Impact of hospital readiness on patient safety incidents during the COVID-19 pandemic in Indonesia: health worker perceptions.

OBJECTIVES: This study examined the impact of hospital readiness on patient safety from the healthcare workers' perspective. DESIGN: The study employed a mixed-methods explanatory sequential design, with the quantitative phase taking precedence. We conducted an online survey of 235 healthcare workers at COVID-19 referral hospitals, followed by an interview with 11 participants from various hospital types. SETTING: COVID-19 referral hospitals in Indonesia. PARTICIPANTS: Health workers working at COVID-19 referral hospitals. MEASURES: Hospital ownership; hospital accreditation status; hospital readiness including incident management system, surge capacity, infection control and prevention, and human resource management; patient safety incident. RESULTS: According to the survey, 66.4% of the participants worked at a hospital owned by the provincial or district government, and 69.4% worked at a hospital which had received an excellent status accreditation. More than 80% of the hospitals scored well in the categories of the incident management system (86%), surge capacity (80.9%), infection control and prevention (97.9%), and human resource management (84.7%). However, only 50.6% of the hospitals scored well in managing patient safety incidents. Hospital ownership, accreditation status and hospital readiness all have an impact on patient safety incidents, which were reported in all types of hospitals by both studies. CONCLUSIONS: This study provides significant results for Indonesia in terms of hospital preparedness and patient safety for the COVID-19 pandemic. The accreditation and ownership status of the hospital have aided hospital readiness. Despite the fact that no hospital in the world was prepared for the COVID-19 pandemic, hospital readiness has improved a year later; however, patient safety has not improved. Patient safety incidents occurred regardless of hospital status, with the most common occurrence being delayed treatment. Administrative errors were also recorded in COVID-19 field hospitals that were not accredited. Future research should focus on improving pandemic care quality and implementing initiatives that are applicable to all types of hospitals.

Identifying core competencies for practicing public health professionals: results from a Delphi exercise in Uttar Pradesh, India.

BACKGROUND: Ensuring the current public health workforce has appropriate competencies to fulfill essential public health functions is challenging in many low- and middle-income countries. The absence of an agreed set of core competencies to provide a basis for developing and assessing knowledge, skills, abilities, and attitudes contributes to this challenge. This study aims to identify the requisite core competencies for practicing health professionals in mid-level supervisory and program management roles to effectively perform their public health responsibilities in the resource-poor setting of Uttar Pradesh (UP), India. METHODS: We used a multi-step, interactive Delphi technique to develop an agreed set of public health competencies. A narrative review of core competency frameworks and key informant interviews with human resources for health experts in India were conducted to prepare an initial list of 40 competency statements in eight domains. We then organized a day-long workshop with 22 Indian public health experts and government officials, who added to and modified the initial list. A revised list of 54 competency statements was rated on a 5-point Likert scale. Aggregate statement scores were shared with the participants, who discussed the findings. Finally, the revised list was returned to participants for an additional round of ratings. The Wilcoxon matched-pairs signed-rank test was used to identify stability between steps, and consensus was defined using the percent agreement criterion. RESULTS: Stability between the first and second Delphi scoring steps was reached in 46 of the 54 statements. By the end of the second Delphi scoring step, consensus was reached on 48 competency statements across eight domains: public health sciences, assessment and analysis, policy and program management, financial management and budgeting, partnerships and collaboration, social and cultural determinants, communication, and leadership. CONCLUSIONS: This study produced a consensus set of core competencies and domains in public health that can be used to assess competencies of public health professionals and revise or develop new training programs to address desired competencies. Findings can also be used to support workforce development by informing competency-based job descriptions for recruitment and performance management in the Indian context, and potentially can be adapted for use in resource-poor settings globally.

Effectiveness of a pay-for-performance intervention to improve maternal and child health services in Afghanistan: a cluster-randomized trial.

BACKGROUND: A cluster randomized trial of a pay-for-performance (P4P) scheme was implemented in Afghanistan to test whether P4P could improve maternal and child (MCH) services. METHODS: All 442 primary care facilities in 11 provinces were matched by type of facility and outpatient volume, and randomly assigned to the P4P or comparison arm. P4P facilities were given bonus payments based on the MCH services provided. An endline household sample survey was conducted in 72 randomly selected matched pair catchment areas (3421 P4P households; 3427 comparison).The quality of services was assessed in 81 randomly sampled matched pairs of facilities. Data collectors and households were blinded to the intervention assignment. MCH outcomes were assessed at the cluster level. RESULTS: There were no substantial differences in any of the five MCH coverage indicators (P4P vs comparison): modern contraception(10.7% vs 11.2% (P = 0.90); antenatal care: 56.2% vs 55.6% (P = 0.94); skilled birth attendance (33.9% vs 28.5%, P = 0.17); postnatal care (31.2% vs 30.3%, P = 0.98); and childhood pentavalent3 vaccination (49.6 vs 52.3%, P = 0.41), or in the equity measures. There were substantial increases in the quality of history and physical examinations index (P = 0.01); client counselling index (P = 0.01); and time spent with patients (P = 0.05). Health workers reported limited understanding about the bonuses. CONCLUSIONS: The intervention had minimal effect, possibly due to difficulties communicating with health workers and inattention to demand-side factors. P4P interventions need to consider management and community demand issues.

Leadership in Times of Crisis: The Example of Ebola Virus Disease in Liberia.

The Ebola epidemic of 2014-2015 was one of the most significant public health threats of the 21st century, a crisis that challenged leadership in West Africa and around the world. Using the experience of Liberia's epidemic control efforts, we highlight the critical role that leadership played during four phases of the epidemic response: (1) crisis recognition and early mobilization; (2) the emergency phase; (3) the declining epidemic; and (4) the long tail. We examine how the decisions and actions taken in each phase of the epidemic address key crisis leadership tasks, including sense-making, decision making, meaning-making, crisis termination, and learning, and assess how leadership approaches evolved during the different epidemic phases to accomplish these tasks. A contingency leadership theory lens is used to identify situations where strong leadership, good leader-member relations, and well-structured tasks can facilitate different leadership approaches. The first phase of the epidemic was hampered by insufficient attention to sense-making and weak decision making, in part because of the existing hierarchical leadership approach. This contributed to amplification of the epidemic. The emergency phase of the epidemic brought a change in leadership that focused on sense-making, decision-making, and meaning-making tasks. A distributed leadership approach replaced the old hierarchies. In addition to sharing leadership responsibility and authority, the distributed leadership approach involved strategically engaging stakeholders and communicating intensively. Although much of the hierarchical leadership approaches returned in the latter phases of the epidemic, there remain more empowered leaders at different levels across the country. Systematically tackling crisis leadership tasks, recognizing situations where different leadership approaches can be used, and employing a distributed leadership approach are helpful lessons to prepare for and respond to future crises.