Formal and informal hospital emergency management practices: Managing for safety and performance amid crisis.

BACKGROUND: Although formal preparedness for unexpected crises has long been a concern of health care policy and delivery, many hospitals struggled to manage staff and equipment shortages, precarious finances, and supply chain disruptions among other difficulties during the COVID-19 pandemic. Our purpose was to analyze how hospitals used formal and informal emergency management practices to maintain safe and high-quality care while responding to crisis. METHODS: We conducted a qualitative study based on 26 interviews with hospital leaders and emergency managers from 12 U.S. hospitals purposively sampled to vary along geographic location, urban/rural delineation, size, resource availability, system membership, teaching status, and performance levels among other characteristics. RESULTS: In order to manage staff, space, supplies, and systems related challenges, hospitals engaged formal and informal practices around planning, teaming, and exchanging resources and information.Relying solely only on formal or informal practices proved inadequate, especially when prespecified plans, the incident command structure, and existing contracts and communication platforms failed to support resilient response. We identified emergent capabilities - imaginative planning, recombinant teaming, and transformational exchange - through which hospitals achieved harmonious interplay between the formal and informal practices of emergency management that supported safe care and resilience amid crisis. CONCLUSION: Managing emergent challenges for and amid crisis calls for health care delivery organizations to engage creative planning processes, enable motivated workers with diverse skill sets to team up, and establish rich inter- and intra-organizational partnerships that support vital exchange.

Organizational learning in surgery in Tanzania's health system: a descriptive cross-sectional study.

Organizational learning is critical for delivering safe, high-quality surgical care, especially in low- and middle-income countries (LMICs) where perioperative outcomes remain poor. While current investments in LMICs prioritize physical infrastructure, equipment, and staffing, investments in organizational learning are equally important to support innovation, creativity, and continuous improvement of surgical quality. This study aims to assess the extent to which health facilities in Tanzania's Lake Zone perform as learning organizations from the perspectives of surgical providers. The insights gained from this study can motivate future quality improvement initiatives and investments to improve surgical outcomes. We conducted a cross-sectional analysis using data from an adapted survey to explore the key components of organizational learning, including a supportive learning environment, effective learning processes, and encouraging leadership. Our sample included surgical team members and leaders at 20 facilities (health centers, district hospitals, and regional hospitals). We calculated the average of the responses at individual facilities. Responses that were 5+ on a 7-point scale or 4+ on a 5-point scale were considered positive. We examined the variation in responses by facility characteristics using a one-way ANOVA or Student's t-test. We used univariate and multiple regression to assess relationships between facility characteristics and perceptions of organizational learning. Ninety-eight surgical providers and leaders participated in the survey. The mean facility positive response rate was 95.1% (SD 6.1%). Time for reflection was the least favorable domain with a score of 62.5% (SD 35.8%). There was variation by facility characteristics including differences in time for reflection when comparing by level of care (P = .02) and location (P = .01), and differences in trying new approaches (P = .008), capacity building (P = .008), and information transfer (P = .01) when comparing public versus faith-based facilities. In multivariable analysis, suburban centers had less time for reflection than urban facilities (adjusted difference = -0.48; 95% CI: -0.95, -0.01; P = .046). Surgical team members reported more positive responses compared to surgical team leaders. We found a high overall positive response rate in characterizing organizational learning in surgery in 20 health facilities in Tanzania's Lake Zone. Our findings identify areas for improvement and provide a baseline for assessing the effectiveness of change initiatives. Future research should focus on validating the adapted survey and exploring the impact of strong learning environments on surgical outcomes in LMICs. Organizational learning is crucial in surgery and further research, funding, and policy work should be dedicated to improving learning cultures in health facilities.

Research capacity, motivators and barriers to conducting research among healthcare providers in Tanzania's public health system: a mixed methods study.

BACKGROUND: Building health research capacity in low- and middle-income countries is essential to achieving universal access to safe, high-quality healthcare. It can enable healthcare workers to conduct locally relevant research and apply findings to strengthen their health delivery systems. However, lack of funding, experience, know-how, and weak research infrastructures hinders their ability. Understanding research capacity, engagement, and contextual factors that either promote or obstruct research efforts by healthcare workers can inform national strategies aimed at building research capacity. METHODS: We used a convergent mixed-methods study design to understand research capacity and research engagement of healthcare workers in Tanzania's public health system, including the barriers, motivators, and facilitators to conducting research. Our sample included 462 randomly selected healthcare workers from 45 facilities. We conducted surveys and interviews to capture data in five categories: (1) healthcare workers research capacity; (2) research engagement; (3) barriers, motivators, and facilitators; (4) interest in conducting research; and (5) institutional research capacity. We assessed quantitative and qualitative data using frequency and thematic analysis, respectively; we merged the data to identify recurring and unifying concepts. RESULTS: Respondents reported low experience and confidence in quantitative (34% and 28.7%, respectively) and qualitative research methods (34.5% and 19.6%, respectively). Less than half (44%) of healthcare workers engaged in research. Engagement in research was positively associated with: working at a District Hospital or above (p = 0.006), having a university degree or more (p = 0.007), and previous research experience (p = 0.001); it was negatively associated with female sex (p = 0.033). Barriers to conducting research included lack of research funding, time, skills, opportunities to practice, and research infrastructure. Motivators and facilitators included a desire to address health problems, professional development, and local and international collaborations. Almost all healthcare workers (92%) indicated interest in building their research capacity. CONCLUSION: Individual and institutional research capacity and engagement among healthcare workers in Tanzania is low, despite high interest for capacity building. We propose a fourfold pathway for building research capacity in Tanzania through (1) high-quality research training and mentorship; (2) strengthening research infrastructure, funding, and coordination; (3) implementing policies and strategies that stimulate engagement; and (4) strengthening local and international collaborations.

Moving Forward from COVID-19: Organizational Dimensions of Effective Hospital Emergency Management.

Federal investment in emergency preparedness has increased notably since the 9/11 attacks, yet it is unclear if and how US hospital readiness has changed in the 20 years since then. In particular, understanding effective aspects of hospital emergency management programs is essential to improve healthcare systems' readiness for future disasters. The authors of this article examined the state of US hospital emergency management, focusing on the following question: During the COVID-19 pandemic, what aspects of hospital emergency management, including program components and organizational characteristics, were most effective in supporting and improving emergency preparedness and response? We conducted semistructured interviews of emergency managers and leaders at 12 urban and rural hospitals across the country. Through qualitative analysis of content derived from examination of transcripts from our interviews, we identified 7 dimensions of effective healthcare emergency management: (1) identify capable leaders; (2) assure robust institutional support; (3) design effective, tiered communications systems; (4) embrace the hospital incident command system to delineate roles and responsibilities; (5) actively promote collaboration and team building; (6) appreciate the necessity of training and exercises; and (7) balance structure and flexibility. These dimensions represent the unique and critical intersection of organizational factors and emergency management program characteristics at the core of hospital emergency preparedness and response. Extending these findings, we provide several recommendations for hospitals to better develop and sustain what we call a response culture in supporting effective emergency management.