Service Delivery Experience Research Articles

Communication Skill of Service Provider as the Principal Determinant of Customer Satisfaction: A Case of Doctors’ Service

Communication style is intensely influential on customers' purchase probability, trust, satisfaction, perceived service quality, and perceptions of brand affection, competence, and attachment. Social interaction models tell us that when consumers engage in service interactions, they rely largely on the communication style of the service personnel to develop their evaluations in which they have little knowledge of service issues. The frontline service personnel represent the image of the organization. The perception of customers towards the organization is influenced by their experiences at the frontline. A poor service delivery experience by a customer influences the image of the organization as the customer may share his/her bad encounters with other people. So, it is important that the organization ensure the quality of frontline services to secure a positive image of the organization. The study suggests the need for employers to provide training to the staff to improve their communication skills and develop favourable attitudes.

The impact of COVID-19 on a specialised menopause clinic: Changes in practice and women's experiences.

The COVID-19 pandemic necessitated the rapid change in a dedicated multidisciplinary menopause clinic from in-person consultations to telehealth. The aim of this study was to explore the impact of COVID-19 on menopause service delivery and consumer experiences. Two-part study involving the following. (i) Clinical audit conducted June-July 2019 (pre-COVID-19) and June-July 2020 (COVID-19) assessing practice and service delivery changes. Assessment outcomes included: patient demographics, cause of menopause, presence of menopause symptoms, appointment attendance, medical history, investigations and menopause treatments. (ii) A post-clinic online survey exploring the acceptability and experience of telehealth, once telehealth models of care had been routinely used in the menopause service (2021). Pre-COVID (n = 156) and COVID-19 (n = 150) clinic consultations were audited. Menopause care delivery changed significantly from 100% face-to-face consultations in 2019 to 95.4% telehealth consultations in 2020. In 2020, fewer women had investigations performed vs 2019 (P < 0.001), although use of menopausal therapies was similar (P < 0.05). Ninety-four women completed the online survey. Most women (70%) were satisfied with their telehealth consultation and perceived that the doctor effectively communicated with them (76%). Women preferred face-to-face consultations for their first menopause clinic visit (69%) and telehealth for review consultations (65%). The majority of women (62%) viewed the continuation of telehealth consultations as 'moderately' to 'extremely useful' post-pandemic. The COVID-19 pandemic caused significant changes to menopause service delivery. Telehealth was perceived as feasible and acceptable by women, supporting the continuation of a hybrid service delivery model incorporating telehealth and face-to-face consultation to meet the needs of women.

Developing a Model of Higher Education Service Delivery Experience Among International Students

Recently, the higher education sector has faced enormous competition as a result of the internationalisation of higher education globally. Despite developing active recruitment strategies, the higher education sector is still struggling with the critical issue of dissatisfaction with the service delivery experience among international students. As a result, there is a need to develop a model to comprehend international students' experiences with service delivery in higher education. In this paper, the theoretical foundation is explored to explain a systematic view of the customer (international students) experience phenomenon by specifying the relevance variables. The underlying theories include the means-end chain (MEC) theory, value-percept disparity theory, and theory of planned behaviour. These theories explain the customer experience in service delivery through a cognitive-emotional-behavioural path that links the causal interrelationships among variables. The variables include service personal values, service value, service quality, emotional satisfaction, and behaviour intentions. The empirical studies have supported the existence of interrelationships among these variables. The theoretical and practical (managerial) implications of the model developed are discussed, as are the directions for future research.

