Frontline Workers Research Articles

Frontline workers’ role in digital self-service co-production: Channel promoters, digital helpers, or intermediators

When public services move online, citizens are expected to serve themselves on digital platforms and enrol in public services through self-service procedures. In this digital encounter, many citizens struggle to live up to the “self” in self-services and seek in-person assistance from public professionals. These professional actors play an essential role in enabling the co-production of self-services for citizens who struggle to be truly self-serving. This article explores the frontline workers’ roles in self-service co-production when interacting with citizens seeking help in the service procedures. Service interactions have been studied in two meeting centres of the Norwegian Labor and Welfare Administration. We have conducted observations of office interactions in general and at digital self-service stations in particular. Interviews with public officials have complemented these observations. We use intermediation and co-production theory as analytical lenses in our data analysis. The findings show that the role of frontline workers can be both flexible and narrow in nature and that they take on the role of intermediaries when acting as a bridge between the analogue world and the digital domain. We also see that the intermediating role frontline workers take will vary and is influenced by organisational, personal, and external circumstances that can enable or restrain the co-production of self-services.

Nursing as an earthquake survivor: A qualitative study on nurses traumatized by the Kahramanmaraş earthquake in Turkey.

Nurses' critical input and firsthand disaster management experience are vital to healthcare quality. This study aims to comprehend nurses' experiences during and after the earthquakes, their coping mechanisms for posttraumatic stress disorder (PTSD), and the consequent effects on their profession, given the nurses' crucial role in disaster response. A descriptive qualitative study using semistructured interviews was conducted between April and May 2024. Fifteen nurses were selected using criterion and snowball sampling methods from those working as earthquake survivor nurses in the affected areas. The COREQ guidelines for reporting qualitative research were followed. Five main themes were: emotional reactions/physical difficulties, career and motivation, PTSD and well-being, suggestions, and work performance. The results highlighted the significant psychological and professional challenges that nurses encounter, including the effects of severe PTSD symptoms, coping strategies, and the influence on their capacity to deliver care. Nurses dealing with earthquakes face unique challenges that test their resilience on all levels. Learning from their experiences and coping mechanisms can help healthcare systems support these frontline workers better. Investing in disaster preparedness and mental health resources for nurses is crucial for their well-being and the overall strength of the healthcare system during crises. Effectively managing workloads and rest periods can reduce physical fatigue and prevent burnout. Shift rotations and adequate staffing levels are necessary. Access to psychological mental health support is vital for nurses to recover from the psychological effects of disasters. Regular disaster preparedness training is imperative for physical safety and psychological resilience. Robust support systems, including safe accommodation and peer support groups, are crucial for nurses in disaster response.

Impact of the COVID-19 pandemic on medical office assistants (MOAs) Working in Primary Care: A Qualitative Study.

Medical Office Assistants (MOAs), also known as receptionists and clerks, are front line workers and the most accessible member of the primary care team. Historically, their contributions to primary care have been unrecognised and undervalued. The COVID-19 pandemic put pressure on existing roles and systems in primary care: how MOAs adapted is unknown. To explore the experiences of MOAs working in primary care during the COVID-19 pandemic from the perspectives of MOAs and family physicians (FPs) who worked with MOAs during this period. A qualitative study using Constructivist Grounded Theory, conducted in Ontario, Canada METHOD: Seventeen participants were recruited through professional contacts of the research team. Individual semi-structured interviews were conducted with MOAs and FPs across the province. MOAs' many responsibilities in primary care intensified during the pandemic. MOAs leveraged their healthcare system knowledge and therapeutic relationships with patients to reduce patient distress. Unfortunately, MOAs experienced more frustration, and in some cases, abuse from patients. MOAs' ability to adapt to new systems and respond to high patient needs seemed to be positively influenced by their relationships with patients and FPs. FPs expressed concern for MOA welfare and recognised their critical role on primary care teams. MOAs made significant contributions to primary care during the COVID-19 pandemic. This study suggests MOAs have greater capacity than previously recognised which has important implications for planning in an era of under-resourced healthcare.

