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Gomes G, Tontini G, Krause VM, Bernardes M. Before and during COVID-19: the roles of transformational leadership, organizational culture and work-life balance in healthcare. J Health Organ Manag 2024; ahead-of-print. [PMID: 38802303 DOI: 10.1108/jhom-07-2023-0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
PURPOSE This research aims to investigate the role of transformational leadership and organizational culture - encompassing Clan, Adhocracy, Hierarchical and Market Cultures - in the context of work-life balance for healthcare workers. It aims to present a comparison of observations made pre and mid-pandemic. DESIGN/METHODOLOGY/APPROACH A structured questionnaire was utilized to collect data from a varied sample of 355 employees (258 before and 97 during the pandemic) representing multiple sectors and positions within a hospital. The interpretation of the data was accomplished using Partial Least Squares Structural Equation Modeling (PLS-SEM). FINDINGS Findings reveal that prior to the pandemic, transformational leadership significantly influenced all forms of organizational culture perceptions, with a strong influence on Clan Culture. Clan Culture displayed a consistent positive correlation with WLB both before and during the pandemic. During the pandemic, Market Culture exhibited a negative effect on WLB and Adhocracy Culture demonstrated a positive effect, impacts which were absent before the pandemic. Transformational leadership had a positive impact on WLB before the pandemic, but no discernible effect during the pandemic was observed. ORIGINALITY/VALUE The results indicate that the dynamics between transformational leadership, organizational culture and work-life balance are susceptible to alterations in the face of external crisis events. This study offers a unique exploration of these dynamics in the healthcare sector during the ongoing global pandemic.
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Braund H, Dalgarno N, Ritsma B, Appireddy R. Exploring virtual care clinical experience from non-physician healthcare providers (VCAPE). SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100289. [PMID: 37283887 PMCID: PMC10228159 DOI: 10.1016/j.ssmqr.2023.100289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023]
Abstract
COVID-19 has caused an urgent implementation of virtual care (VC). Most research has focused on patient and physician experience with virtual care. Non-physician healthcare providers have played an active role in transitioning to virtual care, yet little is known about their experiences. This study explored their lived experiences in caring for patients virtually. Forty non-physician healthcare providers from local hospitals, community, and home care settings in Kingston, ON, Canada, participated and included nurse practitioners, occupational therapists, physiotherapists, psychologists, registered dietitians, social workers, and speech-language pathologists. Data were collected using semi-structured interviews between February and July 2021 and were analyzed thematically. The study was guided by organizational change theory. Four themes were identified from the data: 1) Quality of care, 2) Resources and training, 3) Healthcare system efficiency, and 4) Health equity and access for patients. Providers suggested that VC increased patient-centredness and had clear benefits for patients. Participants had little to no training in conducting patient care, virtually stating this as a key challenge. They believed that VC increased the efficiency of the healthcare system and was more proactive. Despite concerns regarding inequities across healthcare, participants reported that VC could improve equity as long as patients had access to technology. The study highlights the urgent need to support all healthcare providers in delivering optimal patient-centred care. We should leverage some of the advantages offered by VC to improve the efficiency of healthcare delivery, reduce provider burnout, and increase capacity across organizational systems.
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Affiliation(s)
- Heather Braund
- Office of Professional Development and Educational Scholarship, Faculty of Health Science, Queen's University, Kingston, ON, K7L2V7, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Faculty of Health Science, Queen's University, Kingston, ON, K7L2V7, Canada
| | - Benjamin Ritsma
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, ON, K7L2V7, Canada
| | - Ramana Appireddy
- Department of Medicine, Queen's University, Kingston, ON, K7L2V7, Canada
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Seljemo C, Wiig S, Røise O, Ree E. The role of local context for managers' strategies when adapting to the COVID-19 pandemic in Norwegian homecare services: a multiple case study. BMC Health Serv Res 2023; 23:492. [PMID: 37194101 DOI: 10.1186/s12913-023-09444-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/25/2023] [Indexed: 05/18/2023] Open
Abstract
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.