Supporting people affected by problematic alcohol, substance use and other behaviours under pandemic conditions: A pragmatic evaluation of how SMART recovery Australia responded to COVID-19

BackgroundThe COVID-19 pandemic prompted rapid, reflexive transition from face-to-face to online healthcare. For group-based addiction services, evidence for the impact on service delivery and participant experience is limited. MethodsA 12-month (plus 2-month follow-up) pragmatic evaluation of the upscaling of online mutual-help groups by SMART Recovery Australia (SRAU) was conducted using The Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Data captured by SRAU between 1st July 2020 and 31st August 2021 included participant questionnaires, Zoom Data Analytics and administrative logs. ResultsReach: The number of online groups increased from just 6 pre-COVID-19 to 132. These groups were delivered on 2786 (M = 232.16, SD = 42.34 per month) occasions, to 41,752 (M = 3479.33, SD = 576.34) attendees. Effectiveness: Participants (n = 1052) reported finding the online group meetings highly engaging and a positive, recovery supportive experience. 91 % of people with experience of face-to-face group meetings rated their online experience as equivalent or better. Adoption: Eleven services (including SRAU) and five volunteers delivered group meetings for the entire 12-months. Implementation: SRAU surpassed their goal of establishing 100 groups. Maintenance: The average number of meetings delivered [t(11.14) = -1.45, p = 0.1737] and attendees [t(1.95) = -3.28, p = 0.1880] per month were maintained across a two-month follow-up period. ConclusionsSRAU scaled-up the delivery of online mutual-help groups in response to the COVID-19 pandemic. Findings support the accessibility, acceptability and sustainability of delivering SMART Recovery mutual-help groups online. Not only are these findings important in light of the global pandemic and public safety, but they demonstrate the potential for reaching and supporting difficult and under-served populations.

A recent survey of augmentative and alternative communication use and service delivery experiences of people with amyotrophic lateral sclerosis in the United States

Purpose The objective of this study was to explore and describe current trends in the augmentative and alternative communication (AAC) use and service delivery experiences of people with amyotrophic lateral sclerosis (PALS) in the U.S. Methods Cross-sectional data were collected from 216 PALS via an anonymous online questionnaire in 2021. Results Over 70% of participants reported at least some detectable speech disturbance, and approximately half used aided communication during face-to-face interactions. Among respondents with severe speech impairment, over 90% reported using speech-generating devices, and just over half reported using low-tech AAC. Most participants had met with an SLP to discuss speech and communication, but varied in both timing of the initial intervention and frequency of ongoing intervention. Fewer than half reported that their family members or other important people had received education or support related to communication for PALS. Participants also shared their use of and experiences with telephone and video calls, access methods, mounting systems, word prediction and stored phrases, and message and voice banking. Conclusions Results highlight the importance of early referral for AAC intervention, ongoing re-evaluation and treatment, involvement of communication partners and support for multimodal communication and adaptation to changing needs.

Speech and Language Teletherapy Services During The COVID-19 Pandemic: A National Survey

<h3>Research Objectives</h3> To characterize the Covid-19 experience and telerehabilitation access, service delivery experiences, and perceived effectiveness in a national cohort of adults with aphasia. <h3>Design</h3> Online Survey. <h3>Setting</h3> Distributed nationally in early 2021 through aphasia centers, university clinics, and social media. <h3>Participants</h3> Individuals with aphasia. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> The survey included questions related to demographics, knowledge and attitudes about the coronavirus, healthcare experiences including telehealth/ telerehabilitation immediately before and during the pandemic, familiarity with technology, physical and mental health during the pandemic, and life changes in regards to access to family and friends, routines, and family income/employment. <h3>Results</h3> A sample of 440 respondents with aphasia met eligibility criteria. 60% of respondents indicated that they felt nervous or stressed because of the coronavirus some of the time, and 18.5% most or all of the time. 80% of respondents indicated that the coronavirus pandemic had changed their access to healthcare. 47.6% of respondents indicated that they had missed or canceled a medical appointments because they were worried about getting the coronavirus. Of the 272 participants who were actively receiving some form of speech and language therapy, 70.5% indicated that they had an individual appointment with a speech language pathologist via telerehabilitation since the coronavirus pandemic began. The majority of respondents indicated that the telerehabilitation appointment was the same or better than traditional in-person speech and language therapy. <h3>Conclusions</h3> Respondents who perceived that they were at high risk of Covid-19 infection and death were more likely to accept telerehabilitation services than patients who perceived themselves at low risk. Utilization of telerehabilitation services varied by household access to high speed internet and familiarity with information technology resources. <h3>Author(s) Disclosures</h3> Supported by Grant #DC017174-02S1 Authors have no conflicts.

