Temporary healthcare services for crisis response: organization and management of a mass vaccination center.

PURPOSE: Scientific description of the organization and management of a temporary large scale healthcare (T-LSHc) vaccination clinic and evidence-based guidance for future temporary healthcare (T-Hc) services. DESIGN/METHODOLOGY/APPROACH: Mixed-methods rapid feedback case study, using interviews, document analysis and quantitative data, with both data collection and analysis guided by a research-informed systems program theory of the clinic. FINDINGS: Private contractors were not willing to bid for contracts to set up and close a T-LSHc vaccination clinic in 2022, although they had done so earlier in the year. The public health system was able successfully to set up and run the clinic itself for 2 months, serving 3,000 people a day at its peak. Part of the success was because a dedicated unit to set up and run T-Hc services had been created in 2020. The Stockholm organization model differed from the Milan model by using information technology to reduce the need for a large number of on-site doctors. RESEARCH LIMITATIONS/IMPLICATIONS: There may be recall bias in interview data as interviews were carried out four months after the closing of the clinic. The conclusions apply to clinically simple but managerially complex T-Hc services but are limited to public healthcare systems operating in a similar context to that of the case study service. The study contributes to the new science of healthcare crisis organization and management and fills gaps in knowledge in disaster medicine for enduring and fluctuating health crises. The findings show the importance of a capacity to establish and manage T-Hc, and of the specialist management and HIT competence that health systems will need to build to meet the crises that threaten our health, both now and in the future. PRACTICAL IMPLICATIONS: Public healthcare systems can provide clinically simple and managerially complex T-Hc services quickly and successfully if they have experience and capacity to plan and set up such services, skilled operational managers respected by staff, staff who can be redeployed, and suitable health information technology. SOCIAL IMPLICATIONS: The need for healthcare services to respond to crises is likely to increase in the future. Information for creating the service may be limited at first and changing. The exact nature of the health threat may be uncertain, as may the demand and needs of subpopulations and individuals. The study findings can help to respond quickly to reduce morbidity illness and death through creating and organizing temporary large-scale public healthcare services when existing services cannot be reorganized to meet the scale of the need. ORIGINALITY/VALUE: This article is the first detailed empirical description and analysis of a large-scale temporary healthcare service operated by the primary care division of an integrated public healthcare system, with research informed guidance for future services of this type in similar contexts. This article compares two organization models of T-LSHc services, and contributes to an emerging subdiscipline of the organization and management of disaster and crisis healthcare.

Rapid implementation of remote digital primary care in Stockholm and implications for further system-wide implementation: practitioner's and manager's experience of the Always Open mobile application.

OBJECTIVE: To contribute actionable knowledge how to increase appropriate use of digital technologies in primary care by understanding clinical managers experiences with a digital connection system, Always Open, during the COVID-19 pandemic. DESIGN AND SUBJECTS: The overall design was a qualitative study with directed content analysis method. Data were collected from documents and focus group (n = 12) interviews with clinical managers (n = 99) of primary care. The seven domains of the Non-adoption, Abandonment, and challenges to the Scale-up, Spread and Sustainability (NASSS) framework was used to understand the implementation process, as described by the clinical managers. RESULTS: Focus group participants reported that their units made their own local decisions to make more use of the technology provided by the health system. Most participants considered that the technology was ready to use, despite some limitations, that included individual clinician's and patient preferences, and how ready their unit was for making changes to practice and organization. Some raised concerns about how standardizing some aspects possibly conflicted with the decentralized management model of the organization. The overall experience was reported to be positive, with an intention to sustain the achievements. CONCLUSION: Focus group interviews found that clinical unit managers reported that they and their staff were positive about the digital technology system for remote care. For the future, they wanted changes to be made at different levels of the health system to better combine digital and physical care. Possibilities to use digital technology to integrate primary and hospital health care were identified.

Rapid adoption of Always Open as a digital connection mHealth system for remote digital care was observed during the pandemic without a structured implementation program.Many factors could explain the rapid adoption and the intention to sustain the use of Always Open such as professional ethics, financial reimbursement, patient needs and support.Standardization needs to be balanced with flexibility to ensure that staff can decide what is appropriate for patients.The general experience was positive and a continual high use of Always Open was reported in units that adopted the system.The decentralized management model may have contributed to the capacity to provide flexible services suited to local needs.

