We administered an online survey in April to May 2022 to health care administrators and frontline staff intimately involved in their hospital's emergency response during the COVID-19 pandemic, which included a sample of 379 respondents across nine rural and urban hospitals (response rate: 44.4%). We used confirmatory factor analysis and quantile regressions to examine the results.

RESULTS

Applying confirmatory factor analysis, we retained 36 items in our survey that comprised eight measures for formal and informal practices to assess crisis leadership and management. To test effectiveness of the specified practices, we regressed self-reported resilience and performance measures on the formality and informality scores. Findings show that informal practices mattered most for resilience, whereas formal practices mattered most for performance. We also identified specific practices (anticipation, transactional and relational interactions, and ad hoc collaborations) for resilience and performance.

PRACTICE IMPLICATIONS

These validated measures of organizational practices assess emergency response during crisis, with an emphasis on the actions and decisions of leadership as well as the management of organizational structures and processes. Organizations using these measures may subsequently modify preparedness and planning approaches to better manage future crises.

Unveiling the Mechanisms through Which Leader Integrity Shapes Ethical Leadership Behavior: Theory of Planned Behavior Perspective

Leadership integrity is crucial in shaping ethical leadership or promoting a rigorous adherence to moral principles and standards. This study explores the intricate relationship between leader integrity, moral identification, self-regulation, and ethical leadership behavior, providing practical insights for healthcare leaders seeking to enhance ethical practices. It addresses a critical gap in the research landscape by focusing on individual-level ethical leadership within the healthcare sector, where prior investigations have been limited. This study examines the mediating role of moral identification among leader integrity and ethical leadership behavior. We surveyed 181 health sector workers and employed SmartPLS to assess the conceptualized relationships. The analyses reveal a significant indirect influence of leader integrity on ethical leadership behavior, whereas moral identification mediates the relationship. Our findings further indicate an intriguing moderation effect of self-regulation on the relationship between moral identification and ethical leadership behavior. This divergence from previous research underscores the significance of contextual and methodological factors in studying leadership integrity and ethical behavior. Our study contributes to the literature on the relationship through planned behavior theory by demonstrating that moral identification mediates the relationship between leader integrity and ethical leadership behavior in the context of the theory of planned behavior. Our findings underscore the significance of fostering leader integrity within organizations to indirectly promote ethical leadership behaviors through moral identification. Organizations should prioritize initiatives that cultivate moral identification among their members to enhance ethical cultures.

Substance Use Disorder Treatment Programs during a Health Crisis: Response to the COVID-19 Pandemic and Future Implications

Background: The COVID-19 pandemic rapidly changed how substance use disorder (SUD) treatment services are delivered. In this qualitative study, we examined what changes SUD treatment programs in Arkansas implemented in response to the pandemic, what factors influenced their ability to implement these changes, and their reflections, outlook, and future recommendations. Methods: Between May and August 2020, we conducted semi-structured phone interviews with 29 leaders at 21 SUD programs throughout Arkansas. Interview questions focused on what changes programs implemented in response to the pandemic, barriers and facilitators to implementation, and future outlook. Interviews were thematically analyzed. Results: Programs implemented similar infection control practices, including COVID-19 screening at entry, masks, hand hygiene, and social distancing. Residential programs discontinued outside visitations and capped admissions, and outpatient programs implemented telehealth services. Clients generally responded well to the changes, however many experienced difficulties (e.g., anxiety, lack of access to telehealth). While programs welcomed additional financial support (e.g., CARES act) and looser regulatory restrictions (e.g., telehealth use), many struggled economically due to lower demand and insufficient reimbursement. Programs varied in leadership and staff responses to the pandemic, and in their capacity to implement the changes (e.g., facilities, staffing). Finally, interviewees acknowledged they were unprepared for the pandemic and were uncertain about the future. Conclusions: The insights from the COVID-19 pandemic and SUD programs' responses helps researchers, policymakers and practitioners understand what has happened during the pandemic, how to prepare for future crises, and how to build more resilient SUD and public health systems.

