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      Prioritizing people and rapid learning in times of crisis: A virtual learning initiative to support health workers during the COVID‐19 pandemic

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          Abstract

          The Western Cape province was the early epicentre of the coronavirus disease 2019 pandemic in South Africa and on the African continent. In this short article we report on an initiative set up within the provincial Department of Health early in the pandemic to facilitate collective learning and support for health workers and managers across the health system, emphasising the importance of leadership, systems resilience, nonhierarchical learning and connectedness. These strategies included regular and systematic engagement with organised labour, different ways of gauging and responding to staff morale, and daily ‘huddles’ for raid learning and responsive action. We propose three transformational actions that could deliver health systems that protect staff during good times and in times of system shocks. (a) Continuously invest in building the foundations of system resilience in good times, to draw on in an acute crisis situation. (b) Provide consistent leadership for an explicit commitment to supporting health workers through decisive action across the system. (c) Optimise available resources and partners, act on improvement ideas and obstacles. Build trusting relationships amongst and across actors.

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          Most cited references15

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          Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic

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            Is Open Access

            Everyday resilience in district health systems: emerging insights from the front lines in Kenya and South Africa

            Recent global crises have brought into sharp relief the absolute necessity of resilient health systems that can recognise and react to societal crises. While such crises focus the global mind, the real work lies, however, in being resilient in the face of routine, multiple challenges. But what are these challenges and what is the work of nurturing everyday resilience in health systems? This paper considers these questions, drawing on long-term, primarily qualitative research conducted in three different district health system settings in Kenya and South Africa, and adopting principles from case study research methodology and meta-synthesis in its analytic approach. The paper presents evidence of the instability and daily disruptions managed at the front lines of the district health system. These include patient complaints, unpredictable staff, compliance demands, organisational instability linked to decentralisation processes and frequently changing, and sometimes unclear, policy imperatives. The paper also identifies managerial responses to these challenges and assesses whether or not they indicate everyday resilience, using two conceptual lenses. From this analysis, we suggest that such resilience seems to arise from the leadership offered by multiple managers, through a combination of strategies that become embedded in relationships and managerial routines, drawing on wider organisational capacities and resources. While stable governance structures and adequate resources do influence everyday resilience, they are not enough to sustain it. Instead, it appears important to nurture the power of leaders across every system to reframe challenges, strengthen their routine practices in ways that encourage mindful staff engagement, and develop social networks within and outside organisations. Further research can build on these insights to deepen understanding.
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              Organizational change and everyday health system resilience: lessons from Cape Town, South Africa

              This paper reports a study from Cape Town, South Africa, that tested an existing framework of everyday health system resilience (EHSR) in examining how a local health system responded to the chronic stress of large-scale organizational change. Over two years (2017-18), through cycles of action-learning involving local researchers and managers, the authorial team tracked the stress experienced, the response strategies implemented and their consequences. The paper considers how a set of micro-governance interventions and mid-level leadership practices supported responses to stress whilst nurturing organizational resilience capacities. Data collection involved observation, in-depth interviews and analysis of meeting minutes and secondary data. Data analysis included iterative synthesis and validation processes. The paper offers five sets of insights that add to the limited empirical health system resilience and EHSR literature: 1) resilience is a process not an end-state; 2) resilience strategies are deployed in combination rather than linearly, after each other; 3) three sets of organizational resilience capacities work together to support collective problem-solving and action; 4) these capacities can be nurtured by mid-level managers’ leadership practices and simple adaptations of routine organizational processes, such as meetings; 5) central level actions must nurture EHSR by enabling the leadership practices and micro-governance processes entailed in everyday decision-making.
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                Author and article information

                Contributors
                ulehmann@uwc.ac.za
                Journal
                Int J Health Plann Manage
                Int J Health Plann Manage
                10.1002/(ISSN)1099-1751
                HPM
                The International Journal of Health Planning and Management
                John Wiley and Sons Inc. (Hoboken )
                0749-6753
                1099-1751
                25 March 2021
                May 2021
                : 36
                : Suppl 1 , Global health and health workforce development: Education, management and policy during the COVID‐19 crisis and beyond ( doiID: 10.1002/hpm.v36.S1 )
                : 168-173
                Affiliations
                [ 1 ] Western Cape Government: Health Cape Town South Africa
                [ 2 ] Health Policy and Systems Division School of Public Health and Family Medicine University of Cape Town Cape Town South Africa
                [ 3 ] Institute for Healthcare Improvement Boston USA
                [ 4 ] Department of Global Health and Development London School of Hygiene and Tropical Medicine London UK
                [ 5 ] Department of Maternal and Child Health Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
                [ 6 ] Chapman and Co Consultants St. Louis Missouri US
                [ 7 ] Red Cross War Memorial Children's Hospital Cape Town South Africa
                [ 8 ] Department of Paediatrics and Child Health Faculty of Health Sciences University of Cape Town Cape Town South Africa
                [ 9 ] School of Public Health University of the Western Cape Cape Town South Africa
                Author notes
                [*] [* ] Correspondence

                Uta Lehmann, School of Public Health University of the Western Cape, PBag X17, Bellville 7535, South Africa.

                Email: ulehmann@ 123456uwc.ac.za

                Author information
                https://orcid.org/0000-0002-2775-7703
                https://orcid.org/0000-0002-2627-8954
                Article
                HPM3149
                10.1002/hpm.3149
                8250842
                33764595
                903e145f-281e-4d61-bc35-13c5afb15454
                © 2021 John Wiley & Sons Ltd.

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 26 February 2021
                : 02 March 2021
                Page count
                Figures: 1, Tables: 0, Pages: 6, Words: 2689
                Categories
                Special Report
                Special Reports
                Custom metadata
                2.0
                May 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.4 mode:remove_FC converted:02.07.2021

                Economics of health & social care
                collaboration,covid‐19,health workforce support,leadership,learning,resilience,sense‐making

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