Background
Managers’ role in resilience
The role of contextual factors
Aim and research questions
Methods
Design
Norwegian geography and demography
Study context
Case selection
Characteristics | Case 1 | Case 2 | Case 3 | Case 4 |
---|---|---|---|---|
Municipality description and population | Urban, centralized municipality. 100 000+ | Rural, decentralized municipality. 5000–10 000 | Rural, centralized municipality. 5000–10 000 | Urban, centralized municipality. 100 000+ |
Organization | Several homecare departments with different bases | Several homecare departments with different bases | One homecare department located in the municipality’s healthcare centre | Several homecare departments with different bases and one department with a base in the local healthcare centre |
Number of homecare departments represented | 1 | 2 | 1 | 4 |
Average local infection pressure during the interviews | High | Low | Low | Medium |
Recruitment and participants
Participants | Case 1 | Case 2 | Case 3 | Case 4 | Total |
---|---|---|---|---|---|
Front-line managers
| n = 1 | n = 2 | n = 1 | n = 5 | n = 9 |
Middle managers
| n = 1 | n = 2 | n = 1 | n = 1 | n = 5 |
Top-level managers
| n = 1 | n = 1 | n = 1 | n = 1 | n = 4 |
Infection control doctors
| n = 0 | n = 1 | n = 1 | n = 1 | n = 3 |
Total
| n = 3 | n = 6 | n = 4 | n = 8 | n = 21 |
Data collection
Data analysis
Cases | Data extract | Coded for | Theme |
---|---|---|---|
Case 1
|
Many of our employees work several different places, so we had to reallocate some of our staff. Some were temporarily employed, and if they worked part-time two different places, they were offered full-time position at one place.
| Reorganizing and reallocating resources | Managerial strategies to mitigate shortages of healthcare staff |
Case 2
|
Then we had to start search for personnel from other parts in the organization and redistribute tasks among staff… … We had some personnel in sick leave that could contribute because their work were facilitated according to what they managed to do.
| Reorganizing and reallocating resources | |
Case 3
|
We implemented new work schedules and cohorts, which cost a lot of money. Many of our healthcare staff works in small positions, so we had to increase their positions in that period.
| Measures to ensure adequate staffing | |
Case 4
|
We have a minimum staffing with two nurses and if one waits for a [Covid-19] test result, we need to take action to ensure proper staffing (…) in case the person doesn’t receive the test result before their shift. So we are ahead
| Hired in extra personnel to ensure adequate staffing |
Results
Main Challenges | CASE 1 Urban, centralized municipality. Population: 100 000+ High infection pressure | CASE 2 Rural, decentralized municipality. Population: 5000–10 000 Low infection pressure | CASE 3 Rural, centralized municipality. Population: 5000–10 000 Low infection pressure | CASE 4 Urban, centralized municipality. Population: 100 000+ Medium infection pressure |
---|---|---|---|---|
Shortage of healthcare staff
| Healthcare personnel working part-time at several employees. Lack of personnel due to quarantine (infection, symptoms, travel and national lock-down). Employees being home with children due to lock down of non-essential services (school, child day care). | Finding resources to new pandemic related tasks (related to geographical location). Balancing resources and competence when reallocating. High absence rate (quarantine) due to travel restrictions (related to geographical location) | Finding resources to new pandemic related tasks. Limited access to resources due to travel restrictions and recommendations of working in one municipality. Balancing resources and competence when reallocating | Lack of personnel due to quarantine (infection, symptoms, travel and national lock-down) |
Lack of preparedness, infection prevention and control
| No practical experience with emergency preparedness and response. Rooms and buildings were not designed in accordance with current infection control measures. Homecare recipients become in need for higher level of care (e.g., nursing home) Lack of infection control equipment | Climatic challenges due to infection control tasks (testing). Long distance between essential healthcare services within the region (e.g., intensive care, PCR-test analysis and transportation). Stressful to handle long term preparedness Home care recipients’ experiences loss of life quality due to lock down of non-essential services. Lack of infection control equipment/date expire on current equipment | Challenging to plan for uncertainty. Unclear roles and responsibility. Challenging to practice user participation. Homecare recipients at nursing home residents became lonely due to lock down of essential services and restrictions due to physical meetings. Lack of understanding due to national infection control measures (low local infection rate). Lack of infection control equipment | Adjusting guidelines, plans and regulations into local context (e.g., the municipality also has a rural part with a healthcare centre). Stressful to handle long term preparedness Homecare recipients experienced loss of health due to lockdown of non-essential services and become in need for higher level of care (e.g., nursing home). Lack of infection control equipment Demanding to handle infection control outbreaks in homecare services. Difficult to split workforce into teams in rural areas |
Information, collaboration, dialogue across units and levels.
