COVID-19 outbreak: implications on healthcare operations

Tactical capacity planning under uncertainty - a capacity limitation analysis

PURPOSE

Tactical capacity planning is crucial when hospitals must cope with substantial changes in patient requirements, as recently experienced during the Covid-19 pandemic. However, there is only little understanding of the nature of capacity limitations in a hospital, which is essential for effective tactical capacity planning.

DESIGN/METHODOLOGY/APPROACH

We report a detailed analysis of capacity limitations at a Norwegian tertiary public hospital and conducted 22 in-depth interviews. The informants participated in capacity planning and decision-making during the Covid-19 pandemic. Data are clustered into categories of capacity limitations and a correspondence analysis provides additional insights.

FINDINGS

Personnel and information were the most mentioned types of capacity limitations, and middle management and organizational functions providing specialized treatment felt most exposed to capacity limitations. Further analysis reveals that capacity limitations are dynamic and vary across hierarchical levels and organizational functions.

RESEARCH LIMITATIONS/IMPLICATIONS

Future research on tactical capacity planning should take interdisciplinary patient pathways better into account as capacity limitations are dynamic and systematically different for organizational functions and hierarchical levels.

PRACTICAL IMPLICATIONS

We argue that our study possesses common characteristics of tertiary public hospitals, including professional silos and fragmentation of responsibilities along patient pathways. Therefore, we recommend operations managers in hospitals to focus more on intra-organizational information flows to increase the agility of their organization.

ORIGINALITY/VALUE

Our detailed capacity limitation analysis at a tertiary public hospital in Norway during the Covid-19 pandemic provides novel insights into the nature of capacity limitations, which may enhance tactical capacity planning.

Changes in Health Spending During the COVID-19 Pandemic by Expenditure Type and Household Profiles in Mexican Households

OBJECTIVE

This study aimed to analyze the changes in the health expenditure of households in Mexico during the COVID-19 pandemic to approximate changes in healthcare that can lead to difficulties in detecting noncommunicable diseases, among others.

METHODS

We compare health spending before and after the pandemic through various estimators using multivariate linear regression models at the household level. We also explore heterogeneous effects by zone, sex, and household composition by age. We explore potential mechanisms of change estimating probit models of healthcare. We use microdata from the National Health and Nutrition Survey 2018 and COVID-19.

RESULTS

The results suggest a significant reduction in health spending, mainly referring to oral health, clinical analysis, and medical studies. Moreover, differences arise by type of area and household age profile. Changes are more significant among families with children younger than 12 years and households situated in urban areas. Regarding the mechanisms, the results suggest that the lower spending is not due to fewer health needs but rather due to less healthcare attention.

CONCLUSION

The COVID-19 pandemic had a significant and heterogeneous impact on household health spending. This lower spending could lead to less detection of noncommunicable diseases, translating into more pressure on the health system in the medium and long term.

Barriers and facilitators to integrated cancer care between primary and secondary care: a scoping review

PURPOSE

This scoping review identifies and characterises reported barriers and facilitators to providing integrated cancer care reported in the international literature, and develops recommendations for clinical practice.

METHODS

This scoping review included literature published between 2009 and 2022 and describes the delivery of integrated cancer care between primary and secondary care sectors. Searches were conducted of an online database Ovid Medline and grey literature.

RESULTS

The review included thirty-two papers. Barriers and facilitators to integrated cancer care were identified in three core areas: (1) at an individual user level around patient-healthcare professional interactions, (2) at an organisational level, and (3) at a healthcare system level. The review findings identified a need for further training for primary care professionals on cancer care, clarity in the delineation of primary care and oncologist roles (i.e. who does what), effective communication and engagement between primary and secondary care, and the provision of protocols and guidelines for follow-up care in cancer.

CONCLUSIONS

Information sharing and communication between primary and secondary care must improve to meet the increasing demand for support for people living with and beyond cancer. Delivering integrated pathways between primary and secondary care will yield improvements in patient outcomes and health economic costs.

Hospital Adaptions to Mitigate the COVID-19 Pandemic Effects on MARQUIS Toolkit Implementation and Sustainability

OBJECTIVE

To explore the perceived effects of COVID-19 on MARQUIS toolkit implementation and sustainability, challenges faced by hospitals in sustaining medication reconciliation efforts, and the strategies used to mitigate the negative effects of the pandemic.

DATA SOURCES AND STUDY SETTINGS

Primary qualitative data were extracted from a Web-based survey. Data were collected from hospitals that participated in MARQUIS2 ( n = 18) and the MARQUIS Collaborative ( n = 5).

STUDY DESIGN

A qualitative, cross-sectional study was conducted.

DATA COLLECTION/DATA EXTRACTION

Qualitative data were extracted from a Research Electronic Data Capture survey databased and uploaded into an Excel data analysis template. Two coders independently coded the data with a third coder resolving discrepancies.

PRINCIPAL FINDINGS

Thirty-one team members participated, including pharmacists ( n = 20; 65%), physicians ( n = 9; 29%), or quality-improvement (QI) specialists ( n = 2; 6%) with expertise in medication reconciliation (MedRec) (14; 45%) or QI (10; 32%). Organizational resources were limited, including funding, staffing, and access to pharmacy students. To support program continuation, hospitals reallocated staff and used new MedRec order sets. Telemedicine, workflow adaptations, leadership support, QI team involvement, and ongoing audits and feedback promoted toolkit sustainability.

CONCLUSIONS

COVID-19 affected the capacity of hospitals to sustain the MARQUIS toolkit. However, hospitals adapted various strategies to sustain the toolkit.

Medication management of COVID-19 patients during transition to virtual models of care: a qualitative study

INTRODUCTION

Expansion of hospital service models was one of the strategies implemented to manage the COVID-19 pandemic through virtual models of care. COVID-19 patients were hospital inpatients transferred to virtual wards and managed outside the hospital. Pharmacists had to provide distance medication management and support services. Virtual care patient support incorporated telehealth consultations by doctors, pharmacists and nurses. This study explored hospital clinicians' experiences and perspectives on medication management and safety issues of the COVID-19 patients transferred from inpatient units (IPUs) to virtual models of care at the time of transfer.

METHODS

Semi-structured qualitative interviews were conducted with purposively selected doctors, pharmacists and nurses involved in the management of COVID-19 patients in a virtual model of care (home or hotel). Clinicians were interviewed face-to-face or via MS Teams between March and May 2022. An interview schedule included 13 questions and prompts to explore perceptions of medication management and safety aspects.

RESULTS

Twenty clinicians were interviewed: six doctors, seven pharmacists, and seven nurses. The average interview time was 26 min (SD: 4.7; range 21-39). Four major medication management and safety themes emerged from the data: (1) complexities involved in efficient handover between IPU and virtual models of care; (2) lack of clarity on roles and responsibilities between hospital and primary care clinicians; (3) communication challenges when pharmacists work remotely; and (4) proactive management of specific medication safety risks. A common thread throughout the themes was concerns for potential impact on patient safety.

CONCLUSION

Overall, clinicians were supportive of the virtual models although patient safety issues were raised that need to be addressed in the development of future services. The results from this study may inform improvements in medication safety implementation of future virtual models of care.

Determining current approaches to the evaluation of the quality of healthcare simulation-based education provision: a scoping review

Background: With an increase in simulation being used in healthcare education, there is a need to ensure the quality of simulation-based education is high. This scoping review was conducted to answer the question: What are the current approaches to the evaluation of the quality of health-care simulation-based education provision? Methods: Databases PubMed, Cochrane, ERIC, CINAHL and Medline were searched in March 2023 to retrieve peer-reviewed healthcare research and review articles written in the English language within the last 20 years. All data were extracted from six studies, themed and presented in the main text and in tabular form. Results: Two scoping reviews, one systematic review and three research articles were included. Three main themes were found: adherence to existing design frameworks, lack of validation of these frameworks and lack of evaluation frameworks, and a proposed evaluation framework. Many of the excluded articles focussed on gaining participant feedback to evaluate simulation activities, rather than evaluating the quality of the design and implementation of the simulation. Conclusions: Benchmarking of current United Kingdom (UK) healthcare simulation against UK and international simulation standards is required to increase its quality, therefore, an agreed UK template framework to evaluate simulation packages is recommended.

COVID-19 Patients' Medication Management during Transition of Care from Hospital to Virtual Care: A Cross-Sectional Survey and Audit

BACKGROUND

Virtual models of care were implemented to ease hospital bed pressure during COVID-19. We evaluated the medication management of COVID-19 patients transferred to virtual models of care.

METHOD

A retrospective audit of COVID-19 patients transferred from inpatient units to virtual care during January 2022 and surveys from patients transferred during December 2021-February 2022 was carried out.