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Affiliation(s)
- Camilla Seljemo
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Olav Røise
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Eline Ree
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Abebe E, Bao A, Kokkinias P, Russ-Jara AL, Degnan D. Maximizing student potential: Lessons for pharmacy programs from the patient safety movement. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 9:100216. [PMID: 36632371 PMCID: PMC9827372 DOI: 10.1016/j.rcsop.2022.100216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/06/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
Higher education institutions (HEIs), including pharmacy programs, are experiencing growing pressure from the public and policy makers to develop student-centered learning experiences that meet societal needs. While HEIs may have in-house initiatives to meet such challenges, there are also opportunities for cross-domain learning and application of useful concepts from other sectors. One such sector that lends itself to cross-domain learning is the healthcare industry. Like HEIs, the healthcare industry has been experiencing pressure from its stakeholders, in this case, to address patient safety gaps. These forces intensified at the turn of the century leading to the emergence of what is now known as the patient safety movement, which enabled increased advocacy, education, and research to reduce healthcare-related harm. Despite persistent challenges, a key achievement of the patient safety movement has been application of a systems framework to understand and solve patient safety gaps. That is, patient safety gaps are often a result of system defects rather than isolated acts of individual workers operating in a complex social and technical work setting (often referred to as sociotechnical system). Commonly used systems frameworks describe a sociotechnical system through its components: 1) structure (e.g., people, tools/technology, physical workspaces); 2) processes (e.g., medication administration); and 3) outcomes (e.g., medication safety, patient satisfaction). At their core, both HEIs and healthcare organizations are complex sociotechnical systems that organize their structures to support specific processes - learning in HEIs and patient safety in healthcare - to ultimately improve outcomes for students and patients, respectively. This paper describes parallels between HEIs and the healthcare domain to illustrate how patient safety concepts and practices from healthcare can be adapted to HEIs in order to enhance educational structures, processes, and learning outcomes.
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Affiliation(s)
- Ephrem Abebe
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA
- School of Medicine, Indiana University, Indianapolis, IN, USA
- Corresponding author at: Department of Pharmacy Practice, Purdue University College of Pharmacy, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA.
| | - Amy Bao
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Peter Kokkinias
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | - Alissa L. Russ-Jara
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA
| | - Dan Degnan
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN, USA
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Maria A, Mukherjee R, Upadhyay S, Pratima K, Bandyopadhyay T, Gupta R, Dubey B, Sharma A, Mall PK, Sahoo M, Pathak KK, Pawar P, Mohapatra A. Barriers and enablers of breastfeeding in mother-newborn dyads in institutional settings during the COVID-19 pandemic: A qualitative study across seven government hospitals of Delhi, India. Front Nutr 2022; 9:1052340. [PMID: 36570141 PMCID: PMC9773092 DOI: 10.3389/fnut.2022.1052340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/10/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction The COVID-19 pandemic disrupted newborn care and breastfeeding practices across most healthcare facilities. We undertook this study to explore the barriers and enablers for newborn care and breastfeeding practices in hospitals in Delhi, India for recently delivered mother (RDM)-newborn dyads during the first wave of the COVID-19 pandemic (2020) and inductively design a "pathway of impaction" for informing mitigatory initiatives during the current and future pandemics, at least in the initial months. Materials and methods We used an exploratory descriptive design (qualitative research method) and collected information from seven leading public health facilities in Delhi, India. We conducted separate interviews with the head and senior faculty from the Departments of Pediatrics/Neonatology (n = 12) and Obstetrics (n = 7), resident doctors (n = 14), nurses (labor room/maternity ward; n = 13), and RDMs (n = 45) across three profiles: (a) COVID-19-negative RDM with healthy newborn (n = 18), (b) COVID-19-positive RDM with healthy newborn (n = 19), and (c) COVID-19 positive RDM with sick newborn needing intensive care (n = 8) along with their care-giving family members (n = 39). We analyzed the data using grounded theory as the method and phenomenology as the philosophy of our research. Results Anxiety among clients and providers, evolving evidence and advisories, separation of the COVID-positive RDM from her newborn at birth, providers' tendency to minimize contact duration and frequency with COVID-positive mothers, compromised counseling on breastfeeding, logistic difficulties in expression and transportation of COVID-positive mother's milk to her baby in the nursery, COVID restrictions, staff shortage and unavailable family support in wards and nursery, and inadequate infrastructure were identified as major barriers. Keeping the RDM-newborn together, harmonization of standard operating procedures between professional associations and within and between departments, strategic mobilization of resources, optimization of human resources, strengthening client-provider interaction, risk triaging, leveraging technology, and leadership-in-crisis-situations were notable enablers. Conclusion The separation of the RDM and newborn led to a cascade of disruptions to newborn care and breastfeeding practices in the study institutions. Separating the newborn from the mother should be avoided during public health emergencies unless there is robust evidence favoring the same; routine institutional practices should be family centered.
