Resumen La pandemia por COVID-19 ha forzado la adopcion de cambios drasticos en Atencion Primaria, modificando la organizacion y las dinamicas de trabajo establecidas hasta entonces. De un dia para otro los profesionales tuvieron que adaptarse a la nueva situacion para atender el aluvion de casos y contactos, evitar contagios y mantener la atencion a otros problemas de salud. Al inicio de la pandemia los profesionales hubieron de instaurar en Atencion Primaria nuevas practicas y circuitos asistenciales de manera improvisada, por falta de orientaciones actualizadas, sin los medios de proteccion adecuados, evaluando sobre la marcha sus riesgos y beneficios. Abordamos cuales han sido los principales cambios organizativos en el primer nivel asistencial y describimos, desde el punto de vista de la seguridad del paciente, las consecuencias para pacientes y profesionales de la atencion prioritaria a la COVID-19. Finalmente, nos planteamos como incorporar el conocimiento adquirido durante la pandemia, analizando las ventajas e inconvenientes de las medidas adoptadas, para mantener en lo posible una Atencion Primaria segura, accesible y de calidad. CE: Single paragraph Abstract see JSS

Organización de la Atención Primaria en tiempos de pandemia

This study aims to demonstrate how senior leadership applies to high-reliability organizations' functions when managing the Coronavirus pandemic in healthcare organizations and extend the current research by focusing on identifying which functions are more important for the leadership when managing crises in healthcare organizations. To achieve the aim of the study, a qualitative research approach was applied with well-known statistical analyses. Descriptive statistics were applied to determine the characteristics of variables. A correlation matrix shows the relationship between variables, while explanatory factor analyses were employed to determine the reliability of the variables. Ordinary least square regression analysis was used to emphasize the relationship between the role of leadership and different functions in high reliability healthcare organizations in Turkey. It has been found that the role of leadership has a positive and significant relationship with organizational safety, organizational trust, collective mindfulness, flexibility, and communication functions. In addition, the importance of leadership in healthcare organizations will improve many functions in an effective and professional manner, which is reflected in the reduction of the spread of Coronavirus which has been found among workers and in different environments.

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The importance of the leadership functions of a high-reliability health care organization in managing the COVID-19 pandemic in Turkey

Background: Health professionals (HPs) coping with the coronavirus pandemic are at risk of working under stressful conditions impacting their professional well-being. The aim of this paper was to explore HP’s professional quality of life and occupational stress during the COVID-19 pandemic in Greece. Method: A cross-sectional study was conducted (from October to December 2020) in a COVID-19 reference hospital, one of the biggest in Attica. The method of convenience sampling has been used. Data collection was carried out through an anonymous, self-administered questionnaire including, apart from HPs’ demographic and occupational characteristics, Professional Quality of Life Scale (ProQoL) and Job Stress Measure. A total of 250 questionnaires were distributed to physicians and nurses. One hundred eighty-six questionnaires were fully completed (response rate = 78.8%). The analysis was based on descriptive and inductive statistics, using SPSS v25. Results: Participants’ mean age was 41.5 ± 10.4 years; 75.3% were women and 62.4% was nursing staff. ProQoL analysis showed that the majority had moderate compassion satisfaction (74.2%) and burnout (78.5%), while 48.8% had moderate level of secondary post-traumatic stress. The mean value of occupational stress was estimated at 2.76, showing a moderate level of stress. HPs’ demographic and occupational characteristics seemed to affect both work stress and ProQoL (P ⩽ .05). Occupational stress was positively correlated with both burnout (r = 0.461, P = .001) and secondary post-traumatic stress (r = 0.596, P = .001), indicating that an increase in health professionals’ stress at work corresponds to a simultaneous increase in ProQoL. Conclusions: HPs’ professional quality of life and occupational stress seemed to be moderate during the COVID-19 pandemic in Greece. In order to achieve an improvement in HPs’ overall professional well-being, priority should be given to the strengthening of the capacity of the healthcare system as well as to supporting HPs in both stress management and psychological resilience.