RESULTS

One hundred patients were randomly selected: mean age 59 years (SD: 19.8), mean number of medicines at admission 4.3 (SD: 4.03), mean length of virtual ward stay 4.4 days (SD: 2.1). Pharmacists reviewed 43% (43/100) of patients' medications during their hospital stay and provided 29% (29/100) with discharge medicine lists at transfer. Ninety-two (92%) patients were prescribed at least one new high-risk medicine whilst in hospital, but this was not a factor considered to receive a pharmacist medication review. Forty patients (40%) were discharged on newly commenced high-risk medicines, and this was also not a factor in receiving a pharmacist discharge medication list. In total, 25% of patient surveys (96/378) were returned: 70% (66/96) reported adequate medicine information at transfer and 55% (52/96) during the virtual model period.

CONCLUSION

Patient survey data show overall positive experiences of medication management and support. Audit data highlight gaps in medication management during the transfer to a virtual model, highlighting the need for patient prioritisation.

Providing recovery support to wounded, injured, and sick UK military personnel throughout the COVID-19 pandemic

Health precautions implemented by the United Kingdom (UK) government to limit the spread of the Coronavirus Disease 2019 (COVID-19) led to the closure of many well-being support services in 2020. This created a need to re-think how impactful recovery support courses can be provided. One such service was that of the five-day Multi Activity Course (MAC) which was redesigned in accordance with national health guidelines to allow continued access for Wounded, Injured and Sick (WIS) military personnel to the service; the positive impacts of which are well established. This study investigated the influence of the newly developed Reduced numbers MAC (R-MAC) on the WIS participants lives during and for 12 months after attending. The R-MAC led to comparable impacts for participants well-being, at a time in which people's mental well-being was often being adversely affected. The positive mental well-being of the 261 participants improved by 33% throughout the course and remained 14% higher for the 37 participants who provided data six months after attending. Key facets of the experience that were most impactful for the participants were (i) shared experience with other veterans, (ii) discussing issues in a safe environment while receiving support from the staff and (iii) developing knowledge around self-help/personal development. Adapting to the challenging circumstances and developing the R-MAC mitigated against the already adverse impact of the COVID-19 pandemic for the WIS participants.

Assessing the Effect of Nonvisual Information Factors in Pandemic-Related Video Communication: Randomized Controlled Between-Subjects Experiment

BACKGROUND

Videos have been an important medium for providing health and risk communication to the public during the COVID-19 pandemic. Public health officials, health care professionals, and policy makers have used videos to communicate pandemic-related content to large parts of the population. Evidence regarding the outcomes of such communication, along with their determinants, is however limited.

OBJECTIVE

The aim of this study was to test the impact of nonvisual information factors of video communication on 4 outcomes: trust, comprehension, intentions, and behavior.

METHODS

Twelve short health communication videos related to pandemics were produced and shown to a large sample of participants, applying a randomized controlled between-subjects design. Three factors were included in the creation of the videos: the topic (exponential growth, handwashing, and burden of pandemics on the health care system), the source (expert and nonexpert), and a call to action (present or absent). Participants were randomly assigned to 1 video intervention, and 1194 valid replies were collected. The data were analyzed using factorial ANOVA.

RESULTS

The 3 pandemic-related topics did not affect trust, comprehension, intentions, or behavior. Trust was positively influenced by an expert source (2.5%), whereas a nonexpert source instead had a positive effect on the proxy for behavior (5.7%) compared with the expert source. The inclusion of a call to action had a positive effect on both trust (4.1%) and comprehension (15%).

CONCLUSIONS

Trust and comprehension in pandemic-related video communication can be enhanced by using expert sources and by including a call to action, irrespective of the topic being communicated. Intentions and behavior appear to be affected to a small extent by the 3 factors tested in this study.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/34275.

A rapid mixed-methods evaluation of remote home monitoring models during the COVID-19 pandemic in England

Background

Remote home monitoring services were developed and implemented for patients with COVID-19 during the pandemic. Patients monitored blood oxygen saturation and other readings (e.g. temperature) at home and were escalated as necessary.

Objective

To evaluate effectiveness, costs, implementation, and staff and patient experiences (including disparities and mode) of COVID-19 remote home monitoring services in England during the COVID-19 pandemic (waves 1 and 2).

Methods

A rapid mixed-methods evaluation, conducted in two phases. Phase 1 (July-August 2020) comprised a rapid systematic review, implementation and economic analysis study (in eight sites). Phase 2 (January-June 2021) comprised a large-scale, multisite, mixed-methods study of effectiveness, costs, implementation and patient/staff experience, using national data sets, surveys (28 sites) and interviews (17 sites).

Results

Phase 1 Findings from the review and empirical study indicated that these services have been implemented worldwide and vary substantially. Empirical findings highlighted that communication, appropriate information and multiple modes of monitoring facilitated implementation; barriers included unclear referral processes, workforce availability and lack of administrative support. Phase 2 We received surveys from 292 staff (39% response rate) and 1069 patients/carers (18% response rate). We conducted interviews with 58 staff, 62 patients/carers and 5 national leads. Despite national roll-out, enrolment to services was lower than expected (average enrolment across 37 clinical commissioning groups judged to have completed data was 8.7%). There was large variability in implementation of services, influenced by patient (e.g. local population needs), workforce (e.g. workload), organisational (e.g. collaboration) and resource (e.g. software) factors. We found that for every 10% increase in enrolment to the programme, mortality was reduced by 2% (95% confidence interval: 4% reduction to 1% increase), admissions increased by 3% (-1% to 7%), in-hospital mortality fell by 3% (-8% to 3%) and lengths of stay increased by 1.8% (-1.2% to 4.9%). None of these results are statistically significant. We found slightly longer hospital lengths of stay associated with virtual ward services (adjusted incidence rate ratio 1.05, 95% confidence interval 1.01 to 1.09), and no statistically significant impact on subsequent COVID-19 readmissions (adjusted odds ratio 0.95, 95% confidence interval 0.89 to 1.02). Low patient enrolment rates and incomplete data may have affected chances of detecting possible impact. The mean running cost per patient varied for different types of service and mode; and was driven by the number and grade of staff. Staff, patients and carers generally reported positive experiences of services. Services were easy to deliver but staff needed additional training. Staff knowledge/confidence, NHS resources/workload, dynamics between multidisciplinary team members and patients' engagement with the service (e.g. using the oximeter to record and submit readings) influenced delivery. Patients and carers felt services and human contact received reassured them and were easy to engage with. Engagement was conditional on patient, support, resource and service factors. Many sites designed services to suit the needs of their local population. Despite adaptations, disparities were reported across some patient groups. For example, older adults and patients from ethnic minorities reported more difficulties engaging with the service. Tech-enabled models helped to manage large patient groups but did not completely replace phone calls.

Limitations

Limitations included data completeness, inability to link data on service use to outcomes at a patient level, low survey response rates and under-representation of some patient groups.

Future work

Further research should consider the long-term impact and cost-effectiveness of these services and the appropriateness of different models for different groups of patients.

Conclusions

We were not able to find quantitative evidence that COVID-19 remote home monitoring services have been effective. However, low enrolment rates, incomplete data and varied implementation reduced our chances of detecting any impact that may have existed. While services were viewed positively by staff and patients, barriers to implementation, delivery and engagement should be considered.

Study registration

This study is registered with the ISRCTN (14962466).

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (RSET: 16/138/17; BRACE: 16/138/31) and NHSEI and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 13. See the NIHR Journals Library website for further project information. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care.

Leveraging multi-tier healthcare facility network simulations for capacity planning in a pandemic

The COVID-19 pandemic has placed severe demands on healthcare facilities across the world, and in several countries, makeshift COVID-19 centres have been operationalised to handle patient overflow. In developing countries such as India, the public healthcare system (PHS) is organised as a hierarchical network with patient flows from lower-tier primary health centres (PHC) to mid-tier community health centres (CHC) and downstream to district hospitals (DH). In this study, we demonstrate how a network-based modelling and simulation approach utilising generic modelling principles can (a) quantify the extent to which the existing facilities in the PHS can effectively cope with the forecasted COVID-19 caseload; and (b) inform decisions on capacity at makeshift COVID-19 Care Centres (CCC) to handle patient overflows. We apply the approach to an empirical study of a local PHS comprising ten PHCs, three CHCs, one DH and one makeshift CCC. Our work demonstrates how the generic modelling approach finds extensive use in the development of simulations of multi-tier facility networks that may contain multiple instances of generic simulation models of facilities at each network tier. Further, our work demonstrates how multi-tier healthcare facility network simulations can be leveraged for capacity planning in health crises.