Collaboration strategies affecting implementation of a cross-systems intervention for child welfare and substance use treatment: a mixed methods analysis.

Collaboration strategies refer to policies and practices used to align operations and services across organizations or systems. These strategies can influence implementation of cross-system interventions focused on improving integration of care, but remain under-specified and under-examined. This study identifies collaboration strategies and the conditions under which they affected implementation of Sobriety Treatment and Recovery Teams (START), an evidence-based intervention focused on integrating child welfare and behavioral health services for families involved with both systems. Our study sample included 17 county child welfare agencies that implemented START. Data on collaboration strategies and organizational context were obtained from key informant interviews, frontline worker surveys, and contracts. Contextual data were drawn from secondary data, and fidelity data were drawn from an administrative database. Qualitative and quantitative data were integrated using coincidence analysis, and used to identify combinations of conditions that uniquely differentiated agencies with higher and lower fidelity to START. Fidelity was lower for intervention components requiring cross-system collaboration. Although key informants acknowledged the importance of collaboration for START implementation, few agencies used formal collaboration strategies other than staff co-location or reported high communication quality between frontline staff in child welfare and behavioral health. In coincidence analysis, four conditions differentiated agencies with higher and lower fidelity with 100% consistency and 88% coverage. We found that either strong leadership support or, in high need communities, third-party resource support from local behavioral health boards were sufficient for high fidelity. Similarly, in high need communities, absence of third-party resource support was sufficient for low fidelity, while in low need communities, absence of communication quality was sufficient for low fidelity. Administrators, frontline workers, and interested third parties (i.e., other stakeholders not directly involved in implementation) can use collaboration strategies to facilitate implementation. However, the effectiveness of collaboration strategies depends on local context. In agencies where internal leadership support for implementation is low but need for intervention is high, third-party resource support may still be sufficient for high fidelity. Further research is needed to test effectiveness of collaboration strategies in different conditions and on a broader range of process and implementation outcomes. ClinicalTrials.gov, NCT03931005, Registered 04/29/2019, https://classic. gov/ct2/show/NCT03931005 .

Nurses’ knowledge to identify, prevent and manage hypertensive disorder of pregnancy

Background: Hypertensive disorders of pregnancy are major contributors to maternal mortality in South Africa. Preventative strategies in low- and middle-income countries emphasise frequent antenatal visits, symptom identification, patient education and the prophylactic use of calcium and low-dose aspirin to prevent HDP for nurses because they are the frontline workers at antenatal clinics countrywide.Methods: This was a cross-sectional study where a self-administered questionnaire was conducted among nurses (midwives and professional nurses) employed at hospitals and clinics in Durban, South Africa, to assess their understanding and practices regarding identification and initial management of HDP, particularly for eclampsia and PE with severe features. The questionnaires were distributed in person by the researcher.Results: Of the 106 respondents, most (88.7%) worked in the public sector, with over 5 years of experience (64.9%). There was a varied understanding of HDP categories: 72.6% identified gestational hypertension correctly; 49.1%, chronic hypertension; 93.4% PE and 83.0% eclampsia. Knowledge of the recommended treatments for severe PE (55.7%) and eclampsia (66.0%) was moderate with respect to the recommended anticonvulsant and rapid-acting antihypertensive agents, with only 10% recognising the role of aspirin for the prevention of HDP.Conclusion: Substantial knowledge deficiencies existed among nurses in managing HDP.Contribution: Their crucial role in both emergency and preventative care in South African healthcare settings, enhancing educational training on clinical management by providing continuous training and regular updates are imperative to reduce maternal and perinatal complications associated with HDP.