Experience of specialist DVA provision under COVID-19: listening to service user voices to shape future practice

In the context of high rates of domestic violence and abuse (DVA) during the pandemic, specialist DVA services have been required to adapt rapidly to continue to deliver essential support to women and children in both refuges and the community. This study examines service users’ experiences and views of DVA service provision under COVID-19 and discusses implications for future practice. Data are drawn from a wider evaluation of DVA services in five sites in England. Fifty-seven semi-structured interviews and five focus groups were conducted with 70 female survivors and seven children accessing DVA services during the pandemic. Analysis identified key themes in respect of the influence of COVID-19 on the experience of service delivery. COVID-19 restrictions had both positive and negative implications for service users. Remote support reduced face-to-face contact with services, but consistent communication counteracted isolation. Digital practices offered effective means of providing individual and group support, but there were concerns that not all children were able to access online support. Digital support offered convenience and control for survivors but could lack privacy and opportunities for relationship-building. The pivot to remote delivery suggests directions where DVA services can expand the range and nature of future service provision.

Putting out the welcome mat-A qualitative exploration of service delivery processes and procedures as barriers to treatment-seeking for people who use alcohol and other drugs.

There are a range of models and structures that determine features of alcohol and other drug treatment. Despite some structures being long-established, less is known about how specific aspects of service delivery impact treatment-seeking for people who use alcohol and other drugs. This Australian qualitative study explored both people with lived experience of problematic alcohol and other drug use, and health care staff's experiences of service delivery. Thirty-nine semi-structured interviews with people with lived experience and staff from either alcohol and other drug specialist, or broader health-care services, explored experiences of service delivery processes and procedures. Transcripts were thematically analysed and guided by a broad interest in barriers to treatment-seeking. Within alcohol and other drug specialist services (i) time spent on wait lists; and (ii) poor implementation of assessment processes were identified barriers to treatment-seeking and engagement. Within broader health-care services (i) organisational expectations around behaviour and engagement; (ii) alcohol and other drugs viewed as separate to service role; and (iii) limited opportunities to informally engage were identified barriers to treatment-seeking. Results suggest opportunities to engage and undertake needs-based care planning are yet to be fully realised, particularly at the intake and assessment stages of alcohol and other drug service delivery; with frequent reassessment resulting in people repeatedly recounting traumatic experiences, often to different people, only to be placed back on wait lists with no support. Within broader health-care services aspects of service delivery may perpetuate stigma that places such people outside the purview of health care.

CLASSIFYING ONLINE CUSTOMER COMPLAINTS: A MULTIAGENT PERSPECTIVE

This study conducted a content analysis of an online Turkish complaint website to classify online customer complaints about service failures in multi-agent situations of a tourism service supply chain. A total of 400 incidents were collected regarding 422 service failures. The complaints fell into four failure groups: Actual Service, Supplier’s Service, Service Provider’s Employees, and Supplier’s Employees. The findings support the previous literature in a different context by demonstrating that, within a multi-agent context, customers consider the whole service delivery experience. They may therefore integrate or transfer their emotions or behavioral attitudes from the principals (e.g., travel agencies) to agents (e.g., hotels) or vice-versa.

Enhancing Customer Service Experience: A Case of WBL (India)

Sitting at his office, Mr Gangwani was anxiously flipping through the reports scattered on the desk. The continuously growing customer complaints and substandard service delivery ratings were not only disturbing him but affecting the company’s business also, at large. Despite several measures such as organizational restructuring, conduction of employees’ motivation and training sessions, implementation of a state-of-the-art enterprise resource planning (ERP) solution taken by him to streamline organizational processes, etc., the bank’s customers were not satisfied with the service delivery and overall experience. This case presents the deteriorating customer service experience situation at Wealthworth Bank Limited (WBL) and put forward a framework (HEART parameters) as a possible solution to enhance customers’ service experience. It also questions the interoperability of the ‘HEART’ approach across WBL’s various foreign centres.