Modelling supply chain sustainability challenges in the food processing sector amid the COVID-19 outbreak

The recent COVID-19 pandemic has significantly impacted most businesses and their supply chains. Due to the negative impacts of COVID-19, businesses have been facing numerous challenges. Among them, sustainability challenges are critical for any supply chain. In the literature, several studies have discussed the impacts of the COVID-19 pandemic on supply chains; however, there is a significant research gap in analysing supply chain sustainability challenges amid the COVID-19 outbreak in a particular context. To fill this research gap, this study aims to develop a systematic approach to identifying and analysing COVID-19 outbreak-related supply chain sustainability challenges in the context of the Australian food processing sector. To achieve the aims, this paper develops a mixed-method approach consisting of both qualitative and quantitative techniques, namely online survey and the Best-Worst method. From the online survey among experts from the Australian food processing sector, 22 sustainability challenges were finalised and categorised into four categories, namely, economic, environmental, social and ethical, and operational challenges. The empirical findings from the exploratory investigation reveal that increased food processing cost, lack of transparency and traceability, increase in price of raw materials, lack of capital and physical resources, and spread of fake information are the top five sustainability challenges to the Australian food processing sector due to the impacts of the COVID-19 outbreak. The findings of this study will help decision-makers, practitioners, and policymakers by developing the policies, guidelines, and strategies to overcome the most impactful sustainability challenges to ensure sustainable recovery from the impacts of the COVID-19 outbreak.

A Fuzzy Hybrid MCDM Approach for Assessing the Emergency Department Performance during the COVID-19 Outbreak

The use of emergency departments (EDs) has increased during the COVID-19 outbreak, thereby evidencing the key role of these units in the overall response of healthcare systems to the current pandemic scenario. Nevertheless, several disruptions have emerged in the practical scenario including low throughput, overcrowding, and extended waiting times. Therefore, there is a need to develop strategies for upgrading the response of these units against the current pandemic. Given the above, this paper presents a hybrid fuzzy multicriteria decision-making model (MCDM) to evaluate the performance of EDs and create focused improvement interventions. First, the intuitionistic fuzzy analytic hierarchy process (IF-AHP) technique is used to estimate the relative priorities of criteria and sub-criteria considering uncertainty. Then, the intuitionistic fuzzy decision making trial and evaluation laboratory (IF-DEMATEL) is employed to calculate the interdependence and feedback between criteria and sub-criteria under uncertainty, Finally, the combined compromise solution (CoCoSo) is implemented to rank the EDs and detect their weaknesses to device suitable improvement plans. The aforementioned methodology was validated in three emergency centers in Turkey. The results revealed that the most important criterion in ED performance was ER facilities (14.4%), while Procedures and protocols evidenced the highest positive D + R value (18.239) among the dispatchers and is therefore deemed as the main generator within the performance network.

Resilience in keeping the balance between demand and capacity in the COVID-19 pandemic, a case study at a Swedish middle-sized hospital

BACKGROUND

In pandemics, it is critical to find a balance between healthcare demand, and capacity, taking into consideration the demands of the patients affected by the pandemic, as well as other patients (in elective or emergency care). The purpose of this paper is to suggest conceptual models for the capacity requirements at the emergency department, the inpatient care, and intensive care unit as well as a model for building staff capacity in pandemics.

METHODS

This paper is based on a qualitative single case study at a middle-sized hospital in Sweden. The primary data are collected from 27 interviewees and inductively analyzed.

RESULTS

The interviewees described a large difference between the immediate catastrophe scenario described in the emergency plan (which they had trained for), and the reality during the COVID-19 pandemic. The pandemic had a much slower onset and lasted longer compared to, for example, an accident, and the healthcare demand fluctuated with the societal infection. The emergency department and inpatient care could create surge capacity by reducing elective care. Lower inflow of other emergency patients also helped to create surge capacity. The number of intensive care beds increased by 350% at the case hospital. At the same time, the capacity of the employees decreased due to infection, exhaustion, and fear. The study contributes to knowledge of conceptional models and key factors affecting the balance between demand and capacity.

CONCLUSION

The framework suggests conceptual models for balancing surge capacity during a pandemic Health care practitioners need to provide assumptions of the key factors to find the balance between the demand and capacity corresponding to the reality and maintain the delivery of high-quality healthcare services.

Undertaking rapid evaluations during the COVID-19 pandemic: Lessons from evaluating COVID-19 remote home monitoring services in England

Introduction

Rapid evaluations can offer evidence on innovations in health and social care that can be used to inform fast-moving policy and practise, and support their scale-up according to previous research. However, there are few comprehensive accounts of how to plan and conduct large-scale rapid evaluations, ensure scientific rigour, and achieve stakeholder engagement within compressed timeframes.

Methods

Using a case study of a national mixed-methods rapid evaluation of COVID-19 remote home monitoring services in England, conducted during the COVID-19 pandemic, this manuscript examines the process of conducting a large-scale rapid evaluation from design to dissemination and impact, and reflects on the key lessons for conducting future large-scale rapid evaluations. In this manuscript, we describe each stage of the rapid evaluation: convening the team (study team and external collaborators), design and planning (scoping, designing protocols, study set up), data collection and analysis, and dissemination.

Results

We reflect on why certain decisions were made and highlight facilitators and challenges. The manuscript concludes with 12 key lessons for conducting large-scale mixed-methods rapid evaluations of healthcare services. We propose that rapid study teams need to: (1) find ways of quickly building trust with external stakeholders, including evidence-users; (2) consider the needs of the rapid evaluation and resources needed; (3) use scoping to ensure the study is highly focused; (4) carefully consider what cannot be completed within a designated timeframe; (5) use structured processes to ensure consistency and rigour; (6) be flexible and responsive to changing needs and circumstances; (7) consider the risks associated with new data collection approaches of quantitative data (and their usability); (8) consider whether it is possible to use aggregated quantitative data, and what that would mean when presenting results, (9) consider using structured processes & layered analysis approaches to rapidly synthesise qualitative findings, (10) consider the balance between speed and the size and skills of the team, (11) ensure all team members know roles and responsibilities and can communicate quickly and clearly; and (12) consider how best to share findings, in discussion with evidence-users, for rapid understanding and use.

Conclusion

These 12 lessons can be used to inform the development and conduct of future rapid evaluations in a range of contexts and settings.

Just-in-time approach in healthcare inventory management: Does it really work?

Healthcare organizations need to efficiently use their available resources, improve their productivity, reduce operating costs, and provide high-quality services. Just in time (JIT) is an approach that has benefited the healthcare industry in these regards, improving patient outcomes by reducing waste and non-value-adding activities. As such, our main purpose in this study was to discuss the use of JIT systems in healthcare inventory management and highlight their importance, as well as explore the advantages and limitations of JIT systems in healthcare management systems. We also explored supply chain issues in healthcare during the COVID-19 pandemic and provide strategies and recommendations for improvement.

The Impact of the COVID-19 Pandemic on Informal Caregivers of People With Parkinson's Disease Residing in the UK: A Qualitative Study

Informal caregivers can experience various demands when providing care and support for People with Parkinson's disease (PwP) in their own homes. The outbreak of SARS-CoV-2 and public health strategies employed to mitigate the spread of COVID-19 have presented challenges to the general populace on a global basis. The present study used a qualitative research design to explore how the COVID-19 pandemic has impacted informal caregivers in their role of providing care for PwP in their own homes. A series of 1:1 semi-structured interviews were conducted with 11 informal caregivers of PwP (M age = 72.64 years, SD = 8.94 years). A thematic analysis indicated that 1) vulnerabilities to COVID-19, 2) home maintenance & activities of daily living and 3) engagement with healthcare services were 3 themes that provided indications on how the COVID-19 pandemic impacted informal caregivers of PwP. The present study provides illustrations of how being an informal caregiver of PwP and being identified as high risk to COVID-19 can present challenges to the process of caring for loved ones who are also vulnerable to SARS-CoV-2. The results of the present study highlights the necessity to develop strategies to ensure that informal caregivers have the necessary resources to provide care for PwP in their homes and also maintain their own well-being in the post COVID-19 era.

Using network data envelopment analysis to assess the sustainability and resilience of healthcare supply chains in response to the COVID-19 pandemic

The widespread outbreak of a new Coronavirus (COVID-19) strain has reminded the world of the destructive effects of pandemic and epidemic diseases. Pandemic outbreaks such as COVID-19 are considered a type of risk to supply chains (SCs) affecting SC performance. Healthcare SC performance can be assessed using advanced Management Science (MS) and Operations Research (OR) approaches to improve the efficiency of existing healthcare systems when confronted by pandemic outbreaks such as COVID-19 and Influenza. This paper intends to develop a novel network range directional measure (RDM) approach for evaluating the sustainability and resilience of healthcare SCs in response to the COVID-19 pandemic outbreak. First, we propose a non-radial network RDM method in the presence of negative data. Then, the model is extended to deal with the different types of data such as ratio, integer, undesirable, and zero in efficiency measurement of sustainable and resilient healthcare SCs. To mitigate conditions of uncertainty in performance evaluation results, we use chance-constrained programming (CCP) for the developed model. The proposed approach suggests how to improve the efficiency of healthcare SCs. We present a case study, along with managerial implications, demonstrating the applicability and usefulness of the proposed model. The results show how well our proposed model can assess the sustainability and resilience of healthcare supply chains in the presence of dissimilar types of data and how, under different conditions, the efficiency of decision-making units (DMUs) changes.

