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. 2022 Aug:25:100518.
doi: 10.1016/j.lanwpc.2022.100518. Epub 2022 Jul 7.

Lessons from the frontline: Leadership and governance experiences in the COVID-19 pandemic response across the Pacific region

Georgina Phillips  1   2 , Mangu Kendino  3 , Claire E Brolan  4   5 , Rob Mitchell  1   6 , Lisa-Maree Herron  4 , Sarah Kὃrver  7 , Deepak Sharma  8 , Gerard O'Reilly  1   6 , Penisimani Poloniati  9 , Berlin Kafoa  10 , Megan Cox  11   12   13
Affiliations

Lessons from the frontline: Leadership and governance experiences in the COVID-19 pandemic response across the Pacific region

Georgina Phillips et al. Lancet Reg Health West Pac. 2022 Aug.

Abstract

Background: Universal access to safe, effective emergency care (EC) during the COVID-19 pandemic has illustrated its centrality to healthcare systems. The 'Leadership and Governance' building block provides policy, accountability and stewardship to health systems, and is essential to determining effectiveness of pandemic response. This study aimed to explore the experience of leadership and governance during the COVID-19 pandemic from frontline clinicians and stakeholders across the Pacific region.

Methods: Australian and Pacific researchers collaborated to conduct this large, qualitative research project in three phases between March 2020 and July 2021. Data was gathered from 116 Pacific regional participants through online support forums, in-depth interviews and focus groups. A phenomenological approach shaped inductive and deductive data analysis, within a previously identified Pacific EC systems building block framework.

Findings: Politics profoundly influenced pandemic response effectiveness, even at the clinical coalface. Experienced clinicians spoke authoritatively to decision-makers; focusing on safety, quality and service duty. Rapid adaptability, past surge event experience, team-focus and systems-thinking enabled EC leadership. Transparent communication, collaboration, mutual respect and trust created unity between frontline clinicians and 'top-level' administrators. Pacific cultural assets of relationship-building and community cohesion strengthened responses.

Interpretation: Effective governance occurs when political, administrative and clinical actors work collaboratively in relationships characterised by trust, transparency, altruism and evidence. Trained, supported EC leadership will enhance frontline service provision, health security preparedness and future Universal Health Coverage goals.

Funding: Epidemic Ethics/World Health Organization (WHO), Foreign, Commonwealth and Development Office/Wellcome Grant 214711/Z/18/Z. Co-funding: Australasian College for Emergency Medicine Foundation, International Development Fund Grant.

Keywords: COVID-19; Emergency care; Emergency medicine; Health governance; Health leadership; Health system building blocks; Health systems; Pacific Islands; Pacific region.

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Conflict of interest statement

MC, GP, RM and GOR declare they are recipients of International Development Fund Grants from the Australasian College for Emergency Medicine Foundation. GP reports past research funding from the Pacific Community (SPC) and visiting Faculty status at the University of Papua New Guinea and Fiji National University. Additionally, RM reports grants from the Australian Government Department of Foreign Affairs and Trade as well as scholarships from the National Health and Medical Research Council (NHMRC) and Monash University. GOR reports that he is the recipient of a NHMRC Early Career Research Fellowship. CEB reports past research consultancy funding from SPC.

Figures

Figure 1
Figure 1
WHO health system building blocks, adapted for the Pacific EC context and this qualitative research project.
See this image and copyright information in PMC

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