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Affiliation(s)
- Arti Maria
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India,*Correspondence: Arti Maria
| | - Ritika Mukherjee
- Generating Research Insights for Development (GRID) Council, Executive Office, Noida, Uttar Pradesh, India
| | - Swati Upadhyay
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Kumari Pratima
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Tapas Bandyopadhyay
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Rachita Gupta
- WHO Country Office for India, Nutrition, R.K. Khanna Stadium, Safdarjung Enclave, New Delhi, India
| | - Bhawna Dubey
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Abhinav Sharma
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Pranaya Kumar Mall
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Manaswinee Sahoo
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Keshav Kumar Pathak
- Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Priyanka Pawar
- Generating Research Insights for Development (GRID) Council, Executive Office, Noida, Uttar Pradesh, India
| | - Archisman Mohapatra
- Generating Research Insights for Development (GRID) Council, Executive Office, Noida, Uttar Pradesh, India,Archisman Mohapatra
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Malamateniou DC. "We can all be leaders". J Med Imaging Radiat Sci 2022; 53:S1-S3. [PMID: 36435594 DOI: 10.1016/j.jmir.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Dr Christina Malamateniou
- Department of Radiography, School of Health and Psychological Sciences, University of London, London, UK; Filière TRM, Haute Ecole de Santé Vaud (HESAV), Lausanne, Switzerland.
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Marschall J, Babcock HM, Mosimann UP. Navigating the pandemic in an acute-care hospital-The overlooked relationship between hospital leadership and infection prevention. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e144. [PMID: 36483432 PMCID: PMC9726587 DOI: 10.1017/ash.2022.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, United States
| | - Hilary M. Babcock
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, United States
- BJC Healthcare, St Louis, Missouri, United States
| | - Urs P. Mosimann
- Medical Directorate, Bern University Hospital, Bern, Switzerland
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Physician Engagement before and during the COVID-19 Pandemic in Thailand. Healthcare (Basel) 2022; 10:healthcare10081394. [PMID: 35893216 PMCID: PMC9332341 DOI: 10.3390/healthcare10081394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/21/2022] [Accepted: 07/24/2022] [Indexed: 11/17/2022] Open
Abstract
The COVID-19 pandemic has affected not only the quality of care and patient safety but also physician engagement. The aim of this study was to investigate physician engagement before and during the COVID-19 pandemic and to identify the areas to improve regarding physician engagement. An online survey was conducted from April 2019 to September 2020 among the physicians of 44 hospitals under the Bangkok Dusit Medical Services Public Company Limited (BDMS) before and during the COVID-19 pandemic. The results were analyzed using an independent T-test and one-way ANOVA to compare the continuous variables across groups. Multiple linear regression was used to identify and adjust the variables to determine the areas for improvement. Among the 10,746 respondents, physician engagement during the COVID-19 pandemic was significantly higher than in the pre-COVID-19 period (4.12 vs. 4.06, p-value < 0.001). The top three recommendations to promote physician engagement during the COVID-19 situation comprised (1) marketing (70%), (2) intra-and inter-organizational communication (69%), and (3) the competency of clinical staff (67%). During the COVID-19 pandemic, the positive outcomes toward physician engagement focused on infra-organizational development. These results can be considered in a strategy to optimize physician engagement, which affects the quality of care and patient safety.