Post-acute COVID syndrome (long COVID): What should radiographers know and the potential impact for imaging services

OBJECTIVES

The COVID-19 pandemic caused an unprecedented health crisis resulting in over 6 million deaths worldwide, a figure, which continues to grow. In addition to the excess mortality, there are individuals who recovered from the acute stages, but suffered long-term changes in their health post COVID-19, commonly referred to as long COVID. It is estimated there are currently 1.8 million long COVID sufferers by May 2022 in the UK alone. The aim of this narrative literature review is to explore the signs, symptoms and diagnosis of long COVID and the potential impact on imaging services.

KEY FINDINGS

Long COVID is estimated to occur in 9.5% of those with two doses of vaccination and 14.6% if those with a single dose or no vaccination. Long COVID is defined by ongoing symptoms lasting for 12 or more weeks post acute infection. Symptoms are associated with reductions in the quality of daily life and may involve multisystem manifestations or present as a single symptom.

CONCLUSION

The full impact of long COVID on imaging services is yet to be realised, but there is likely to be significant increased demand for imaging, particularly in CT for the assessment of lung disease. Educators will need to include aspects related to long COVID pathophysiology and imaging presentations in curricula, underpinned by the rapidly evolving evidence base.

IMPLICATIONS FOR PRACTICE

Symptoms relating to long COVID are likely to become a common reason for imaging, with a particular burden on Computed Tomography services. Planning, education and updating protocols in line with a rapidly emerging evidence base is going to be essential.

Organizational responses to the COVID-19 pandemic in Victoria, Australia: A qualitative study across four healthcare settings

Objective

Organizational responses that support healthcare workers (HCWs) and mitigate health risks are necessary to offset the impact of the COVID-19 pandemic. We aimed to understand how HCWs and key personnel working in healthcare settings in Melbourne, Australia perceived their employing organizations' responses to the COVID-19 pandemic.

Method

In this qualitative study, conducted May-July 2021 as part of the longitudinal Coronavirus in Victorian Healthcare and Aged Care Workers (COVIC-HA) study, we purposively sampled and interviewed HCWs and key personnel from healthcare organizations across hospital, ambulance, aged care and primary care (general practice) settings. We also examined HCWs' free-text responses to a question about organizational resources and/or supports from the COVIC-HA Study's baseline survey. We thematically analyzed data using an iterative process.

Results

We analyzed data from interviews with 28 HCWs and 21 key personnel and free-text responses from 365 HCWs, yielding three major themes: navigating a changing and uncertain environment, maintaining service delivery during a pandemic, and meeting the safety and psychological needs of staff . HCWs valued organizational efforts to engage openly and honesty with staff, and proactive responses such as strategies to enhance workplace safety (e.g., personal protective equipment spotters). Suggestions for improvement identified in the themes included streamlined information processes, greater involvement of HCWs in decision-making, increased investment in staff wellbeing initiatives and sustainable approaches to strengthen the healthcare workforce.

Conclusions

This study provides in-depth insights into the challenges and successes of organizational responses across four healthcare settings in the uncertain environment of a pandemic. Future efforts to mitigate the impact of acute stressors on HCWs should include a strong focus on bidirectional communication, effective and realistic strategies to strengthen and sustain the healthcare workforce, and greater investment in flexible and meaningful psychological support and wellbeing initiatives for HCWs.

Lean Six Sigma in Healthcare: A Systematic Literature Review on Challenges, Organisational Readiness and Critical Success Factors

Lean Six Sigma (LSS) has been applied in many healthcare organisations, but there has been limited research on the evolution of LSS application in healthcare. This paper aims to present the challenges, critical success factors (CSFs), readiness factors and most common tools and techniques used for LSS deployment in healthcare. A systematic literature review (SLR) was utilised to research the study objectives. Peer-reviewed literature over a 16-year period was studied to understand the deliverables of LSS. The SLR process identified relevant articles and screened a final selection for those under study. The systematic literature review helped the authors to identify the challenges and tools/techniques used for LSS in healthcare. Several CSFs and readiness factors for LSS deployment in healthcare are also presented. This work informs healthcare managers and professionals on the important factors for successful LSS deployment before embarking on the LSS journey. In addition, this work is a valuable resource for healthcare LSS practitioners and academic researchers to learn about, investigate and deploy LSS in the healthcare sector. This study is one of the most comprehensive SLRs covering the importance and specificity of understanding challenges, CSFs and organisational readiness for LSS in healthcare. This study provides knowledge of the successful deployment of LSS in healthcare.

Lean Six Sigma in Healthcare: A Systematic Literature Review on Motivations and Benefits

While Lean Six Sigma (LSS) has been applied extensively in healthcare organisations, there has been limited research on the trends of LSS application in healthcare in recent years. This paper aims to present the key motivations and benefits of LSS in healthcare with a view to highlighting the types of problems that LSS in healthcare can aid in solving. The authors used a systematic literature review (SLR) approach to achieving the article’s purpose. Peer-reviewed journal articles published between 2011 and 2021 are considered to achieve the study objectives. The systematic review helped the authors to identify the evolution, benefits, and motivations for LSS in healthcare. This work includes directions for managers and healthcare professionals in healthcare organisations to embark on a focused LSS journey aligned with the strategic objectives. This study is perhaps one of the most comprehensive SLRs covering a vital agenda of LSS in healthcare. This study provides all the deliverables of LSS for its successful deployment in healthcare.

Colorectal cancer in patients with SARS-CoV-2: a systematic review and meta-analysis

Background

Patients with colorectal cancer (CRC) are more likely to develop severe course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and experience increased risk of mortality compared to SARS-CoV-2 patients without CRC.

Objectives

To estimate the prevalence of SARS-CoV-2 infection in CRC patients and analyse the demographic parameters, clinical characteristics and treatment outcomes in CRC patients with COVID-19 illness.

Methods

For this systematic review and meta-analysis, we searched Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, Scopus and Nature for studies on the incidence of SARS-CoV-2 infection in CRC patients, published from December 1, 2019 to December 31, 2021, with English language restriction. Effect sizes of prevalence were pooled with 95% confidence intervals (CIs). Sub-group analyses were performed to minimize heterogeneity. Binary logistic regression model was used to explore the effect of various demographic and clinical characteristics on patient’s final treatment outcome (survival or death).

Results

Of the 472 papers that were identified, 69 articles were included in the systematic review and meta-analysis (41 cohort, 16 case-report, 9 case-series, 2 cross-sectional, and 1 case-control studies). Studies involving 3362 CRC patients with confirmed SARS-CoV-2 (all patients were adults) were analyzed. The overall pooled proportions of CRC patients who had laboratory-confirmed community-acquired and hospital-acquired SARS-CoV-2 infections were 8.1% (95% CI 6.1 to 10.1, n = 1308, 24 studies, I² 98%, p = 0.66), and 1.5% (95% CI 1.1 to 1.9, n = 472, 27 studies, I² 94%, p < 0.01). The median patient age ranged from 51.6 years to 80 years across studies. The majority of the patients were male (n = 2243, 66.7%) and belonged to White (Caucasian) (n = 262, 7.8%), Hispanic (n = 156, 4.6%) and Asian (n = 153, 4.4%) ethnicity. The main source of SARS-CoV-2 infection in CRC patients was community-acquired (n = 2882, 85.7%; p = 0.014). Most of those SARS-CoV-2 patients had stage III CRC (n = 725, 21.6%; p = 0.036) and were treated mainly with surgical resections (n = 304, 9%) and chemotherapies (n = 187, 5.6%), p = 0.008. The odd ratios of death were significantly high in patients with old age (≥ 60 years) (OR 1.96, 95% CI 0.94–0.96; p < 0.001), male gender (OR 1.44, 95% CI 0.41–0.47; p < 0.001) CRC stage III (OR 1.54, 95% CI 0.02–1.05; p = 0.041), CRC stage IV (OR 1.69, 95% CI 0.17–1.2; p = 0.009), recent active treatment with chemotherapies (OR 1.35, 95% CI 0.5–0.66; p = 0.023) or surgical resections (OR 1.4, 95% CI 0.8–0.73; p = 0.016) and admission to ICU (OR 1.88, 95% CI 0.85–1.12; p < 0.001) compared to those who survived.