Mental health provider perspectives of the COVID-19 pandemic impact on service delivery: a focus on challenges in remote engagement, suicide risk assessment, and treatment of psychosis

BackgroundThe COVID-19 pandemic has been impacting the need, utilization, and delivery of mental health services with greater challenges being faced by clients and providers. With many clients facing reduced access to services and social isolation, a focus on suicide risk assessment and prevention is critical. Concern is particularly increased for clients with schizophrenia spectrum disorders given data show suicide rates are disproportionately high for those with psychosis in comparison to the general population. Provider perspectives of challenges in service delivery are needed to inform efforts to improve access, feasibility, and quality of mental health care throughout the evolving pandemic. This study explored mental health provider perspectives of client challenges in service utilization and provider challenges in service delivery, including remote engagement, suicide risk assessment, and treatment of psychosis.MethodsData were collected from social work mental health providers (n = 12) in United States community mental health setting. Providers consented to participate and responded to questions about service delivery experiences in late 2020 and in relation to COVID-19. Demographic and practice-related provider data were explored descriptively using SPSS and qualitative data using open coding and grounded theory methods in Dedoose.ResultsAmong the 9 providers who engaged in remote service delivery, 7 (77.8%) experienced challenges in remote engagement with clients and 8 (88.9%) experienced challenges in treatment of psychosis. Among the 7 providers who engaged in remote suicide assessment, 4(57%) experienced challenges. Qualitative themes emerged including logistic (e.g., technology access and use), engagement (e.g., virtual rapport-building and limited remote services), and clinical (e.g., difficulty assessing suicide risk, internal stimuli, abnormal involuntary movement, and affect) challenges in service delivery.ConclusionsProvider perspectives are essential to inform efforts to build resources and problem-solve challenges and barriers that both providers and clients face throughout various shifts in mental health service delivery. Findings emphasize the need to troubleshoot client access to technology, bolster support for providers to prevent burnout, and greater provider training to improve skills in remote engagement, assessment, and treatment, particularly in relation to psychosis and suicide prevention. Study implications are not only critical for the evolving COVID-19 pandemic, but also in preparation for ongoing shifts in service delivery as technology evolves.

Luck, our journey, doing the best we could: The experiences of speech-language pathologists, parents, and teachers in service delivery for school-aged children

Purpose: Speech-language pathology intervention is effective in supporting the needs of school-aged children with speech and language difficulties, particularly when implemented collaboratively among speech-language pathologists (SLPs), parents, and teachers. However, such intervention is not always accessible, affordable, or timely. The present study explored the experiences of SLPs, parents, and teachers with regard to service delivery for school-aged children as recorded in submissions to the Senate Inquiry into speech-language pathology services in Australia almost 10 years ago and related those experiences to current service provision. Method: In 2013, the Australian Government Senate formed a committee for inquiry and report into the prevalence of speech, language, and communication disorders and speech-language pathology services in Australia. The current study used a phenomenological approach to analyse submissions from SLPs (n = 9), parents (n = 8), and teachers (n = 3) of primary school-aged children who had submitted their experiences of speech-language pathology intervention. Result: Themes that emerged from the submissions showed that participants’ experiences of service delivery were associated with “luck”, “our journey”, and “doing the best we could”. Participants described their experiences as “luck” when they were able to access services that they knew others could not; they described their experiences as a “journey” when they reflected on the process of seeking, accessing, and obtaining services which was often quite circuitous; and they described their experience as “doing the best we could” when they persisted in seeking or providing services, despite frustration in not fulfilling their perceived duty of care. Conclusion: The experiences of SLPs, parents and teachers highlight the importance of listening to the stories of these groups to understand the strengths and challenges of service delivery for school-aged children and the need for timely, targeted, and evidence-based care. The experiences of service delivery described by participants in the Senate Inquiry are still common today and thus the need to address the issues they raised remains.