The role of local context for managers' strategies when adapting to the COVID-19 pandemic in Norwegian homecare services: a multiple case study

BACKGROUND

The COVID-19 pandemic had a major impact on healthcare systems around the world, and lack of resources, lack of adequate preparedness and infection control equipment have been highlighted as common challenges. Healthcare managers' capacity to adapt to the challenges brought by the COVID-19 pandemic is crucial to ensure safe and high-quality care during a crisis. There is a lack of research on how these adaptations are made at different levels of the homecare services system and how the local context influences the managerial strategies applied in response to a healthcare crisis. This study explores the role of local context for managers' experiences and strategies in homecare services during the COVID-19 pandemic.

METHODS

A qualitative multiple case study in four municipalities with different geographic locations (centralized and decentralized) across Norway. A review of contingency plans was performed, and 21 managers were interviewed individually during the period March to September 2021. All interviews were conducted digitally using a semi-structured interview guide, and data was subjected to inductive thematic analysis.

RESULTS

The analysis revealed variations in managers' strategies related to the size and geographical location of the homecare services. The opportunities to apply different strategies varied among the municipalities. To ensure adequate staffing, managers collaborated, reorganized, and reallocated resources within their local health system. New guidelines, routines and infection control measures were developed and implemented in the absence of adequate preparedness plans and modified according to the local context. Supportive and present leadership in addition to collaboration and coordination across national, regional, and local levels were highlighted as key factors in all municipalities.

CONCLUSION

Managers who designed new and adaptive strategies to respond to the COVID-19 pandemic were central in ensuring high-quality Norwegian homecare services. To ensure transferability, national guidelines and measures must be context-dependent or -sensitive and must accommodate flexibility at all levels in a local healthcare service system.

Health-care leaders' experiences of the competencies required for crisis management during COVID-19: a systematic review of qualitative studies

PURPOSE

This paper aims to synthesize health-care leaders' experiences of the competencies required for crisis management.

DESIGN/METHODOLOGY/APPROACH

The systematic review followed the joanna briggs institute (JBI) guidance for systematic reviews of qualitative evidence. The search strategy included free text words and medical subject headings and peer-reviewed qualitative studies published in English, Finnish and Swedish and was not limited by year or country of publication. The databases searched in March 2022 were Scopus, PubMed, CINAHL, ABI/INFORM and the Finnish database Medic. Gray literature was searched using MedNar and EBSCO Open Dissertations. Studies were screened by title and abstract (n = 9,014) and full text (n = 43), and their quality was assessed by two independent reviewers. Eight studies were included. The data was analyzed using meta-aggregation.

FINDINGS

Fifty-one findings (themes and subthemes) were extracted, and 11 categories were created based on their similarities. Five synthesized findings were developed: the competence to comprehend the operational environment; the competence to stay resilient amidst change; the competence to adapt to and manage change; the competence to manage and take care of staff; and the competence to co-operate and communicate with diverse stakeholders.

ORIGINALITY/VALUE

This systematic review produced novel information about health-care leaders' experiences of the competencies required for crisis management during COVID-19. This study complements the field of research into crisis management in health care by introducing five original and unique competency clusters required for crisis management during the acute phase of COVID-19.

Difficult Times, Difficult Decisions: Examining the Impact of Perceived Crisis Response Strategies During COVID-19

Crises, such as the COVID-19 pandemic, require rapid action to be taken by leaders, despite minimal understanding of the impact of implemented crisis management policies and procedures in organizations. This study's purpose was to establish a greater understanding of which perceived crisis response strategies were the most beneficial or detrimental to relevant perceptions and outcomes during the recent COVID-19 crisis. Using a time-lagged study design and a sample of 454 healthcare employees, latent profile analysis was used to identify strategy profiles used by organizations based on several policy/procedure categories (i.e., human-resource supportive, human-resource disadvantaging, behavioral/interactional human safety and protection-focused, and environmental and structural safety supports-focused policies and procedures). Results indicated that four perceived crisis response strategies were employed: (1) human resource-disadvantaging, (2) maximizing, (3) safety and human resource-supportive, and (4) inactive. Perceived crisis response strategy was linked to several employee well-being (e.g., work stress) and behavioral (e.g., safety behavior) outcomes via proximal perceptions (i.e., perceived organizational support, ethical leadership, and safety climate). Proximal perceptions were the most positive for employees within organizations that enacted safety and human resource-supportive policies and procedures or that utilized a maximizing approach by implementing a wide array of crisis response policies and procedures. This paper contributes to the literature by providing crucial information needed to reduce organizational decision-making time in the event of future crises.

