Challenges of primary health care leadership during the COVID-19 pandemic in Sweden: a qualitative study of managers' experiences.

PURPOSE: At the outbreak of the COVID-19 pandemic, health care was at the centre of the crisis. New demands made existing organizational practices and services obsolete. Primary health care had a great deal of responsibility for COVID-19-related care. The pandemic demanded effective leadership to manage the new difficulties. This paper aims to explore experiences and perceptions of managers in primary health care in relation to their efforts to manage the COVID-19 crisis in their everyday work. DESIGN/METHODOLOGY/APPROACH: The authors used a qualitative approach based on 14 semi-structured interviews with managers in primary health care from four regions in Sweden. The interviews were conducted during September to December 2020. Data were analysed using conventional qualitative content analysis. FINDINGS: Data analysis yielded three categories: lonely in decision-making; stretched to the limit; and proud to have coped. The participants felt lonely in their decision-making, and they were stretched to the limit of their own and the organization's capacity. The psychosocial working conditions in primary care worsened considerably during the pandemic because demands on leaders increased while their ability to control the work situation decreased. However, they also expressed pride that they and their employees had managed the situation by being flexible and having a common focus. ORIGINALITY/VALUE: Looking ahead and using lessons learnt, and apart from making wise decisions under pressure, an important implication for primary health-care leaders is to not underestimate the power of acknowledging the virtues of humanity and justice during a crisis. Continuing professional education for leaders focusing on crisis leadership could help prepare leaders for future crises.

Seven lessons from the coronavirus pandemic for primary health care: A qualitative study of registered and assistant nurses in Sweden.

AIM: The aim of this study was to explore lessons from the pandemic by registered and assistant nurses in Swedish primary health care (PHC) of potential relevance for the future operation of PHC. METHODS: Twenty-one semi-structured interviews were conducted with registered and assistant nurses. We used a purposeful sampling strategy to achieve a diverse sample with regard to size and location of PHC centres. Data were analysed using qualitative content analysis. RESULTS: Analysis yielded two categories: lessons from the pandemic pertaining to PHC personnel and patient behaviours (adaptability of the personnel; importance of hygiene and maintaining physical distance; and importance of being attentive to illness symptoms) and lessons from the pandemic related to primary healthcare work routines (effectiveness of digital job meetings; advantages of digital patient consultations; importance of keeping infectious patients separate from other patients; and the need to allow only pre-booked patient appointments). CONCLUSIONS: The seven sub-categories represent seven lessons from the pandemic. The lessons generated both instrumental knowledge, which the nurses could apply in work-related decisions, and conceptual knowledge which yielded improved understanding of problems and potential solutions for PHC.

Working conditions in primary healthcare during the COVID-19 pandemic: an interview study with physicians in Sweden.

OBJECTIVE: The aim of this study was to explore how the COVID-19 pandemic changed the working conditions of physicians in Swedish primary healthcare. DESIGN: This is a descriptive, qualitative study with individual semistructured interviews. Data were analysed using inductive content analysis. SETTING: Swedish primary healthcare units in both rural and urban areas. PARTICIPANTS: A total of 11 primary care physicians fulfilled participation. RESULTS: Two main categories emerged: 'work organisation and routines' and 'psychosocial work environment', containing three and five subcategories, respectively. The pandemic enforced changes in work organisation and routines. Increased flexibility, including more patient-oriented delivery of care, and novel means of interorganisational and intraorganisational interactions were perceived as positive by physicians. The pandemic also caused several changes in physicians' psychosocial work environment. Increased workload, information overload, as well as ethical considerations and feelings of uncertainty made the work environment stressful for physicians. CONCLUSIONS: The COVID-19 pandemic affected the working conditions of physicians in Swedish primary healthcare in numerous ways. The pandemic enforced changes in work organisation and routines for physicians in primary healthcare. Further research is needed to investigate how the pandemic will affect primary healthcare in the longer term. Learning from the pandemic is important because this will not be the last crisis that primary care and its healthcare professionals will face.