Masters and doctorate student experiences of service delivery at public universities in Kwazulu-Natal, South Africa

The high student attrition at the masters' and doctorate levels requires universities to be customer-oriented, and flexible in their capacity to deliver higher value to mature students whose needs and expectations are high. Therefore, this study aims to assess student experience and service delivery levels that academic departments provide postgraduate students at public universities in KwaZulu-Natal. An empirical study was conducted amongst masters’ and doctorate students at a university of technology, a traditional university, and a comprehensive university. The study involved a survey questionnaire with a five-point Likert scale and included seven service delivery dimensions which respondents were to rank accordingly. Data were subjected to descriptive and inferential statistics and the factors that emerged from factor analysis were tested for reliability and validity by conducting Cronbach's alpha. The results show that postgraduate students are university customers and therefore expect courtesy and professionalism in the delivery of postgraduate programmes. The results further suggest that retention capabilities exist for the traditional university compared to the other types of universities. Students seem to be moderately satisfied with the quality of academic services offered by universities. Service delivery experience among students appears to vary across universities. Universities should take cognisance of the gaps and attempt to be more customer-oriented to ensure the needs and expectations of graduate students are met. The findings of the study may serve as guidelines for a follow-up qualitative study to establish the specific areas where students were not satisfied.

\u2018Grey nomad\u2019 travellers\u2019 use of remote health services in Australia: a qualitative enquiry of hospital managers\u2019 perspectives

BackgroundFor more than the last two decades, older Australians travelling domestically in self-sufficient accommodation and recreational vehicles for extended periods of time have been referred to as ‘Grey Nomads’. By 2021 more than 750,000 such recreational vehicles were registered in Australia. Tourism data for the year to September 2017 show 11.8 million domestic camping and caravanning trips in Australia, 29% of which were people aged 55 and over. As the ‘baby boomer’ generation increasingly comes to retirement, the size of this travelling population is growing. This term applies to the spike in birth rates after World War II from 1946–1964. This growing group of domestic travellers are potential healthcare consumers in remote areas but relatively little is known about their travel, healthcare needs or care seeking practices. Grey nomads have been described as reflective of the age-comparable sector of the Australian population in that many live with chronic illness. Early concerns were raised that they may “burden” already stretched rural and remote healthcare services but relatively little is known about the impact of these travellers.MethodsThe aim of this study was to explore the utilisation of healthcare services in remote locations in Australia by grey nomads including women travellers, from the perspective of healthcare professionals working in these settings. The study objective was to interview healthcare professionals to seek their experience and details of service delivery to grey nomads.In March 2020 [prior to state border closures due to the COVID-19 pandemic] a field study was conducted to identify the impact of grey nomads on healthcare services in remote New South Wales and Queensland. A qualitative approach was taken to explore the perspectives of nursing healthcare managers working in remote towns along a popular travel route. With appropriate Research Ethics Committee approval, managers were purposively sampled and sample size was determined by data saturation. Thirteen managers were contacted and twelve interviews were scheduled to take place face to face in the healthcare facilities (small hospitals with acute care and aged care services) at mutually convenient times. A semi-structured interview schedule was developed in line with the research aim. The interviews were audio-recorded, transcribed and thematic analysis was undertaken concurrently with data collection for ongoing refinement of questions and to address emerging issues.ResultsThese nursing managers described a strong service and community ethos. They regarded travellers’ healthcare needs no differently to those of local people and described their strong commitment to the provision of healthcare services for their local communities, applying an inclusive definition of community. Traveller presentations were described as predominantly exacerbations of chronic illness such as chest pain, medication-related attendances, and accidents and injuries. No hospital activity data for traveller presentations were available as no reports were routinely generated. Travellers were reported as not always having realistic expectations about what healthcare is available in remote areas and arriving with mixed levels of preparedness. Most travellers were said to be well-prepared for their travel and self-management of their health. However, the healthcare services that can be provided in rural and remote areas needed to be better understood by travellers from metropolitan areas and their urban healthcare providers.ConclusionParticipants did not perceive travellers as a burden on health services but recommendations were made regarding their expectations and preparedness. Australia’s national transition to electronic health records including a patient—held record was identified as a future support for continuity of care for travellers and to facilitate treatment planning. With no current information to characterise traveller presentations, routinely collected hospital data could be extracted to characterise this patient population, their presentations and the resources required to meet their care needs.