https://journals.sagepub.com/doi/pdf/10.1177/11786329221096042

Professional Quality of Life and Occupational Stress in Healthcare Professionals During the COVID-19 Pandemic in Greece

BACKGROUND AND AIMS: The COVID-19 pandemic represents a source of stress and potential burnout for many physicians. This single-site survey aimed at assessing perceived stress and risk to develop burnout syndrome among physicians operating in COVID wards. METHODS: This longitudinal survey evaluated stress and burnout in 51 physicians operating in the COVID team of Gemelli Hospital, Italy. Participants were asked to complete the Maslach Burnout Inventory (MBI) and the Perceived Stress Questionnaire on a short run (PSQs) (referring to the past 7 days) at baseline (T0) and then for four weeks (T1-T4). Perceived Stress Questionnaire on a long run (PSQl) (referring to the past 2 years) was completed only at T0. RESULTS: Compared with physicians board-certified in internal medicine, those board-certified in other disciplines showed higher scores for the Emotional Exhaustion (EE) score of the MBI scale (P < .001). Depersonalisation (DP) score showed a reduction over time (P = .002). Attending physicians scored lower than the resident physicians on the DP scale (P = .048) and higher than resident physicians on the Personal Accomplishment (PA) scale (P = .04). PSQl predicted higher scores on the EE scale (P = .003), DP scale (P = .003) and lower scores on the PA scale (P < .001). PSQs showed a reduction over time (P = .03). Attending physicians had a lower PSQs score compared with the resident physicians (P = .04). CONCLUSIONS: Medical specialty and clinical position could represent risk factors for the development of burnout in a COVID team. In these preliminary results, physicians board-certified in internal medicine showed lower risk of developing EE during the entire course of the study.

Risk of burnout and stress in physicians working in a COVID team: A longitudinal survey.

Design for resilient performance: Concept and principles.

Importance The COVID-19 pandemic is the greatest global test of health leadership of our generation. There is an urgent need to provide guidance for leaders at all levels during the unprecedented preresolution recovery stage. Objective To create an evidence- and expertise-informed framework of leadership imperatives to serve as a resource to guide health and public health leaders during the postemergency stage of the pandemic. Evidence Review A literature search in PubMed, MEDLINE, and Embase revealed 10 910 articles published between 2000 and 2021 that included the termsleadershipand variations ofemergency,crisis,disaster,pandemic,COVID-19, orpublic health. Using the Standards for Quality Improvement Reporting Excellence reporting guideline for consensus statement development, this assessment adopted a 6-round modified Delphi approach involving 32 expert coauthors from 17 countries who participated in creating and validating a framework outlining essential leadership imperatives. Findings The 10 imperatives in the framework are: (1) acknowledge staff and celebrate successes; (2) provide support for staff well-being; (3) develop a clear understanding of the current local and global context, along with informed projections; (4) prepare for future emergencies (personnel, resources, protocols, contingency plans, coalitions, and training); (5) reassess priorities explicitly and regularly and provide purpose, meaning, and direction; (6) maximize team, organizational, and system performance and discuss enhancements; (7) manage the backlog of paused services and consider improvements while avoiding burnout and moral distress; (8) sustain learning, innovations, and collaborations, and imagine future possibilities; (9) provide regular communication and engender trust; and (10) in consultation with public health and fellow leaders, provide safety information and recommendations to government, other organizations, staff, and the community to improve equitable and integrated care and emergency preparedness systemwide. Conclusions and Relevance Leaders who most effectively implement these imperatives are ideally positioned to address urgent needs and inequalities in health systems and to cocreate with their organizations a future that best serves stakeholders and communities.

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Adeel Abbas Dhahri

Papers

Guidance for Health Care Leaders During the Recovery Stage of the COVID-19 Pandemic: A Consensus Statement.