Managers' strategies in handling the COVID-19 pandemic in Norwegian nursing homes and homecare services

PURPOSE

This study aims to explore nursing home and home care managers' strategies in handling the COVID-19 pandemic.

DESIGN/METHODOLOGY/APPROACH

This study has a qualitative design with semistructured individual interviews conducted digitally by videophone (Zoom). Eight managers from nursing homes and five managers from home care services located in a large urban municipality in eastern Norway participated. Systematic text condensation methodology was used for the analysis.

FINDINGS

The managers used several strategies to handle challenges related to the COVID-19 pandemic, including being proactive and thinking ahead in terms of possible scenarios that might occur, continuously training of staff in new procedures and routines and systematic information sharing at all levels, as well as providing different ways of disseminating information for staff, service users and next-of-kins. To handle staffing challenges, managers used strategies such as hiring short-term staff that were temporary laid off from other industries and bringing in students.

ORIGINALITY/VALUE

The COVID-19 pandemic heavily affected health-care systems worldwide, which has led to many health-care studies. The situation in nursing homes and home care services, which were strongly impacted by the pandemic and in charge of a vulnerable group of people, has not yet received enough attention in research. This study, therefore, seeks to contribute to this research gap by investigating how managers in nursing homes and home care services used different strategies to handle the COVID-19 pandemic.

Public Health Management of the COVID-19 Pandemic in Australia: The Role of the Morrison Government

The Australian Commonwealth government has four health-related responsibilities during the SARS-CoV-2 pandemic: to provide national leadership; to manage external borders; to protect residents of residential aged care facilities; and to approve, procure and roll-out tests and vaccines. State governments are responsible for determining what public health measures are appropriate and implementing them-including managing the border quarantine arrangements and the testing, tracing, and isolation regime-and managing the hospital response. This paper analyses the national government's response to the pandemic and discusses why it has attracted a thesaurus of negative adjectives.

Employees Perception of Organizational Crises and Their Reactions to Them – A Norwegian Organizational Case Study

Organizational sensemaking is crucial for resource planning and crisis management since facing complex strategic problems that exceed their capacity and ability, such as crises, forces organizations to engage in inter-organizational collaboration, which leads to obtaining individual and diverse perspectives to comprehend the issues and find solutions. This online qualitative survey study examines how Norwegian Sea Rescue Society employees perceived the concept of an organizational crisis and how they sensed their co-workers react to it. The scope was the ongoing COVID-19 pandemic, a global event affecting all countries and organizations and responding similarly globally. Data were collected during the Fall of 2020. The instrument of choice was the Internal Crisis Management and Crisis Communication survey (ICMCC). The results showed that the overall sample strongly believed in their organization’s overall resilience level. However, a somewhat vague understanding of roles and responsibilities in a crisis where detected, together with some signs of informal communication, rumor spreading, misunderstanding, frustration, and insecurity. This study contributes to the academic field of organizational research, hence crisis management and sensemaking, and could be valuable to managers and decision-makers across sectors. Increased knowledge about how employees react to a crisis may help optimize internal crisis management planning and utilize robust mitigation and response strategies.

Organizational logics in time of crises: How physicians narrate the healthcare response to the Covid-19 pandemic in Swedish hospitals

BACKGROUND

The COVID-19 pandemic has challenged healthcare organizations and puts focus on risk management in many ways. Both medical staff and leaders at various levels have been forced to find solutions to problems they had not previously encountered. This study aimed to explore how physicians in Sweden narrated the changes in organizational logic in response to the Covid-19 pandemic using neo-institutional theory and discursive psychology. In specific, we aimed to explore how physicians articulated their understanding of if and, in that case, how the organizational logic has changed during this crisis response.