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Bayat M, Raeissadat SA, Lashgari S, Bolandnazar NS, Taheri SN, Soleimani M. Post-COVID-19 functional limitations in hospitalized patients and associated risk factors: A 3-month follow-up study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1965. [PMID: 35766187 PMCID: PMC9350172 DOI: 10.1002/pri.1965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/05/2022] [Indexed: 11/24/2022]
Abstract
Background and Purpose Many patients experience post‐COVID‐19 functional limitations. This study aimed to monitor the functional improvement of patients over 3 months of follow‐up and determine the risk factors. Methods This prospective cohort study evaluated 100 hospitalized patients who recovered from COVID‐19 infection. The mean age was 53.2 ± 13.1 years. Fifty‐nine had at least one comorbid condition. The mean lengths of the hospital and ICU stays were 7.8 ± 3.3 and 5.3 ± 2.5 days, respectively. The functional status of the patients was evaluated using functional independence measure (FIM) and post‐COVID‐19 functional status (PCFS) questionnaires at four time‐points of discharge, 1 week, 1 month, and 3 months after discharge. Results Mean FIM score was 107.2 ± 17.4 at the time of discharge, 113.3 ± 14.9 at 1 week, 120.3 ± 10.2 at 1 month, and 124.3 ± 6.4 at 3 months after discharge (p < 0.001). The PCFS score was 2.71 ± 1.25 at discharge, 2.09 ± 1.3 at 1 week, 1.14 ± 1.1 at 1 month, and 0.64 ± 0.59 at 3 months after discharge (p < 0.001). Female sex, older age, and the lengths of hospital and ICU stays were negatively correlated with the functional status score. Discussion Post‐COVID‐19 functional limitations are observed in hospitalized patients and improve over 3 months after discharge. Female sex, older age, longer hospital, and ICU stays are risk factors that negatively impact functional status.
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Affiliation(s)
- Masumeh Bayat
- Department of Physical Medicine and Rehabilitation, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Raeissadat
- Department of Physical Medicine and Rehabilitation, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shervin Lashgari
- Department of Physical Medicine and Rehabilitation, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Najmeh Sadat Bolandnazar
- Department of Physical Medicine and Rehabilitation, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Nima Taheri
- Trauma and Injury Research Center, Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Balogun M, Dada FO, Oladimeji A, Gwacham-Anisiobi U, Sekoni A, Banke-Thomas A. Leading in a time of crisis: exploring early experiences of health facility leaders during the COVID-19 pandemic in Nigeria's epicentre. Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print. [PMID: 35543177 DOI: 10.1108/lhs-02-2022-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The COVID-19 pandemic has had a disruptive effect on the health system. Health facility leaders were at the forefront of maintaining service delivery and were exposed to varied stressors in the early phase of the pandemic. This study aims to explore the leadership experiences of health facility leaders during the early phase of the COVID-19 pandemic in Nigeria's epicentre. DESIGN/METHODOLOGY/APPROACH This study conducted an exploratory descriptive qualitative study. To achieve this, 33 health facility leaders of different cadres across primary, secondary, and tertiary levels of the public health care system in Lagos, Nigeria, were remotely interviewed. The key informant interviews were transcribed verbatim and were analysed by using thematic analysis. FINDINGS The health facility leaders experienced heightened levels of fear, anxiety and stressors during the early phase of the pandemic. They also had genuine concerns about exposing their family members to the virus and had to manage some health-care workers who were afraid for their lives and reluctant. Coping mechanisms included psychological and social support, innovative hygiene measures at health facility and at home, training and staff welfare in more ways than usual. They were motivated to continue rendering services during the crisis because of their passion, their calling, the Hippocratic oath and support from the State government. ORIGINALITY/VALUE The experiences of health facility leaders from different parts of the world have been documented. However, to the best of the authors' knowledge, this is one of the first studies that specifically report multi-layer leadership experiences of health facility leaders during the early phase of the COVID-19 pandemic in sub-Saharan Africa.