No man is an island: management of the emergency response to the SARS-CoV-2 (COVID-19) outbreak in a large public decentralised service delivery organisation.

BACKGROUND: We wanted to better understand whether and how agility can be achieved in a decentralised service delivery organisation in Sweden. The pandemic outbreak of SARS-Cov-2 (Covid-19) provided an opportunity to assess decentralisation as a strategy to improve the responsiveness of healthcare and at the same time handle an unpredictable and unexpected event. METHODS: Data from in-depth interviews with a crisis management team (n = 23) and free text answers in a weekly survey to subordinated clinical directors, i.e. unit managers, (n = 108) were scrutinised in a directed content analysis. Dynamic capabilities as a prerequisite for dynamic effectiveness, understood as reaching strategic and operative effectiveness simultaneously, were explored by using three frameworks for dynamic effectiveness, dynamic capabilities and delegated authority in a decentralised organisation. RESULTS: Unpredictable events, such as the pandemic Covid-19 outbreak, demand a high grade of ability to be flexible. We find that a high degree of operational effectiveness, which is imperative in an emergency situation, also is a driver of seeking new strategic positions to even better meet new demands. The characteristics of the dynamic capabilities evolving from this process are described and discussed in relation to decentralisation, defined by decision space, organisational and individual capacity as well as accountability. We present arguments supporting that a decentralised management model can facilitate the agility required in an emergency. CONCLUSIONS: This study is, to our knowledge, the first of its kind where a decentralised management model in a service delivery organisation in healthcare is studied in relation to crisis management. Although stemming from one organisation, our findings indicating the value of decentralisation in situations of crisis are corroborated by theory, suggesting that they could be relevant in other organisational settings also.

Managers do it their way: How managers act in a decentralised healthcare services provider organisation - a mixed methods study.

Purpose: Decentralisation is considered a way to get managers more committed and more prone to respond to local needs. This study analyses how managers perceive a decentralised management model within a large public healthcare delivery organisation in Sweden. Design/methodology/approach: A programme theory evaluation was performed applying direct content analysis to in-depth interviews with healthcare managers. Balance score card data were used in a blinded comparative content analysis to explore relations between performance and how the delegated authority was perceived and used by the managers. Findings: Managers' perceptions of the decentralised management model supported its intentions to enable the front-line to make decisions to better meet customer needs and flexibly adapt to local conditions. The managers appreciated and used their delegated authority. Central policies and control on human resources and investments were accepted as those are to the benefit of the whole organisation. Leadership development and organisation-wide improvement programmes were of support. Units showing high organisational performance had proactive managers, although differences in manager perceptions across units were small. Originality: This, one of the first of its kind, study of a decentralisation in service delivery organisation shows a congruence between the rationale of a management model, the managers' perceptions of the authority and accountability as well as management practises. These observations stemming from a large public primary and community healthcare organisation has not, to our knowledge, been reported and provide research-informed guidance on decentralisation as one strategy for resolving challenges in healthcare service delivery organisations.

Implementation Science for Managers and Healthcare Organizations Responding to Emergencies.

The purpose of the article is to illustrate how implementation science concepts and methods can be applied by researchers and implementers to understand and assist emergency management in a large primary and community healthcare organization. The article refers to a single-case implementation action evaluation of an emergency management system in a healthcare organization. It describes the methods used in this study and findings to explain how a joint healthcare and university research team were able to use the science and methods both to help implementation and contribute to science. We report two sets of findings. First, findings about implementation of emergency management to illustrate how the investigation adapted implementation science and concepts to achieve the objectives evaluation. We discovered that implementation science provides useful concepts to understand contextual factors and adds to knowledge about organizational change and emergency management in the uncertain and evolving situation we encountered. The second set of findings are the strengths and limitations of both implementation science and the action evaluation methods we used to achieve the dual objectives of practical help with implementation and to contribute to science. The article uses the first implementation action evaluation study of the response of large public primary and community healthcare organization to a pandemic to illustrate how implementation science can be applied. This type of study was able to improve implementation of the response as well as contribute to scientific knowledge about emergency healthcare management and organization.