Envisioning the Future of Burnout Support: Understanding Frontline Workers' Experiences in Nonprofit Gender-Based Violence Organizations

Frontline workers (FLWs) provide essential services necessary for a functioning society, but the nature of their work contributes to their high rates of burnout. This burnout impacts not only their own health, but also has dire consequences for the people most in need of their services. Digital interventions for burnout may provide scalable, accessible, and cost-effective care. However, such interventions have been designed to intervene at the individual-level and have been inadequate in sustainably alleviating burnout. In addition, these interventions have not considered how we might integrate more effective organizational-level strategies or reflect FLWs' own experiences and the unique contexts of frontline work in their design. One important, yet understudied, domain of frontline work that experiences high rates of burnout is gender-based violence (GBV) service provision in nonprofit organizations. Using a community-based participatory research approach, we ran 8 co-design workshops with FLWs and supervisors from various nonprofit GBV organizations in a large metropolitan city in the United States to understand their experiences, hopes, and perceptions of technology for burnout support within their organizations. We found that participants greatly valued their support systems and supervisory relationships at work. And while there was a desire to use technology as support tools for burnout, participants were wary of how it could conflict with these support systems and important organizational values. We contribute a multilevel framework for digital burnout interventions and argue for a methodological shift to an assets-based approach, reframing the future of research and design of burnout interventions to center and reflect the needs, values, and lived experiences of FLWs.

Studying Up Public Sector AI: How Networks of Power Relations Shape Agency Decisions Around AI Design and Use

As public sector agencies rapidly introduce new AI tools in high-stakes domains like social services, it becomes critical to understand how decisions to adopt these tools are made in practice. We borrow from the anthropological practice to "study up" those in positions of power, and reorient our study of public sector AI around those who have the power and responsibility to make decisions about the role that AI tools will play in their agency. Through semi-structured interviews and design activities with 16 agency decision-makers, we examine how decisions about AI design and adoption are influenced by their interactions with and assumptions about other actors within these agencies (e.g., frontline workers and agency leaders), as well as those above (legal systems and contracted companies), and below (impacted communities). By centering these networks of power relations, our findings shed light on how infrastructural, legal, and social factors create barriers and disincentives to the involvement of a broader range of stakeholders in decisions about AI design and adoption. Agency decision-makers desired more practical support for stakeholder involvement around public sector AI to help overcome the knowledge and power differentials they perceived between them and other stakeholders (e.g., frontline workers and impacted community members). Building on these findings, we discuss implications for future research and policy around actualizing participatory AI approaches in public sector contexts.

Intermediation: Algorithmic Prioritization in Practice in Homeless Services

Homelessness is a significant and growing crisis in the United States. In an effort to more efficiently and fairly distribute limited housing resources, jurisdictions across the US have adopted algorithmic prioritization systems to help select which unhoused people should receive resources. Given the impact of algorithmic prioritization on the lives of unhoused people, there is a need to more fully examine how these systems are implemented in practice by frontline workers such as social service workers. In this paper, we present a qualitative study that draws on interviews and artifact walkthroughs with fifteen social service workers to examine how they interacted with algorithmic prioritization systems as part of their job duties. We found that social service workers employed discretionary work practices to mediate between the rigid formats of algorithmic prioritization systems and the messy, situated realities of homelessness. We term these discretionary work practices 'intermediation' and provide four examples that illustrate how our interlocutors were able to maintain their commitment to advocacy and to express their expertise despite the automation of major aspects of their professional decision-making. These work practices, which we argue were motivated by care for clients, as well as a desire to preserve professional autonomy, lead us to conclude that discretion cannot easily be removed from bureaucratic systems and that removing discretion is not necessarily a desirable outcome.

Retention of nickel, cobalt and chromium in skin at conditions mimicking intense hand hygiene practices using water, soap, and hand-disinfectant in vitro