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Affiliation(s)
- Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Festus Opeyemi Dada
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Adetola Oladimeji
- Solina Center for International Development and Research, Abuja, Nigeria
| | | | - Adekemi Sekoni
- Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Aduragbemi Banke-Thomas
- School of Human Sciences, University of Greenwich, London, UK and LSE Health, The London School of Economics and Political Science, London, UK
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Dzara K, Pusic M, Carlile N, Krupat E, Alexander EK. Educational adaptation to clinical training during the COVID-19 pandemic: a process analysis. BMC MEDICAL EDUCATION 2022; 22:200. [PMID: 35321706 PMCID: PMC8942055 DOI: 10.1186/s12909-022-03237-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The COVID-19 pandemic is unprecedented in terms of the extent and rapidity of the disruption forced upon formal clinical education, most notably the extensive transition of clinical skills learning to interactive video-based clinical education. METHODS In a phenomenologic study, we used thematic analysis to explore the COVID-19 disruption to clinical training and understand processes relating to adaptation in a large academic medical center. We conducted semi-structured interviews with 14 clinical teachers and 16 trainees representing all levels of clinical learning. Interviews occurred within the initial three months of the crisis, and data were analyzed following a thematic analysis coding process. RESULTS We constructed eight themes synthesizing our participants' perceptions of the immediate unanticipated disruption, noting in the process their alignment with a change management framework. These included: urgency in adapting, with an obvious imperative for change; overcoming inconsistent involvement and support through the formation of self-organized frontline coalitions; attempts to develop strategy and vision via initially reactive but eventually consistent communication; empowering a volunteer army through co-creation and a flattened hierarchy; and efforts to sustain improvement and positive momentum with celebration of trial, error, and growth. The majority of participants found positive outcomes resulting from the tumultuous change process. Moreover, they were now more readily accepting of change, and tolerant of the ambiguous and iterative nature inherent in the education change process. Many anticipated that some innovation would, or would at least deserve to, continue post- crisis. CONCLUSIONS The COVID-19 pandemic afforded an opportunity to study the content and process of change during an active crisis. In this case of clinical education, our findings provide insight into the ways an academic medical system adapts to unanticipated circumstances. We found alignment with broader organizational change management models and that, compared with crisis management models (and their shorter term focus on resolving such crises), stakeholders self-organized in a reliable manner that carries the potential advantage of preserving such beneficial change.
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Affiliation(s)
- Kristina Dzara
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Brigham Education Institute, 75 Francis Street, TH-1-127, Boston, MA, 02115, USA
| | - Martin Pusic
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Brigham Education Institute, 75 Francis Street, TH-1-127, Boston, MA, 02115, USA
| | - Narath Carlile
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Brigham Education Institute, 75 Francis Street, TH-1-127, Boston, MA, 02115, USA
| | - Edward Krupat
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Brigham Education Institute, 75 Francis Street, TH-1-127, Boston, MA, 02115, USA
| | - Erik K Alexander
- Harvard Medical School, Boston, MA, USA.
- Brigham and Women's Hospital, Brigham Education Institute, 75 Francis Street, TH-1-127, Boston, MA, 02115, USA.
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Transforming a public university hospital and its area of influence into a comprehensive resource in response to the COVID-19 pandemic. J Healthc Qual Res 2022; 37:335-342. [PMID: 35780057 PMCID: PMC8907019 DOI: 10.1016/j.jhqr.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/26/2021] [Accepted: 02/16/2022] [Indexed: 01/08/2023]
Abstract
Introduction and objectives The outbreak of COVID-19 has overwhelmed healthcare systems all over the world. The aim of this article is to describe the process of transforming the Vall d’Hebron University Hospital, the second largest hospital in Spain, into a COVID-19 centre coordinating response to the pandemic in its reference area. Materials and methods The study draws on the experience of the authors in transforming the hospital into a comprehensive resource in response to the COVID-19 pandemic. The strategy is based on four central strategies: early planning, coordination of all healthcare agents in its reference area, definition of clear leadership roles, and the organisation of care based on multidisciplinary teams with minimal recruitment of new staff. Results The transformation strategy enabled the hospital to cope with the surge in patients without exceeding its capacity. During the response phases, which amounted to a period of 57 days, 3106 patients consulted the ER and 2054 were admitted, 346 of whom were treated at the ICU. To accommodate the number of adult COVID-19 patients, adult ICU availability was progressive increased by 371%, and ordinary beds increased by 240. A total of 671 staff members went on sick leave after testing positive for COVID-19. Conclusion The transformation experience of the hospital provides insight into how effectively adapt the structures and functioning of large hospitals. The relevance of territorial coordination during the pandemic is stressed as an effective strategy that contributed coping the pandemic.
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