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卫生保健工作者在 COVID-19 大流行期间的重新部署:卫生系统领导人策略的定性研究。

Redeployment of Health Care Workers in the COVID-19 Pandemic: A Qualitative Study of Health System Leaders' Strategies.

机构信息

From the Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health.

出版信息

J Patient Saf. 2021 Jun 1;17(4):256-263. doi: 10.1097/PTS.0000000000000847.

Abstract

OBJECTIVES

This study aimed to determine the strategies used and critical considerations among an international sample of hospital leaders when mobilizing human resources in response to the clinical demands associated with the COVID-19 pandemic surge.

METHODS

This was a cross-sectional, qualitative research study designed to investigate strategies used by health system leaders from around the world when mobilizing human resources in response to the global COVD-19 pandemic. Prospective interviewees were identified through nonprobability and purposive sampling methods from May to July 2020. The primary outcomes were the critical considerations, as perceived by health system leaders, when redeploying health care workers during the COVID-19 pandemic determined through thematic analysis of transcribed notes. Redeployment was defined as reassigning personnel to a different location or retraining personnel for a different task.

RESULTS

Nine hospital leaders from 9 hospitals in 8 health systems located in 5 countries (United States, United Kingdom, New Zealand, Singapore, and South Korea) were interviewed. Six hospitals in 5 health systems experienced a surge of critically ill patients with COVID-19, and the remaining 3 hospitals anticipated, but did not experience, a similar surge. Seven of 8 hospitals redeployed their health care workforce, and 1 had a redeployment plan in place but did not need to use it. Thematic analysis of the interview notes identified 3 themes representing effective practices and lessons learned when preparing and executing workforce redeployment: process, leadership, and communication. Critical considerations within each theme were identified. Because of the various expertise of redeployed personnel, retraining had to be customized and a decentralized flexible strategy was implemented. There were 3 concerns regarding redeployed personnel. These included the fear of becoming infected, the concern over their skills and patient safety, and concerns regarding professional loss (such as loss of education opportunities in their chosen profession). Transparency via multiple different types of communications is important to prevent the development of doubt and rumors.

CONCLUSIONS

Redeployment strategies should critically consider the process of redeploying and supporting the health care workforce, decentralized leadership that encourages and supports local implementation of system-wide plans, and communication that is transparent, regular, consistent, and informed by data.

摘要

目的

本研究旨在确定国际范围内医院领导人在应对与 COVID-19 大流行激增相关的临床需求时调动人力资源所采用的策略和关键考虑因素。

方法

这是一项横断面、定性研究,旨在调查全球卫生系统领导人在应对全球 COVID-19 大流行时调动人力资源所采用的策略。前瞻性受访者通过非概率和目的性抽样方法于 2020 年 5 月至 7 月确定。主要结果是通过对记录的笔记进行主题分析,确定卫生系统领导人在 COVID-19 大流行期间重新部署卫生保健工作者时的关键考虑因素。重新部署被定义为将人员重新分配到不同的地点或对人员进行不同任务的再培训。

结果

采访了来自 8 个国家的 9 家医院的 9 位医院领导人。在 5 个国家(美国、英国、新西兰、新加坡和韩国)的 5 个卫生系统的 6 家医院经历了 COVID-19 重症患者的激增,而其余 3 家医院预计会出现类似的激增,但并未出现。8 家医院中的 7 家重新部署了他们的医疗劳动力,其中 1 家制定了重新部署计划,但无需使用。对访谈记录的主题分析确定了 3 个代表在准备和执行劳动力重新部署时的有效实践和经验教训的主题:过程、领导力和沟通。每个主题都确定了关键考虑因素。由于重新部署人员的各种专业知识,必须对再培训进行定制,并实施分散灵活的策略。对重新部署人员有 3 个担忧。这些包括对感染的恐惧、对他们的技能和患者安全的担忧,以及对职业损失的担忧(例如在所选专业中失去教育机会)。通过多种不同类型的沟通进行透明沟通对于防止疑虑和谣言的产生很重要。

结论

重新部署策略应严格考虑重新部署和支持医疗保健劳动力的过程、鼓励和支持系统范围内计划在当地实施的分散领导以及透明、定期、一致且由数据提供信息的沟通。

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