BackgroundDuring the COVID-19 pandemic, increased hand hygiene practices using water, soap and hand disinfectants, became prevalent, particularly among frontline workers. This study investigates the impact of these practices on the skin’s ability to retain the allergenic metals nickel, cobalt, and chromium. The study constitutes three parts: (I) creating an impaired skin barrier, (II) exposing treated and untreated skin to nickel alone, and (III) in co-exposure with cobalt and chromium.MethodsUsing full-thickness skin from stillborn piglets, in vitro experiments were conducted to assess retention of metals in skin at conditions mimicking intense hand hygiene practices. Treatment of skin with varying concentrations of sodium lauryl sulphate (SLS), to impair its barrier integrity was assessed. This was followed by exposure of treated and untreated skin to the metals, that were dissolved in Milli-Q water, 0.5% SLS, and ethanol respectively.ResultsResults showed that pre-treatment with 5% SLS impaired the skin barrier with regards to the measure of trans epidermal water loss (TEWL). Metal amounts retained in the skin were generally higher in treated than untreated skin. The highest amounts of metal retained in skin were observed for exposure to nickel in ethanol. Co-exposure to nickel, cobalt, and chromium in 0.5% SLS resulted in the highest amounts of total metal retention.ConclusionsThe in vitro findings highlight the increased risk of metal retention in skin due to an impaired barrier. The SLS concentration used in the current study corresponds to those used in many hand hygiene products. Hence, occupational settings with frequent exposure to water, soap and disinfectants need to consider protective measures not only for the irritant exposures themselves but also simultaneous exposure to allergenic metals.

Rapid Learning in Frontline Grocery Workers During the COVID‐19 Pandemic

ABSTRACTProlonged stress and the need for rapid uptake of information can have detrimental effects on memory and cognition, whereas meaningfulness of study material and motivation to learn can have positive effects. How do these opposing conditions impact workplace learning in essential frontline workers during a global pandemic? We analyzed learning data collected longitudinally since before the pandemic in over 85,000 essential frontline grocery workers and nonessential telecommunications workers via a learning management system that incorporates a spaced retrieval schedule, where items are retrieved following retention intervals of varying length. Findings indicate more rapid knowledge uptake in grocery workers (a) during than before the pandemic, (b) for COVID‐19‐related content than non‐COVID content, and (c) in the United States than in Canada. Longer‐term maintenance of training material was similar across groups. Evidence of enhanced workplace learning and retention supports efforts to integrate empirically based strategies from the behavioral sciences into learning‐based technologies.

Work First or Education First? Frontline Service Challenges of Providing Enabling Activation

Activation policies, especially formal upskilling, can strengthen social inequality among long-term unemployed people. Also, receiving skill-enhancing activities may be at odds with the ‘work first’ principle. Drawing on interviews with frontline workers in the Norwegian employment and welfare service (NAV), this article analyses how frontline workers handle the challenging aspects arising from activation policies in providing enabling activities to claimants who need comprehensive support. The findings suggest that frontline workers face claimants who expect to embark on an education, and on the contrary, claimants who lack motivation or capability to do so. In both cases, frontline workers are challenged in terms of experiencing contradictory expectations from policies and users and in assessing future outcomes and suitability of the services. Education activities provided by the public employment agency (PES) involves multiple policy fields and require specific competency on the part of frontline workers.

How to not revert to type: learnings from the pandemic response for universal health system reform

Abstract Background Understanding of the opportunities and learnings for health system change that have arisen during the pandemic is still emerging. Situated in the Irish health reform context of Sláintecare, the programme which aims to deliver universal, integrated healthcare, this study set out to generate evidence on the processes that impacted access to universal, integrated care during COVID-19, with a view to informing universal health system reform and implementation. Methods The study, which is qualitative, was underpinned by a co-production approach with Irish health system leadership. Semi-structured interviews were conducted with 16 health system professionals (including managers and frontline workers) from a range of responses to explore their experiences during the pandemic. Following thematic analysis, a complexity-informed approach guided the interpretation of the findings. Results A range of factors facilitated better access to integrated care during the crisis, falling under three key themes (1) nurturing whole-system thinking through a clear, common goal and shared information base; (2) harnessing, sharing and supporting innovation; and (3) prioritizing trust and relationship-building in a human-centred health system. Conclusions Alongside establishing health system structures, we must also incorporate alternative approaches to reform that recognise the value of shared sense-making in an interdependent system, while also allowing for innovation, exploration and learning; and acknowledging the role of social dynamics in driving change.

Interconnected mental health symptoms: network analysis of depression, anxiety, stress, and burnout among psychiatric nurses in the context of the COVID-19 pandemic.