That's how it should work: the perceptions of a senior management on the value of decentralisation in a service delivery organisation.

PURPOSE: Decentralisation in health care has been proposed as a way to make services more responsive to local needs and by that improve patient care. This study analyses how the senior management team conceptualised and implemented a decentralised management model within a large public health care delivery organisation. DESIGN/METHODOLOGY/APPROACH: Data from in-depth interviews with a senior management team were used in a directed content analysis. Underlying assumptions and activities in the decentralisation process are presented in the logic model and scrutinised in an a priori logic analysis using relevant scientific literature. FINDINGS: The study found support in the scientific literature for the underlying assumptions that increased responsibility will empower managers as clinical directors know their local prerequisites best and are able to adapt to patient needs. Top management should function like an air traffic control tower, trust and loyalty improve managerial capacity, increased managerial skills release creativity and engagement and a system perspective will support collaboration and learning. ORIGINALITY/VALUE: To the authors' knowledge this is the first a priori logic analysis of a decentralised management model in a healthcare delivery organisation in primary and community care. It shows that the activities consist with underlying assumptions, supported by evidence, and timely planned give managers decision space and ability to use their delegated authority, not disregarding accountability and fostering necessary organisational and individual capacities to avoid suboptimisation.

Can management decentralisation resolve challenges faced by healthcare service delivery organisations? Findings for managers and researchers from a scoping review.

PURPOSE: Decentralisation of decision-making from central to lower level organisation has been proposed as a way to increase innovation and make services more responsive to local needs. The purpose of this study was to discover research that can contribute to understanding decentralisation as one strategy for resolving challenges in healthcare service delivery organisations. This scoping review provides examples and research-informed guidance for decentralisation research, planning and implementation. FINDINGS: There is limited empirical research into management decentralisation within primary and community care, but some useful frameworks for assessing and planning decentralisation. Rapid changes are being made to workforce redesign, substitution and patient co-production. Research into such 'micro-decentralisation' is not considered in the decentralisation literature. Neither is how the context of culture, systems and regulations affects implementation of this type of decentralisation. Our recent experience suggests that management decentralisation can enable fast and effective local changes to respond to the evolving Severe acute respiratory syndrome coronavirus 2 (SARS COV-2) pandemic. CONCLUSIONS: Decentralisation can create conditions that support innovation and improvement locally to develop primary and community care. Managers and policy makers can use an appropriate decentralisation strategy to address challenges in workforce retention and recruitment, rising care demands and expectations of patients. There are opportunities for researchers to provide actionable knowledge about changes in organisations and management which could address current challenges in healthcare.

Management of the emergency response to the SARS-CoV-2 (COVID-19) outbreak in Stockholm, Sweden, and winter preparations.

INTRODUCTION Sweden is unique in adopting a 'no-lockdown' public health approach to the SARS-CoV-2 (COVID-19) outbreak. There were fears that health services would not be able to care for high numbers of COVID-19 patients. AIM To describe and review the emergency response of a public primary and community health-care organisation in Stockholm, Sweden, to the demand for care for COVID-19 and non-COVID-19 patients during March-July 2020, and summarise preparations for the months to follow. METHODS This was a rapid implementation action research case study, which also draws on one author's experience as Chief Executive Officer and other members' experience in an emergency management group. RESULTS Sweden experienced similar mortality per million population to the UK, despite the different public health strategy used to address the COVID-19 outbreak. The Stockholm-integrated public primary and community health-care service, serving a population of 2.3 million, made many changes quickly. One change included coordinating non-acute private health-care services, following the local government emergency directive to do so. DISCUSSION It is possible that the fast and effective response by management and services in primary and community health care reduced infection and hospital demand, which contributed to a lower mortality than otherwise expected. The actions and preparations described for Stockholm's response may provide ideas for other health-care systems. The partnership research approach between the Karolinska Medical University and the Region Stockholm health-care system used in this project shows that rapid research methods have advantages for both partners in an emergency situation.