Conclusion

SARS-CoV-2 infection in CRC patient is not uncommon and results in a mortality rate of 26.2%. Key determinants that lead to increased mortality in CRC patients infected with COVID-19 include older age (≥ 60 years old); male gender; Asian and Hispanic ethnicity; if SARS-CoV-2 was acquired from hospital source; advanced CRC (stage III and IV); if patient received chemotherapies or surgical treatment; and if patient was admitted to ICU, ventilated or experienced ARDS.

Viable healthcare supply chain network design for a pandemic

The recent COVID-19 pandemic revealed that healthcare networks must have a flexible and effective structure. In this study, we develop a viable healthcare network design for a pandemic using a multi-stage stochastic approach. We propose a multi-level network that includes health centers, computed tomography scan centers, hospitals, and clinics. Patients have conditions to returning to normal life or quarantining at home. Three objectives are defined: maximizing the probability of patient recovery, minimizing the costs of all centers in the network, and minimizing the Coronavirus death rate. We investigate a real case study in Iran to demonstrate the model's applicability. Finally, we compare the healthcare supply chain network design in a pandemic with a normal situation to advise how the network can continue to remain viable.

Addressing sustainability during and post-COVID-19 pandemic crisis: a literature review and bibliometric analysis to explore the future avenues

Purpose

This paper aims to identify the current research trends in sustainability through an extensive literature review and propose future research agenda under the ambit of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Specifically, the present study aims to uncover the current state of the literature and thereby develop an understanding of how the pandemic has impacted the dimensions of sustainability.

Design/methodology/approach

To achieve the objective, the authors adopted a five-step literature review process, combined with bibliometric and network analysis. The authors also considered news articles and reports of international organizations to comprehensively achieve the research objective.

Findings

The study results show how the pandemic has impacted the social, economic and environmental dimensions of sustainability. The results also highlight the list of authors, countries and institutions that have proactively worked towards eliminating the disruption caused by the COVID-19 pandemic.

Research limitations/implications

The study provides an in-depth understanding of the scholarly contributions to the field of sustainability since the COVID-19 outbreak. The study is useful for policymakers and businesses interested in understanding how the pandemic has impacted the dimensions of sustainability and possible mitigation strategies. Furthermore, the study also provides future research directions in the intersection of pandemic and sustainability dimensions. Specific research questions (RQs) are also proposed to help future research.

Originality/value

To the best of the authors' knowledge, this study is a pioneer attempt to provide a comprehensive understanding of the existing and rapidly growing literature on COVID-19 and its relationship with the various dimensions of sustainability.

The Core of Healthcare Efficiency: A Comprehensive Bibliometric Review on Frontier Analysis of Hospitals

Parametric and non-parametric frontier applications are typical for measuring the efficiency and productivity of many healthcare units. Due to the current COVID-19 pandemic, hospital efficiency is the center of academic discussions and the most desired target for many public authorities under limited resources. Investigating the state of the art of such applications and methodologies in the healthcare sector, besides uncovering strategical managerial prospects, can expand the scientific knowledge on the fundamental differences among efficiency models, variables and applications, drag research attention to the most attractive and recurrent concepts, and broaden a discussion on the specific theoretical and empirical gaps still to be addressed in future research agendas. This work offers a systematic bibliometric review to explore this complex panorama. Hospital efficiency applications from 1996 to 2022 were investigated from the Web of Science base. We selected 65 from the 203 most prominent works based on the Core Publication methodology. We provide core and general classifications according to the clinical outcome, bibliographic coupling of concepts and keywords highlighting the most relevant perspectives and literature gaps, and a comprehensive discussion of the most attractive literature and insights for building a research agenda in the field.

Agricultural biomass supply chain resilience: COVID-19 outbreak vs. sustainability compliance, technological change, uncertainties, and policies

The COVID-19 pandemic has caused a confounding collection of transportation, supply chains, and logistical disruptions, which needs to be well addressed by businesses and governments. During this pandemic, several researchers have concentrated on the sustainability and resilience of supply chains in various industry sectors. Nevertheless, the impacts of the pandemic on sustainability pillars, technological change and uncertainties, and resilience approaches in various sectors have not been clarified yet. More specifically, the agricultural biomass sector has experienced serious disruptions induced by the COVID-19. This paper aims to analyze and assess the agricultural biomass supply and production systems during the COVID-19 and their recovery in post-COVID-19. To the best of our knowledge, this is the first study to evaluate the economic, environmental, social, and technological change effects of the COVID-19 on Biomass Supply Chain resilience. Uncertainties of oil and palm energy demand, price, consumption, export, and production of leading producers and suppliers worldwide are analyzed considering the pre-COVID-19 and current COVID-19 period. It is then followed by recommendations for specific strategies, policies for the biomass industry, and general action plan to overcome the problems of resilience in medium, short, and long-term horizon plans. The findings from this study are valuable resources for the governments, biomass industry, and other stakeholders to provide cleaner post-pandemic energy production and supply and enhance the employees’ engagement.

A wavelet-based deep learning pipeline for efficient COVID-19 diagnosis via CT slices

The quick diagnosis of the novel coronavirus (COVID-19) disease is vital to prevent its propagation and improve therapeutic outcomes. Computed tomography (CT) is believed to be an effective tool for diagnosing COVID-19, however, the CT scan contains hundreds of slices that are complex to be analyzed and could cause delays in diagnosis. Artificial intelligence (AI) especially deep learning (DL), could facilitate and speed up COVID-19 diagnosis from such scans. Several studies employed DL approaches based on 2D CT images from a single view, nevertheless, 3D multiview CT slices demonstrated an excellent ability to enhance the efficiency of COVID-19 diagnosis. The majority of DL-based studies utilized the spatial information of the original CT images to train their models, though, using spectral–temporal information could improve the detection of COVID-19. This article proposes a DL-based pipeline called CoviWavNet for the automatic diagnosis of COVID-19. CoviWavNet uses a 3D multiview dataset called OMNIAHCOV. Initially, it analyzes the CT slices using multilevel discrete wavelet decomposition (DWT) and then uses the heatmaps of the approximation levels to train three ResNet CNN models. These ResNets use the spectral–temporal information of such images to perform classification. Subsequently, it investigates whether the combination of spatial information with spectral–temporal information could improve the diagnostic accuracy of COVID-19. For this purpose, it extracts deep spectral–temporal features from such ResNets using transfer learning and integrates them with deep spatial features extracted from the same ResNets trained with the original CT slices. Then, it utilizes a feature selection step to reduce the dimension of such integrated features and use them as inputs to three support vector machine (SVM) classifiers. To further validate the performance of CoviWavNet, a publicly available benchmark dataset called SARS-COV-2-CT-Scan is employed. The results of CoviWavNet have demonstrated that using the spectral–temporal information of the DWT heatmap images to train the ResNets is superior to utilizing the spatial information of the original CT images. Furthermore, integrating deep spectral–temporal features with deep spatial features has enhanced the classification accuracy of the three SVM classifiers reaching a final accuracy of 99.33% and 99.7% for the OMNIAHCOV and SARS-COV-2-CT-Scan datasets respectively. These accuracies verify the outstanding performance of CoviWavNet compared to other related studies. Thus, CoviWavNet can help radiologists in the rapid and accurate diagnosis of COVID-19 diagnosis.

P, Rao KV. Post-COVID-19 strategic sourcing decisions for escorting stakeholders’ expectations and supplier performance in construction project works

Purpose

The occurrence of COVID-19 has impacted the wide-reaching dimensions of manufacturing, materials, procurement, management, etc., and has loaded disruptions in the wide range of supply chain (SC) activities. The impact of COVID-19 has twisted supplier performance and influenced stakeholders’ thinking towards selecting supplier sources and making strategic sourcing decision for convinced arrangement of construction management (CM) resources. Nowadays, suppliers are intently evaluated by stakeholders in post-COVID-19 phase to induce agile availability of CM resources. Accordingly, this paper aims to demonstrate competent CM dimensions under post COVID-19 scenario for ease managing construction projects by the stakeholders.

Design/methodology/approach

The authors have implicated Grey Sets Theory along with decision-making trial and evaluation laboratory (DEMATEL) technique for understanding significant outcomes. Varieties of diverse decision aspects responsible for strategically influencing supplier sourcing decision is projected under post COVID-19 scenario for handling construction projects by the stakeholders.

Findings

This study investigated sustainable construction management dimensions (SCMD) at the stage of resource deliveries and client aspirations under post COVID-19 situation. The study demonstrated “Lead time” as the most crucial, “Product Range” as the second and “Customers dealings and relationship” as the third crucial aspect considering by the stakeholders for selecting supplier sources based on the attainment of performance score of 0.1338, 0.1273 and 0.1268, respectively. It is found that high lead time stimulates the stakeholders to divert their orders to other competent supplier sources holding a low degree of lead time as compared.