Mental health symptoms such as anxiety, depression, stress, and burnout are common among healthcare workers. However, the interconnections among them remain under-explored. This study aimed to address the interrelationships among these symptoms in psychiatric nurses. We conducted a nationwide survey in the early stage of the COVID-19 pandemic (January to March 2021) to investigate the interconnectedness of depression, anxiety, stress, and burnout among psychiatric nurses. Using network analysis, we identified central symptoms, important bridge symptoms, and the correlations among these central symptoms. Of the 9,224 psychiatric nurses (79.2% female) included in the statistical analyses, 27.6% reported clinically significant depression, 31.2% anxiety, 14.5% stress, and 23.8% burnout. Network analysis revealed that stress had the highest expected influence (EI) value (0.920) and the highest strength among all nodes. The node for depression scored the highest in both closeness and betweenness. Emotional exhaustion (EE) had the highest bridge expected influence (BEI) of 0.340, with the strongest intergroup association between EE and depression. No significant differences were found in gender or frontline work experience (all p > 0.05). Burnout, depression, anxiety, and stress are relatively common among psychiatric nurses in the context of the COVID-19 pandemic. While anxiety was the most prevalent, stress emerged as the core symptom, and depression as an important bridging node. Interventions targeting the core symptoms and bridging nodes may improve the mental health of psychiatric nurses.

Healthcare Internet of Things system implementations for COVID-19 prevention

BackgroundIn response to the widespread transmission of COVID-19 in Australia, healthcare facilities implemented stringent infection control measures, and mandatory and manual screening procedures were introduced to ensure the safety of patients and healthcare staff. However, these necessary measures resulted in imbalances within the healthcare system, a shortage of front-line workers and impacts on patient experience and wait times. The prioritization of infection control measures shifted resources away from routine care, causing delays in accessing necessary healthcare services.Methods and FindingsTo address these challenges, we developed and implemented an Internet of Things (IoT) Smart Screening eGate solution in partnership with a large metropolitan children’s hospital in Australia. This solution integrated a contactless health self-service web app, thermal camera, and physical barrier to automate the COVID-19 health screening and data recording process. During the 3-month pilot period, we deployed the eGate at multiple entrances to the hospital, and monitored the number of users of the system in different periods. We also used a framework of formative evaluation to classify user design challenges within limited resources and improved the design of the eGate to enhance its effectiveness. Our findings show that the IoT eGate solution improved the efficiency of the screening process and reduced the workload and exposure risks of front-line staff and anyone who required access to the hospital. By automating the screening process, we reduced the need for manual screening and minimized contact between individuals, thus reducing the risk of potentially infected.ConclusionIn conclusion, our pilot study demonstrated the potential of IoT technologies in improving the efficiency and safety of medical facilities during pandemics and provided a series of recommendations for the translation of IoT technologies for medical facilities, including the importance of co-design and collaboration with stakeholders, user-centered design, and ongoing monitoring and evaluation.

Assessment of the Knowledge Level of COVID-19 Vaccines and Vaccine Hesitancy amongst Final-Year Medical Students in Southeast Nigeria

Background: Despite how ravaging and deadly COVID-19 infection is, vaccine hesitancy is high among the uneducated, medical students, and health workers, who as frontline workers, should lead by example and drive COVID-19 vaccination efforts. Objectives: This research aims to assess the knowledge level of COVID-19 vaccines among final-year medical students in Southeast-Nigeria universities and determine the factors responsible for the hesitancy of this vaccine among them. Methodology: A cross-sectional study of final-year medical students in six medical schools in Southeast Nigeria using an electronically distributed structured, validated online Google form amongst final-year medical students from which 125 of them responded. Results: Out of a sample of 125 final-year medical students, 123 (98.4%) are aware of COVID-19 vaccines while 2 (1.6%) lack knowledge of COVID-19 vaccines. The demographics of the final year medical students comprised 68 (58%) males and 57 (45.6%) females, 74.4% (93/125) of the respondents do not have a preference for any vaccine while 25.6% (33/125), shows a preference for various vaccine types. 95 (76%) final year medical students have not been vaccinated as against 30 (24%) who have received the vaccine for the Covid-19 virus, this large gap in the vaccination ratio accounted for many factors ranging from safety, availability, side effects, etc. Conclusion: The level of awareness of COVID-19 vaccines is very high among final-year medical students but it is not equivalent to the level of uptake of the vaccines. Despite being future healthcare professionals, medical students' vaccination rates remain suboptimal, highlighting a significant vaccine hesitancy and a large gap between knowledge and practice. Understanding and addressing these underlying factors is crucial to improving vaccine uptake and ensuring that medical students, as future healthcare leaders, are equipped to promote evidence-based public health practice.