Impact of COVID-19 pandemic on foot care services in Ontario, Canada

BackgroundThe COVID-19 pandemic has directly affected the delivery of health care services in Canada, including foot care. The goal of this descriptive study was to understand the impact of the early COVID-19 pandemic (March 2020 to April 2021) on chiropodists’ and podiatrists’ clinical practices and foot care service delivery in Ontario, Canada.MethodsA web-survey was completed by participating chiropodists and podiatrists registered with the College of Chiropodists of Ontario. The survey consisted of 31 multiple choice and open-ended items on clinical practice characteristics, foot care service delivery changes, perceived barriers during the pandemic, and its impact on clinicians. Descriptive statistics were used to characterize the sample and examine clinicians’ responses, and qualitative content analysis was used to explore opened-ended items.ResultsOf the 773 eligible clinicians, 279 participated for a response rate of 36.1%. Most respondents reported a decline in patient volume, an increase in urgent foot health problems, a financial impact on their clinical practices, an emotional impact, and substantial changes to how they provided foot care services, such as incorporating telehealth/virtual care into patient care. Factors that impact clinicians’ perception of future pandemic preparedness are identified.ConclusionThis study describes foot care service delivery in Ontario, Canada during the COVID-19 pandemic. The COVID-19 pandemic saw an increase in urgent foot health problems, decline in patient volume, and impacted clinicians’ mental health and emotional well-being. Future studies should examine patients’ experiences of foot care service delivery and maintaining their foot health during the pandemic, and further examination of factors that impact clinicians’ perception of pandemic preparedness.

The parenting skill development and education service: Telehealth support for families at risk of child maltreatment during the COVID‐19 pandemic

AbstractChildren are at heightened risk of maltreatment during community wide crises. The Parenting Skill Development and Education (PSDE) Service is a 6‐week telehealth intervention designed and implemented during the COVID‐19 pandemic to support families with young children in Australia at risk of child maltreatment. This study aimed to conduct a formative review of the PSDE service to (a) describe families accessing the PSDE during the pandemic, (b) determine parent and referrers' satisfaction of the service and (c) explore clinicians' experiences of service delivery. A mixed‐method study design incorporating the analysis of routinely collected data, and qualitative interviews with clinicians was conducted. Participants were 11 families displaying child maltreatment risk and 11 clinicians. Parents accessing the service were experiencing considerable risk factors for child maltreatment. The service was deemed acceptable by parents and referrers; however, several challenges in telehealth delivery were documented including parent engagement, technology difficulties and assessing child safety. Our findings highlighted the importance of ensuring adequate support and monitoring of families where there is child maltreatment risk during the COVID‐19 pandemic. In addition, these findings highlight the acceptability of telehealth services to support families at risk of child maltreatment for families, clinicians, and referrers.

Recognising autism in healthcare.

Recognition of autism and the associated co-occurring physical and mental health issues has increased over recent years. However, undergraduate and postgraduate curricula take time to adapt and to impact on what is delivered in training so healthcare professionals, including doctors, report little training on these topics. Doctors need to know when someone might be autistic in order to respond to them appropriately. This article sets out the reasons why recognition of autism is important and the positive impacts of recognising and understanding autism on health outcomes, service delivery and patient experience. The negative consequences of not recognising autism or understanding the impact of autistic traits on the person are also explored. A companion article then covers how practice can be made more appropriate for autistic people to improve outcomes.