Research limitations/implications

The present study rollovers its existence by serving critical thinking, conceptual modelling, criteria identification and evaluation under CM domain for drafting effectual strategies by the suppliers. The study investigated the impact of COVID-19 on stakeholders’ decision-making and enlisted SCMD that strategically stimulated them in choosing supplier sourcing decision.

Originality/value

The present study realizes the insights of stakeholders in the post COVID-19 scenario related to the supplier sources based on performance score. The study quantified sustainable supplier attribute for construction work and practices. The study analysed the expectations of the stakeholders purchasing different varieties of construction materials from supplier sources for civil works in the post COVID-19 scenario.

Total quality management in Peruvian goods companies during the COVID-19 pandemic

Purpose

The aim of this research is to empirically assess the nine dimensions of the Total Quality Management (TQM) model, which have been categorized into four blocks: the top management block, the supplier block, the process management block and the customer block. The nine dimensions represent key strategic activities of company performance. A comparative analysis of companies with ISO 9001 certification and those without certification in a developing country during the COVID-19 pandemic is carried out.

Design/methodology/approach

A survey was administered to the management of 259 Peruvian goods companies (in the mining, repair and manufacturing sectors) during the COVID-19 pandemic. The survey consisted of 35 Likert-scale items, which were grouped into the following nine TQM dimensions: Top management (leadership), quality planning, quality audit and assessment, product design, suppliers' quality management, process control and improvement, education and training, quality circles and focus on customer satisfaction. Then, Cronbach's alpha, the Kolmogorov–Smirnov test, the Mann–Whitney U test and means were computed for each of the dimensions. This analysis made it possible to estimate significant differences between ISO 9001 certified and non-certified goods companies in terms of the dimensions.

Findings

The results showed that, for ISO 9001 certified companies, the averages for all of the dimensions were significantly different from those of non-certified companies, except for the education and training dimension. ISO 9001 certified companies scored higher than non-certified companies in the TQM dimensions. For both certified and non-certified companies, the leadership dimension had the highest average and the quality circles dimension had the lowest average.

Originality/value

This study addresses two main gaps highlighted in the research on quality management: the application of Quality Management Systems (QMS) in developing countries like Peru, and the impact of ISO 9001 on the performance of goods companies during the COVID-19 pandemic.

Managing resilience of micro, small and medium enterprises (MSMEs) during COVID-19: analysis of barriers

Purpose

Micro, small and medium enterprises (MSMEs) are facing major difficulties with working capital, need of digitalisation and lack of skilled workforce during this crisis situation. Managing resilience post pandemic is again a huge challenge for MSMEs. Therefore, the main objective of the study is to identify the critical barriers for recovery of MSMEs from the pandemic outbreak and recommending potential solutions for avoiding vulnerabilities.

Design/methodology/approach

The most significant barriers, which will impact MSMEs resilience issues are extracted from vast literature review, discussed with nine experts from MSMEs and further categorised into organisational, operational and technical barriers. Best–worst method (BWM) has been used to find the importance rating of barriers for developing resilience in MSMEs.

Findings

It can be observed that the organisational barriers (0.507) are the most significant, followed by operational barriers (0.300) and then, technological barriers (0.192). Liquidity crunch and inadequate technical skills of employees are the most significant barriers for MSMEs resilience during COVID-19, whereas fluctuation in input cost, unavailability of containers on time and decreased process efficiency are the least significant barriers for recovering MSMEs post COVID-19.

Practical implications

Findings imply that MSMEs should try to overcome major barriers such as resource constraints, lack of skills and knowledge and inefficient inventory planning.

Originality/value

Findings of study will be of immense use for MSMEs in efficient management of operations and in developing resilience during uncertain business environment.

Quality and selling price dependent sustainable perishable inventory policy: Lessons from Covid-19 pandemic

This paper addresses the impact of the Covid-19 lockdown on the warehousing of perishable items facing demand-side shocks, mainly those with selling price and product quality dependent demand, for example, fresh fruits, meats, vegetables, packed foods, etc. Along with demand-side issues, such an inventory system consumes a significant amount of energy in terms of freshness, increasing carbon tax and dwindling the firm's total profit. We formulate two-warehouse inventory models of perishables items using the first-in-first-out (FIFO) dispatching policy under two different Covid-19 lockdown scenarios. The two-warehouse system primarily consists of an owned warehouse (OW) and a rented warehouse (RW). Two different lockdown scenarios are considered as; (i) the lockdown during the consumption of goods in OW and (ii) the lockdown during the consumption of goods in RW. The demand rate is assumed to decline and surge by a finite volume as lockdown is forced and relaxed. The proposed models help in assessing the impact of lockdown on (i) product quality, (ii) product cost, (iii) inventory level, (iv) freshness keeping efforts, (v) investment in green technologies, and (vi) carbon cap and trade policy. We determine the above six parameters to maximize the firm's total profit. The key findings of this model suggest that yield is primarily affected due to carbon cap and trade policy, lockdown period, item price, backlogging, and variation in the holding costs in OW and RW. These models may assist the small, medium, and large firms involved in perishable or cold supply chains to assess the effect of Covid-19 like disruption and take corrective measures to maximize their profit.

Enablers for resilience and pandemic preparedness in food supply chain

The recent COVID-19 pandemic has caused enormous disruptions to supply chain (SCs). Border restrictions forced countless businesses to close either permanently or temporarily. However, the food industry is an essential sector that needs to be operational during a pandemic. Although the food industry has proactively worked towards fulfilling human needs, the food supply chain (FSC) faced numerous challenges, forcing SC managers to rethink their business strategy to cater to consumer demands effectively. In a pandemic situation, manufacturing operations need to repurpose and adapt to produce different high-demand products. Resilience initiatives help fight disruption phases in an uncertain environment by building capacity to resist and recover to a better position. This study identifies 14 key enablers to develop a resilient FSC and reveals the most significant enablers in India. We used a hybrid Delphi-interpretive structural modeling (ISM) and Fuzzy decision-making trial and evaluation laboratory (Fuzzy-DEMATEL) methodology to achieve these goals. The Delphi technique identified essential enablers, while the ISM analyzed the interrelationship among enablers and level of importance in a hierarchical structural model. Finally, the Fuzzy-DEMATEL categorized the enablers into the cause-effect group. This study helps SC decision-makers recognize the enablers and the contextual and causal relationships to improve resilience initiatives. It also helps them repurpose their manufacturing operations and shift to other highly required and high-demand production.

The role of lean in healthcare during COVID-19 pandemic

Purpose

The impact of the COVID-19 pandemic on healthcare operations has raised questions about the applicability and capacity of the lean approach to respond to critical events. Thus, with a dearth of studies addressing this issue, this study aims to understand the role of lean in healthcare operations under the disruptive impact of the COVID-19 pandemic.

Design/methodology/approach

Drawing on a case study carried out in an emergency department in Brazil during the COVID-19 outbreak, the author presents results from semi-structured interviews and document analysis.

Findings

The results show three prominent themes that respond to this study's purpose: lean applicability during the pandemic, lean challenges during the pandemic and the pandemic impact on the lean processes. Furthermore, the study underscores that lean is not the panacea to operational problems caused by the pandemic in healthcare organisations, but it eases the impact on their operations. Finally, this study contributes to the discipline of operations management and highlights the need to rethink lean applications during disruptive events, focusing on flexibility, adaptability and patients' needs.

Research limitations/implications

The literature addressing the pandemic impact on healthcare operations is still new and emerging; therefore, it is possible that some of the studies that are under review and could contribute to this study were not considered.

Practical implications

The study provides a better understanding of the lessons learned from the real-world experiences gained during the pandemic, helping managers to make informed decisions when developing contingency plans to improve healthcare readiness and responsiveness under crisis conditions (e.g. untenable demand and constrained capacity).

Originality/value

Given the contemporary nature of this pandemic, only few emerging studies addressing the impact of the pandemic on lean healthcare operations are available and scholars are calling for more empirical studies. Furthermore, there is an increasing criticism and scepticism about the applicability of lean in healthcare during a pandemic. Thus, this research both provides original contributions by responding to scholars' calls for novel research in this area and further contributes towards filling the void in the literature.

Reimagining global food value chains through effective resilience to COVID-19 shocks and similar future events: A dynamic capability perspective

The restructuring of global value/supply chains gained increasing attention as the unprecedented COVID-19 echoed around the world. Yet, the COVID-19 related theory-driven, large scale quantitative, and empirical studies are relatively scarce. This study advances the extant literature by empirically investigating how do firms in the global food value chains (GFVCs) re-imagine their businesses structure in response to the COVID-19-becoming more resilient and competitive to the current pandemic and similar future events. We leverage a unique data of 231 senior managers of the Australian GFVCs and examine their firms' response strategies. Drawing upon key insights from the dynamic capability view, we find that GFVCs' competitiveness is achieved when exposure to COVID-19 shocks elicits dynamic capabilities-readiness, response, recovery-and these capabilities work jointly and sequentially to cultivate resilience. A key finding of this study is that firms with domestic plus global value chain partners are more resilient than those having only global business partners. This finding implies that excessive reliance on offshoring sometimes becomes lethal, especially amid unexpected and prolonged global shocks and, therefore, companies should strike a balance between domestic and global business partners to remain competitive. These findings offer important contributions to theory, practice, and UN sustainable development goals.

