Abstract
(1) Background: As COVID-19 transmission continues despite vaccination programs, healthcare workers (HCWs) face an ongoing pandemic response. We explore the effects of this on (1) Heartware, by which we refer to morale and commitment of HCWs; and identify how to improve (2) Hardware, or ways of enabling operational safety and functioning. (2) Methods: Qualitative e-diary entries were shared by HCWs during the early phases of the outbreak in Singapore from June to August 2020. Data were collected via an online survey of n = 3616 HCWs of all cadres. Nine institutions—restructured hospitals (n = 5), affiliated primary partners (n = 2) and hospices (n = 2)—participated. Applied thematic analysis was undertaken and organized according to Heartware and Hardware. Major themes are in italics (3) Results: n = 663 (18%) HCWs submitted a qualitative entry. Dominant themes undermining (1) Heartware consisted of burnout from being overworked and emotional exhaustion and at times feeling a lack of appreciation or support at work. The most common themes overriding morale breakers were a stoic acceptance to fight, adjust and hold the line, coupled with motivation from engaging leadership and supportive colleagues. The biggest barrier in (2) Hardware analysis related to sub-optimal segregation strategies within wards and designing better protocols for case detection, triage, and admissions criteria. Overall, the most cited enabler was the timely and well-planned provision of Personal Protective Equipment (PPE) for front-liners, though scope for scale-up was called for by those not considered frontline. Analysis maps internal organizational functioning to wider external public and policy-related narratives. (4) Conclusions: COVID-19 surges are becoming endemic rather than exceptional events. System elasticity needs to build on known pillars coupling improving safety and care delivery with improving HCW morale. Accordingly, a model capturing such facets of Adaptive Pandemic Response derived from our data analyses is described. HCW burnout must be urgently addressed, and health systems moved away from reactive “wartime” response configurations.
Highlights
The most affected are healthcare workers (HCWs) in health systems that were unprepared for the relentless, unpredictable rates of transmission, and an onslaught of challenges that while different in nature have not discriminated in their intensity between low- and high-income countries [6]
We report our study according to the Standards for Reporting Qualitative Research (SRQR) [7], beginning by outlining the study background and problem formulation
Recent studies show that high levels of fear, hopelessness and stress caused by working under the duress of the pandemic can lead to a myriad of adverse outcomes for hospital HCWs [8,9,10,11], for instance, affecting HCWs’ self-efficacy in care delivery [12] and, impeding the operational functioning of tertiary care institutions
Summary
Concern over the well-being and resilience of healthcare workers [1,2,3] (HCWs) worldwide continues to rise with the emergence of new and more transmissible variants [4]. Res. Public Health 2022, 19, 2477 of the COVID-19 virus. At the time of writing, several countries are facing new waves and new challenges to contain these ongoing surges as they hit the tertiary care health system [5]. The most affected are HCWs in health systems that were unprepared for the relentless, unpredictable rates of transmission, and an onslaught of challenges that while different in nature have not discriminated in their intensity between low- and high-income countries [6]. The current study explores e-diary qualitative data of HCWs in Singapore during the latter phases of the first wave (June–August 2020) to better understand how to bridge workforce morale and operational safety and functioning. We report our study according to the Standards for Reporting Qualitative Research (SRQR) [7], beginning by outlining the study background and problem formulation
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