Exploring the COVID-19 pandemic experience of maternity clinicians in a high migrant population and low COVID-19 prevalence country: A qualitative study

BackgroundAustralia experienced a low prevalence of COVID-19 in 2020 compared to many other countries. However, maternity care has been impacted with hospital policy driven changes in practice. Little qualitative research has investigated maternity clinicians’ perception of the impact of COVID-19 in a high-migrant population. AimTo investigate maternity clinicians’ perceptions of patient experience, service delivery and personal experience in a high-migrant population. MethodsWe conducted semi-structured in-depth interviews with 14 maternity care clinicians in Sydney, New South Wales, Australia. Interviews were conducted from November to December 2020. A reflexive thematic approach was used for data analysis. FindingsA key theme in the data was ‘COVID-19 related travel restrictions result in loss of valued family support for migrant families’. However, partners were often ‘stepping-up’ into the role of missing overseas relatives. The main theme in clinical care was a shift in healthcare delivery away from optimising patient care to a focus on preservation and safety of health staff. DiscussionClinicians were of the view migrant women were deeply affected by the loss of traditional support. However, the benefit may be the potential for greater gender equity and bonding opportunities for partners.Conflict with professional beneficence principles and values may result in bending rules when a disconnect exists between relaxed community health orders and restrictive hospital protocols during different phases of a pandemic. ConclusionThis research adds to the literature that migrant women require individualised culturally safe care because of the ongoing impact of loss of support during the COVID-19 pandemic.

TP6.2.9 1224 Surgical Endoscopic Retrograde Cholangio-Pancreatography over three years. A single unit’s experience of service provision and delivery of clinical excellence

Abstract Aims Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is traditionally the domain of medical gastro-enterology. Our practice is exclusively surgeon delivered and therefore represents an alternative paradigm. The British society of Gastro-enterology (BSG) proposed key performance indicators in 2014 to evaluate standards of ERCP practice with focus on performance and safety against which we evaluated our practice. Methods The study period covers 3 years from September 2016 to August 2019. An analysis of prospectively collected data was performed. Performance of the individual surgeons and collective was collated and retrospectively analysed. Results The unit’s caseload for the 3 years period was 1224 procedures. Each surgeon’s share was similar, i.e. 454, 430 and 340 cases respectively (BCG 75 per annum). Most procedures were performed electively, some on emergency basis or within two weeks. Biliary duct stones were the most common indications for the procedure, followed by malignancy. Overall bile duct cannulation rate was 95.3%; and 91.8% for first ERCP (BSG &amp;gt; 85%). CBD clearance was achieved in 80.6% cases, and stone clearance at first ERCP was 78.6% (BSG &amp;gt; 75%). Successful stenting of extra-hepatic biliary stricture was achieved in 89.4% cases at first ERCP (BSG &amp;gt; 80%). Overall complications rate was 6.2% and for level 1 &amp; 2 cases 5.3% (BSG less than 6% is accepted standard). Conclusions We performed a high volume of safe and effective ERCPs with low risk of complications in line with national standards. ERCP has become an exclusive therapeutic tool in surgical management of gall stones disease and biliary malignancy.

Delivering health and social services

Dual delivery of COVID-19 and non-COVID-19 services proved to be the core challenge of the service delivery response. Health systems responded by implementing strategies to manage a surge in demand for both health and social services, while continuing to provide other necessary health care services. These involved adapting or transforming patient care approaches, including the coordination of care across levels (e.g., acute vs. outpatient) and settings (e.g., PHC vs. long-term care), and coordinating response measures with social services provided outside of health system. The initial capacities and available reserves of physical infrastructure, such as hospital and intensive care unit (ICU) beds, the organization and coordination of service delivery and previous experience of responding to epidemics such as SARS or MERS or other health system shocks, influences a country's ability to anticipate and cope with surges in demand for health and social services. This presentation will provide an overview of strategies on ensuring the ability to cope with surge in demand for and managing provision of services for COVID and non-COVID patients, including social services. It will also cover strategies on increasing capacity to cope with surges of need for physical resources, such as infrastructure, equipment and medical supplies. A brief overview of key metrics to assess resilience in delivery of health and social services will also be provided.