Experiences of Perinatal Mental Health Care among Minority Ethnic Women during the COVID-19 Pandemic in London: A Qualitative Study

(1) Background: Approximately one in five women will experience mental health difficulties in the perinatal period. Women from ethnic minority backgrounds face a variety of barriers that can prevent or delay access to appropriate perinatal mental health care. COVID-19 pandemic restrictions created additional obstacles for this group of women. This study aims to explore minority ethnic women's experiences of perinatal mental health services during COVID-19 in London. (2) Methods: Eighteen women from ethnic minority backgrounds were interviewed, and data were subject to a thematic analysis. (3) Results: Three main themes were identified, each with two subthemes: 'Difficulties and Disruptions to Access' (Access to Appointments; Pandemic Restrictions and Disruption), 'Experiences of Remote Delivery' (Preference for Face-to-Face Contact; Advantages of Remote Support); and 'Psychosocial Experiences' linked to COVID-19 (Heightened Anxiety; Social Isolation). (4) Conclusions: Women from ethnic minority backgrounds experienced disrupted perinatal mental health care and COVID-19 restrictions compounding their mental health difficulties. Services should take women's circumstances into account and provide flexibility regarding remote delivery of care.

Birthing under the Condition of the COVID-19 Pandemic in Germany: Interviews with Mothers, Partners, and Obstetric Health Care Workers

BACKGROUND

The COVID-19 pandemic and the necessary containment measures challenge obstetric care. Support persons were excluded while protection measures burdened and disrupted the professionals' ability to care and communicate. The objective of this study was to explore the first-hand experience of the impact of the COVID-19 pandemic on mothers, their partners, and obstetric professionals regarding birth and obstetric care in a university hospital.

METHODS

To answer the descriptive research questions, we conducted a qualitative content analysis using a data triangulation approach. We carried out 35 semi-structured interviews with two stratified purposive samples. Sample one consisted of 25 mothers who had given birth during the pandemic and five partners. Sample two included 10 obstetric professionals whose insights complemented the research findings and contributed to data validation. Participants were recruited from the study sample of a larger project on patient safety from two German university hospitals from February to August 2021. The study was approved by two ethics committees and informed consent was obtained.

RESULTS

Mothers complied with the rules, but felt socially isolated and insecure, especially before transfer to the delivery room. The staff equally reported burdens from their professional perspective: They tried to make up for the lack of partner and social contacts but could not live up to their usual professional standards. The exclusion of partners was seen critically, but necessary to contain the pandemic. The undisturbed time for bonding in the maternity ward was considered positive by both mothers and professionals.

CONCLUSION

The negative effects of risk mitigation measures on childbirth are to be considered carefully when containment measures are applied.

Perception Bias Effects on Healthcare Management in COVID-19 Pandemic: An Application of Cumulative Prospect Theory

Coronavirus disease 2019 (COVID-19) has posed severe threats to human safety in the healthcare sector, particularly in residents in long-term care facilities (LTCFs) at a higher risk of morbidity and mortality. This study aims to draw on cumulative prospect theory (CPT) to develop a decision model to explore LTCF administrators’ risk perceptions and management decisions toward this pandemic. This study employed the policy Delphi method and survey data to examine managers’ perceptions and attitudes and explore the effects of sociodemographic characteristics on healthcare decisions. The findings show that participants exhibited risk aversion for small losses but became risk-neutral when considering devastating damages. LTCF managers exhibited perception bias that led to over- and under-estimation of the occurrence of infection risk. The contextual determinants, including LTCF type, scale, and strategy, simultaneously affect leaders’ risk perception toward consequences and probabilities. Specifically, cost-leadership facilities behave in a loss-averse way, whereas hybrid-strategy LTCFs appear biased in measuring probabilities. This study is the first research that proposes a CPT model to predict administrators’ risk perception under varying mixed gain–loss circumstances involving considerations of healthcare and society in the pandemic context. This study extends the application of CPT into organizational-level decisions. The results highlight that managers counteract their perception bias and subjective estimation to avoid inappropriate decisions in healthcare operations and risk governance for a future health emergency.

What Have We Learnt About the Sourcing of Personal Protective Equipment During Pandemics? Leadership and Management in Healthcare Supply Chain Management: A Scoping Review

Introduction: During the ongoing COVID-19 pandemic there have been much publicised shortages in Personal Protective Equipment for frontline health care workers, from masks to gowns. Recent previous airborne pandemics provide an opportunity to learn how to effectively lead and manage supply chains during crisis situations. Identifying and plotting this learning against time will reveal what has been learnt, when and, significantly, what can be learnt for the future. Aims: (i) To identify the temporal trajectory of leadership and management learning in health supply chain management through pandemics and (ii) to identify leadership and management lessons to enable the resilient supply of key items such as PPE in future pandemics. Methods: We undertook a scoping review in line with PRISMA (scoping review extension) searching Business Source Premier, Health Business Elite, Medline, ProQuest Business Collection and PubMed. Search terms were focused on recent airborne pandemics (SARS; Ebola; Zika virus; H1N1 swine flu, COVID-19), supply chain management, PPE, leadership, learning, inhibitors and facilitators and resilience e.g., SARS AND supply chain^* AND ("personal protective equipment" OR PPE) (leaders^* OR manage^*) Titles and abstracts were downloaded to Endnote and duplicates removed. Two authors independently screened all of the titles and abstracts. Inclusion criteria focused on leadership and management in health supply chains during pandemics, peer reviewed or grey literature (either from business journals or reports): exclusion criteria included not in English and not focused on a named pandemic. Once interrater reliability was assured, authors completed a title and abstract screening independently. Ten percent of the resultant full text articles were screened by both authors, once agreement was reached the full text articles were screened independently noting reasons for exclusion. A data extraction tool was designed to capture findings from the final articles included in the review. Results/Discussion: We found 92 articles and, after screening, included 30 full text articles. The majority were focused on COVID-19 (N = 27) and most were from the USA (N = 13). We identified four themes related to leadership and management of pandemic PPE supply chains, (i) Leadership and management learning for pandemic PPE supply chain management, (ii) Inhibitors of PPE supply chain resilience during a pandemic, (iii) Facilitators employed to manage the immediate impacts of PPE supply chain demands during a pandemic,and (iv) Facilitators proposed to ensure longer term resilience of PPE supply chains during pandemics Our study suggests there has been limited leadership and management learning for PPE supply chains from previous pandemics, however there has been extensive learning through the COVID-19 pandemic. Lessons included the importance of planning, the significance of collaboration and relationship building. Resilience of PPE supply chains was reported to be dependent on multiple levels from individuals to organisation level and also interdependent on (i) sustainability, (ii) the practise of PPE and (iii) long term environmental impact of PPE suggesting the need, long term, to move to a circular economy approach.

Practitioners' learning about healthcare supply chain management in the COVID-19 pandemic: a public procurement perspective

Purpose

The procurement and supply of crucial healthcare products in the early stages of the COVID-19 emergency were chaotic. To prepare for future crises, we must be able to describe what went wrong, and why, and map out ways to build agility and resilience. How can this be done effectively, given the highly complex and diverse network of actors across governments, care providers and supply chains, and the extreme uncertainty and dynamism in the procurement system and supplier markets? The purpose of this study was to capture learning from practitioners in “real time” in a way that could frame and inform capacity building across healthcare systems with varying procurement and supply management maturity.

Design/methodology/approach

This exploratory study involved interviews with 58 senior public procurement practitioners in central and regional governments, NGOs and leaders of professional organizations from 23 countries, very early in the COVID crisis. Following the first, inductive phase of analysis leading to five descriptive dimensions, the awareness-motivation-capability (A-M-C) framework was applied in a further round of coding, to understand immediate challenges faced by procurement practitioners, how the complex, multi-level procurement system that shaped their motivations to respond and critical capabilities required to face these challenges.

Findings

Developments across 23 countries and practitioners' learning about procurement and supply in the pandemic crisis can be captured in five overarching themes: governance and organization, knowledge and skills, information systems, regulation and supply base issues. Together these themes cover the strengths and gaps in procurement and supply capability encountered by procurement leaders and front-line personnel. They highlight the various facets of structure, resource and process which constitute organizational capability. However, to account better for the highly dynamic situation characterized by both unprecedented rivalry and cooperation, analysts must also pay attention to actors' emerging awareness of the situation and their rapidly changing motivations.

