Quality improvement collaborative approach to COVID-19 pandemic preparedness in long-term care homes: a mixed-methods implementation study.

BACKGROUND: The devastating impact of the COVID-19 pandemic on long-term care (LTC) homes underscores the importance of effective pandemic preparedness and response. This mixed-methods, implementation science study investigated how a virtual-based quality improvement (QI) collaborative approach can improve uptake of pandemic-related promising practices and shared learning across six LTC homes in British Columbia, Canada in 2021 during the COVID-19 pandemic health emergency. METHODS: QI teams consisting of residents, family/informal caregivers, care providers and leadership in LTC homes are supported by QI facilitation and shared learning through virtual communication platforms. QI projects address gaps in outbreak preparation, prevention and response; planning for care; staffing; and family presence. Thematically analysed semi-structured qualitative interviews and a validated questionnaire on organisational readiness investigated participants' perceptions of challenges, success factors and benefits of participating in the virtual QI collaborative approach. RESULTS: Nine themes were identified through interview analysis, including two related to challenges (ie, making time for QI and hands tied by external forces), four regarding factors for successes (ie, team buy-in, working together as a team, bringing together diverse perspectives and facilitators keep us on track) and three on the benefits of the QI collaborative approach (ie, seeing improvements, staff empowerment and appetite for change). Continuous QI facilitation and coaching for QI teams was feasible and sustainable virtually via video conferencing (Zoom). The QI team members showed limited engagement on the virtual communication platform (Slack), which was predominantly used by the implementation science team and QI facilitators to coordinate the study and QI projects, respectively. CONCLUSIONS: The virtual-based QI collaborative approach to pandemic preparedness supported LTC homes to rapidly and successfully form multidisciplinary QI teams, learn about QI methods and conduct timely QI projects to implement promising practice for improved COVID-19 pandemic response.

Regulating Borrower Hardship in Australia, Singapore, and Hong Kong: Payment Holidays During COVID-19 and Beyond.

Borrower hardship, while a critical issue, is not often addressed by consumer protection frameworks across the Asia-Pacific. The widespread use of payment holidays during the COVID-19 crisis provides a significant case study on the importance of having borrower hardship provisions as a consumer protection tool. This paper compares the pre-pandemic availability of payment holidays in three Asia-Pacific jurisdictions: Australia, Singapore, and Hong Kong. It evaluates their existing legislative frameworks, as well as regulatory and industry guidelines on borrower hardship, and contrasts this with their use of payment holidays during the pandemic. Where there were existing industry guidelines on borrower hardship, lenders were able to spearhead an industry-wide approach towards payment relief without regulatory intervention by governments. Beyond the pandemic, the paper argues that self-regulation has potential for protecting borrower interests by standardising the scope of, and the procedure for, obtaining hardship relief. It argues that there is a need for a greater prevalence of industry codes of conducts governing lenders' approach towards borrower hardship across the Asia-Pacific.