An Exploration of the Knowledge and Current Practices of Frontline Workers Regarding Elder Abuse.

Annually, approximately 16% of adults aged 60 and older are victims of abuse in community settings. A critical first step toward effectively intervening and reducing the prevalence of elder abuse is to better understand the current state of knowledge, beliefs, and practices. This qualitative descriptive study explored the perceptions of US frontline community workers regarding elder abuse through focus groups and interviews conducted in the spring and summer of 2021. Participants represented various aging and victim services (n = 9), healthcare (n = 7), and law enforcement (n = 8). Thematic data analysis led to the emergence of three major themes in our data: societal influence, individual circumstances, and nature of abuse. Our findings point out several directions in which researchers and policymakers can begin moving the field forward. These include the need to focus on prevention strategies as well as the need to reduce ageist beliefs and attitudes.

COVID-19 Vaccine-induced antibody response to BNT162b2 mRNA in frontline healthcare workers

The emergence of SARS-CoV-2, the virus causing COVID-19, has resulted in a pandemic that has disrupted all sectors of society. Less than a year after the sequencing of the virus’s genome, emergency use authorization for the BNT162b2 vaccine was requested. The aim of this study was to evaluate the response to the BNT162b2-mRNA COVID-19 vaccine in frontline workers from two hospitals in Colombia. Nasopharyngeal swabs were collected for the molecular detection of SARS-CoV-2 using real-time PCR, and blood samples were taken to assess seroconversion using qualitative and quantitative IgA, IgG, and IgM test kits. The study was conducted at a high-complexity healthcare institution in Bucaramanga, Colombia. 245 people were included in the first round and 129 in the second. SARS-CoV-2 molecular tests were conducted by RT-qPCR, and peripheral blood samples were collected to measure IgG, IgM, and IgA. The main outcome was to establish natural infection and the antibody response induced by the vaccine. The entire population was tested at two fixed times with RT-PCR tests and antibody level measurements approximately 4 and 8 months after receiving the second vaccine dose. 62 (25.3%) and 35 (14.3%) participants had a history of positive PCR in the first and second rounds, respectively. All positive cases showed elevated levels of all immunoglobulins, especially IgG. The average concentrations of IgA, IgM, and IgG at 90 days were 1149.5 U/mL (95% CI 828.2-1470.9); 320.3 U/mL (95% CI 218.4-422.3); and 9277.3 U/mL (95% CI 8989.2-9565.3). Frontline healthcare workers showed an adequate response to the BNT162b2 mRNA vaccine.

The role of discretion and street‐level deliberative practices in the COVID‐19 crisis response: Lessons from the Philippines