| No plans for collaboration across units and departments. Lack of common guidelines for public and private sector | Was not heard and lack of understanding from National Health Authorities due to challenges related to geographical location | Was not consulted and invited to dialogue to discuss local challenges by National Health Authorities in an early phase in the pandemic. Challenging to be a part of a large region due to local differences and challenges | Constantly changing national guidelines led to challenges with information flow across levels. Digital platforms not suitable for dialogue in groups |
Remote leadership
| Home office and remote leadership. High workload for managers | Lack of knowledge about nursing leadership (managers with other types of education) | Remote leadership made it challenging to interact with employees and colleagues | Managers had high workload. Remote leadership made it difficult to support employees |
Managerial strategies to mitigate shortages of healthcare staff
“We have a minimum staffing with two nurses and if one waits for a test result, we need to take action to ensure proper staffing for that weekend in case the person doesn’t receive the test result before their shift, so we are ahead.” (Front-line manager, Case 4).
Contingency planning strategies and infection control
Contingency planning and strategies to adapt to local context
“We need proper conditions for testing, so we had to rent suitable premises nearby. Because after we had premises for testing, it became too cold in there and the antigen rapid test could be temporarily affected. So, we needed to do some adjustments along the way, because it can easily be too cold. We wanted an outdoor test station so people didn’t need to leave their cars as we could see many other places, but then people had to work in an outfit used for snowmobile driving, so we couldn’t do it outdoors.” (Infection control doctor, Case 2).
New procedures, infection control training and innovative solutions
“We used the quarantine period actively for courses and training…. So many needed infection control training and while they were home in quarantine they might as well participate in the training courses.” (Middle manager, Case 1).
Strategies for collaboration, dialogue, and coordinated responses across levels
Collaboration and coordination across national and local levels
“… you do not have to be a healthcare professional to do everything. The infection tracking team … we managed to train people from the personnel, technical and the financial department to do that. People that had work tasks that could be set aside if we needed them. So, we have improved our cross-sectoral collaboration. (…) We might be too focused of working within our respective sector, we need to be able to utilize our resources in a better way.” (Middle manager, Case 2).
Information and communication strategies to ensure adequate information across levels
“I think it was a challenge to interpret when you got these restrictions and recommendations, right? Interpreting them into a local context requires you to be clear. Like I am clear giving information to my managers, and it was not always that I had the information I needed to be clear enough.” (Middle manager, Case 2).
Supportive and present leadership
Promoting employees’ safety and effective communication by present and available leadership
“Many of our staff are tired after last Christmas. There was an infection outbreak in our nursing home and the front-line manager worked double shifts almost the entire period, and you see what that meant for her staff. There were hardly any nurses left, so she had to work as a nurse and that meant a lot. And what she established by doing that, that’s valuable. She formed bonds with her employees which I think is very important for future work.” (Middle manager, Case 3).
Being seen, heard, and encouraged by supportive managers
“I think I’ve been a little more focused on each and every manager and to see them every day. It’s been a lot of … we`ve had home office and everything happens digitally, so it has affected the interaction I’ve had with my managers below me. But I’ve been good at calling them on Skype just asking them how they are today. (…) So, it’s been a way of seeing them in everyday work.” (Top-level manager, Case 2).