Originality/value

The application of the A-M-C framework is unique in the healthcare supply chain and disaster management literature. It enables a comprehensive overview of healthcare procurement from a system perspective. This study shows how increasing system preparedness for future emergencies depends both on developing critical capabilities and understanding how awareness and motivation influence the effective deployment of those capabilities.

Variability in the Use of Disposable Surgical Supplies: A Surgeon Survey and Life Cycle Analysis

PURPOSE

A substantial amount of waste is generated during surgery, yet few studies have investigated this problem. Therefore, we conducted a multicenter survey to investigate how the variation in the use of disposable supplies contributes to the environmental and financial burdens of health care.

METHODS

We created a questionnaire to identify differences in supply use and practice characteristics among hand surgeons who participated in the Wrist and Radius Injury Surgical Trial. We determined the average cumulative cost of 10 key surgical items based on the responses. Subsequently, we estimated the kilograms of carbon dioxide emitted during the life cycle of supplies, from raw material extraction to production and disposal, using economic input-output life cycle analysis.

RESULTS

Thirty-five surgeons from 19 institutions responded to the survey (65% response rate). Based on the difference in costs between surgeons who used the fewest and the most supplies, we determined that expenditures and carbon dioxide emissions could decrease by $22.47 and 10.9 kg per procedure, respectively, with leaner use of 10 key items. Furthermore, assuming that surgeon variation in supply use is present in other surgical subspecialties, we estimated that $2.4 billion in savings and an 800.6 thousand metric ton reduction in carbon emissions could be achieved if all US surgeons reduced their supply use by this amount.

CONCLUSIONS

This study revealed considerable variations in the use of disposable supplies among hand surgeons, highlighting the need for evidence-based tools, policies, and education campaigns to reduce hospital waste across health care systems.

CLINICAL RELEVANCE

Optimal use of disposable supplies is necessary to reduce the cost and environmental burden of hand surgery care.

Managerial Responses to the Onset of the COVID-19 Pandemic in Healthcare Organizations Project Management

The goal of this study was to identify and assess the impact of the COVID-19 pandemic on project management practices in healthcare organizations, taking into account, in particular, risk analysis, project performance, organization of the work of project teams, and tendencies in future developments in project management. In order to achieve this goal, a study was conducted on 20 project managers in selected healthcare organizations in Poland. The results indicate that a systematically conducted risk analysis as part of the implemented projects enabled rapid and effective reactions during the COVID-19 pandemic. The pandemic has also significantly altered the organization of the work of project teams and, in the opinion of the research subjects, this will significantly impact future solutions for project management in healthcare organizations. The obtained results form a basis for the increase in professionalization in project management in healthcare organizations.

Understanding the Impact of Digital Health Strategies During the COVID-19 Outbreak in Saudi Arabia

BACKGROUND

The impact of COVID-19 has been analyzed from various aspects on the health care services management, accessibility and delivery of health care services. However, the COVID-19 pandemic has led to disruptions in health care services, which led to the increase in adoption of digital health technologies, mostly arising out of need and necessity.

OBJECTIVE

Focusing on the prevailing situations (increasing reliance on digital health services), this study investigates the impact of digital health technologies from the perspectives of policymakers and citizens.

METHODS

A mixed-methods approach was adopted. Twenty-seven semi-structured online interviews were conducted with experts and policymakers for assessing the impact from policymakers' perspectives. An online survey questionnaire instrument was used to collect the responses from 1698 Saudi Arabian citizens in relation to the various aspects of digital health applications.

RESULTS

Health care expenditures increased during the COVID-19 outbreak, resulting in launch of various digital health applications. While policymakers defended their stand in improving health care services and accessibility; citizens reflected inability to book medicines/personal medical equipment online (Mean=2.4) and suffered a lack of personalized care (Mean=2.9) through digital health applications. Moreover, disparities exist between the population groups with respect to the accessibility, utilization, and perceptions of digital health technologies.

CONCLUSION

Policymakers have to consider and address these differences in formulating digital health policies and implementing them.

RNA Viromics of Southern California Wastewater and Detection of SARS-CoV-2 Single-Nucleotide Variants

Municipal wastewater provides an integrated sample of a diversity of human-associated microbes across a sewershed, including viruses. Wastewater-based epidemiology (WBE) is a promising strategy to detect pathogens and may serve as an early warning system for disease outbreaks. Notably, WBE has garnered substantial interest during the coronavirus disease 2019 (COVID-19) pandemic to track disease burden through analyses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA. Throughout the COVID-19 outbreak, tracking SARS-CoV-2 in wastewater has been an important tool for understanding the spread of the virus. Unlike traditional sequencing of SARS-CoV-2 isolated from clinical samples, which adds testing burden to the health care system, in this study, metatranscriptomics was used to sequence virus directly from wastewater. Here, we present a study in which we explored RNA viral diversity through sequencing 94 wastewater influent samples across seven wastewater treatment plants (WTPs), collected from August 2020 to January 2021, representing approximately 16 million people in Southern California. Enriched viral libraries identified a wide diversity of RNA viruses that differed between WTPs and over time, with detected viruses including coronaviruses, influenza A, and noroviruses. Furthermore, single-nucleotide variants (SNVs) of SARS-CoV-2 were identified in wastewater, and we measured proportions of overall virus and SNVs across several months. We detected several SNVs that are markers for clinically important SARS-CoV-2 variants along with SNVs of unknown function, prevalence, or epidemiological consequence. Our study shows the potential of WBE to detect viruses in wastewater and to track the diversity and spread of viral variants in urban and suburban locations, which may aid public health efforts to monitor disease outbreaks. IMPORTANCE Wastewater-based epidemiology (WBE) can detect pathogens across sewersheds, which represents the collective waste of human populations. As there is a wide diversity of RNA viruses in wastewater, monitoring the presence of these viruses is useful for public health, industry, and ecological studies. Specific to public health, WBE has proven valuable during the coronavirus disease 2019 (COVID-19) pandemic to track the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) without adding burden to health care systems. In this study, we used metatranscriptomics and reverse transcription-droplet digital PCR (RT-ddPCR) to assay RNA viruses across Southern California wastewater from August 2020 to January 2021, representing approximately 16 million people from Los Angeles, Orange, and San Diego counties. We found that SARS-CoV-2 quantification in wastewater correlates well with county-wide COVID-19 case data, and that we can detect SARS-CoV-2 single-nucleotide variants through sequencing. Likewise, wastewater treatment plants (WTPs) harbored different viromes, and we detected other human pathogens, such as noroviruses and adenoviruses, furthering our understanding of wastewater viral ecology.

An Optimized System to Reduce Procurement Risks and Stock-Outs: A Simulation Case Study for a Component Manufacturer

In the current global system; supply chains are at risk due to increasing procurement shortages, supply disruptions, and the reliability of on-time deliveries with the original order quantities. As a result, an anticipated management model is of vital importance to provide companies with the productive flexibility necessary to adapt quickly to supply changes, in order to ensure the quality and delivery time through efficient management of stocks and supply costs. In this context, this research aims to develop a system to complement classical procurement planning based on inventory management methods and MRP (material requirements planning) systems by considering suppliers’ behavior regarding procurement risks. For this purpose, a system is developed that seeks to simulate the impacts of procurement shortages of different natures. Moreover, the research investigates the development of a system that performs procurement planning of a component manufacturer to determine the supply orders necessary to meet the master production schedule. The system is analyzed based on a set of indicators in the event that the supplier of a material needed for production does not supply on time or has short-term problems. Several scenarios are simulated, and the results are quantified by changing the procurement order quantities, which may or may not follow the economic order quantity (EOQ) model, and the potential procurement disruptions or shortages. The results show how the simulation and anticipation of potential suppliers’ procurement behavior concerning potential shortages and their probability are key for successful procurement within a joint strategy with classical procurement methods.

Supply chain recovery challenges in the wake of COVID-19 pandemic

The COVID-19 pandemic has revealed the fragility of global supply chains arising from raw material scarcity, production and transportation disruption, and social distancing. Firms need to carefully anticipate the difficulties during recovery and formulate appropriate strategies to ensure the survival of their businesses and supply chains. To enhance awareness of the issues, this research aims to identify and model recovery challenges in the context of the Bangladeshi ready-made garment industry. A Delphi-based grey decision-making trial and evaluation laboratory (DEMATEL) methodology was used to analyze the data. While the Delphi method helped identify the major supply chain recovery challenges from the impacts of the COVID-19 pandemic, the grey DEMATEL approach helped categorize the causal relationships among these challenges. Of the 23 recovery challenges finalized, 12 are causal challenges. The study's findings can assist decision-makers in developing strategic policies to overcome the recovery challenges in the post-COVID-19 era.