AbstractThis study investigates the role of frontline workers, such as the Barangay Health Emergency Response Teams (BHERTs) in the Philippines, as street‐level bureaucrats (SLBs) in implementing COVID‐19 community quarantine policies. Drawing from SLB theory and deliberative policy analysis (DPA), I explore how SLBs adapted to rapidly changing conditions by exercising discretion in interpreting and adapting the implementation of nationally formulated pandemic management policies to meet local realities. I argue that SLBs functioned as deliberative practitioners, mediating between national policies and local realities while engaging in deliberative practices with their clients. Using the experience of BHERTs in Palompon, Leyte in the Philippines as an illustrative case, I identified the policy mandates (policy‐as‐written) of the BHERTs; the challenges and constraints they faced in implementing community quarantine policies; and the discretion they exercised in implementing community quarantine policies (policy‐as‐practiced). The findings reveal that, to meet their policy mandates and address the challenges they faced, they engaged in deliberative practices and collaborated with citizens in implementing context‐specific and creative strategies. Insights from this study highlight the adaptive and deliberative potential of SLBs in crisis situations and the value of a DPA in understanding SLB theory and research. By examining SLBs’ experiences during the pandemic, this study contributes to the SLB literature and offers practical lessons to policy practitioners in facilitating deliberation and developing context‐specific solutions in times of crisis.Points for practitioners The COVID‐19 pandemic and the subsequent government response in the Philippines have increased the challenges faced by street‐level bureaucrats (SLBs), including resource scarcity, organisational and political pressure, public resistance, and the risk of exposure to the virus. SLBs have shown their capacity to apply discretion and collaborate with their clients to resolve their own and the client's challenges and limitations through negotiation, mediation, conflict management, and active listening. This cooperative approach empowers them to resolve common issues and together formulate effective strategies that are beneficial to all parties involved. Relationships outside of SLBs’ duties as state agents (i.e. socio‐cultural relationships) can be a viable pathway for SLBs to implement alternative policy strategies to meet their policy mandates and address the challenges they face as they implement their mandates. Competing value systems, knowledge claims, and emotional narratives, compounded by a governance crisis, define the complex and informal nature of the policy process in the context of a crisis like the pandemic. Although SLBs demonstrate their capacity to creatively solve the challenges they encounter through deliberative practices, this should not serve as a justification for the government's lack of action in prioritising, safeguarding, and preserving their welfare.

Excellence in Homelessness Services: Evidence-Based Frontline Practices

Optimizing the performance of frontline workers in homelessness services (FWHSs) is vital for delivering effective support to individuals experiencing homelessness while prioritizing worker wellness. This paper builds on a previous study applying Orlick's "Wheel of Excellence" mental success elements, originally based on research with Olympic athletes, to social services. It assessed how high-performing FWHSs used these elements, providing practical insights for tailored mental-readiness training in social service facilities. The success elements—commitment, self-belief, positive imagery, mental preparation, full focus, distraction control, and constructive evaluation—were evident in FWHSs when successfully navigating challenging situations. This study provides further analysis of the elements contributing to FWHS’s mental readiness, including quotations from “excellent” FWHSs to highlight their common best practices. It defines excellence in frontline homelessness services, illustrates the use of the seven success elements, and identifies performance blocks and coping strategies from a frontline perspective. Performance blocks include general stressors and mistakes by trainees. The accompanying motivational quotes from high performers are akin to storytelling, elevating understanding and facilitating learning. Recommendations advocate tailoring existing tools, creating online learning opportunities, and implementing an Indigenous-inspired Sharing Circle for evidence-based practice discussions in homelessness services.

Dealing with Mental Health Problems and Work Performance Among Frontline Healthcare Workers Through the Influence of Digital Platform in Malaysian Private Hospitals: A conceptual analysis

The purpose of this study to examine mental health problems of frontline healthcare workers and their impact on work performance through exploring the influence of digital platforms in Malaysian private hospitals. This research is essential in addressing previous knowledge and theoretical gaps on the antecedents that denote to mental health problems and how digital platforms are used to improve mental health wellbeing. Basically, this study discusses the impact of four independent variables which are categorized as depression, anxiety, insomnia and distress factors whereas dependent variable is work performance. This study also will discuss problems concerning work performance of frontline healthcare workers (doctors, nurses, medical assistance, pharmacists and HR Management), specifically on poor service quality, turnover intention, work-related burnout, and exhaustion in Malaysian private hospitals. Hence, this study explores new solutions on the employees’ work performance related issues to create awareness for the Malaysian private hospitals in improving mental health issues among front-line healthcare workers to enhance their work performance through the influence of digital platforms. Private hospitals in Malaysia are experiencing critical situations related to poor employees’ performance which indirectly influence the overall productivity. Thus, private hospitals need to provide serious attention towards these related issues. A conceptual framework was formulated based on identified research gaps through the literature review. It is expected that this study will enhance the awareness for the management in Malaysian private hospitals on dealing with mental health problems which impacts work performance by exploring digital platforms as a solution.