METHODS

The empirical material stems from interviews with 29 physicians in Sweden in the summer and autumn of 2020. They were asked to reflect on the organizational response to the pandemic focusing on leadership, support, working conditions, and patient care.

RESULTS

The analysis revealed that the organizational logic in Swedish healthcare changed and that the physicians came in troubled positions as leaders. With management, workload, and risk repertoires, the physicians expressed that the organizational logic, to a large extent, was changed based on local contextual circumstances in the 21 self-governing regions. The organizational logic was being altered based upon how the two powerbases (physicians and managers) were interacting over time.

CONCLUSIONS

Given that healthcare probably will deal with future unforeseen crises, it seems essential that healthcare leaders discuss what can be a sustainable organizational logic. There should be more explicit regulatory elements about who is responsible for what in similar situations. The normative elements have probably been stretched during the ongoing crisis, given that physicians have gained practical experience and that there is now also, at least some evidence-based knowledge about this particular pandemic. But the question is what knowledge they need in their education when it comes to dealing with new unknown risks.

Physicians' experiences of challenges in working conditions related to the provision of care during the initial response to the COVID-19 pandemic in Sweden

Purpose

This aim of this study was to explore how hospital-based physicians in Sweden experienced the challenges in working conditions related to the provision of care during the initial response to the COVID-19 pandemic in 2020 when hospitals transitioned to pandemic care.

Design/methodology/approach

The study has a qualitative design. Twenty-five hospital-based physicians were interviewed about their experiences from working in a hospital while healthcare organisations initially responded to COVID-19 pandemic in 2020. A thematic analysis was used to analyse the empirical material.

Findings

The analysis resulted in four themes: involuntary self-management, a self-restrictive bureaucracy, passive occupational safety and health (OSH) management, and information overload. These themes reflect how the physicians perceived their work situation during the pandemic and how they tried to maintain quality care for their patients.

Practical implications

The study gives valuable insights for formulating preparedness in regard to crisis management plans that can secure the provision of care for future emergencies in the healthcare services.

Originality/value

This paper shows that a crisis management plans in the healthcare services should include decision structures and management, measures of risk assessment and OSH management, and the maintenance of personnel wellbeing. A prepared healthcare management can preserve quality care delivery while under crisis.

Facing disruption: Learning from the healthcare supply chain responses in British Columbia during the COVID-19 pandemic

The healthcare supply chain crisis surrounding Personal Protective Equipment (PPE) during the onset of the COVID-19 pandemic presented unique and complex challenges in achieving the primary aim of supply chain management, that is, delivering the right amount of the right supplies to the right people at the right time. This article describes the key findings from a case study on PPE supply chain responses to the COVID-19 pandemic in British Columbia (BC). It highlights a set of constructive response mechanisms to potential crises along healthcare supply chain. Effective and trusted leadership, a unity of purpose, integrated and robust digital infrastructure and capabilities, consistent learning, resilience building, and environmental sensing for reliable intelligence were found to be essential for preparing, for containing, and mitigating the crisis as it evolved across various phases of crisis management.

BRAVE: A Point of Care Adaptive Leadership Approach to Providing Patient-Centric Care in the Emergency Department

The practice of emergency medicine has reached its cross roads. Emergency physicians (EPs) are managing many more time-dependent conditions, initiating complex treatments in the emergency department (ED), handling ethical and end of life care discussions upfront, and even performing procedures which used to be done only in critical care settings, in the resuscitation room. EPs manage a wide spectrum of patients, 24 h a day, which reflects the community and society they practice in. Besides the medical and “technical” issues to handle, they have to learn how to resolve confounding elements which their patients can present with. These may include social, financial, cultural, ethical, relationship, and even employment matters. EPs cannot overlook these, in order to provide holistic care. More and more emphasis is also now given to the social determinants of health. We, from the emergency medicine fraternity, are proposing a unique “BRAVE model,” as a mnemonic to assist in the provision of point of care, adaptive leadership at the bedside in the ED. This represents another useful tool for use in the current climate of the ED, where patients have higher expectations, need more patient-centric resolution and handling of their issues, looming against the background of a more complex society and world.