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

Georgina Phillips; Mangu Kendino; Claire E Brolan; Rob Mitchell; Lisa-Maree Herron; Sarah Kὃrver; Deepak Sharma; Gerard O'Reilly; Penisimani Poloniati; Berlin Kafoa; Megan Cox

doi:10.1016/j.lanwpc.2022.100518

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

Lancet Reg Health West Pac. 2022 Aug:25:100518. doi: 10.1016/j.lanwpc.2022.100518. Epub 2022 Jul 7.

Authors

Georgina Phillips^{1

2}, Mangu Kendino³, Claire E Brolan^{4

5}, Rob Mitchell^{1

6}, Lisa-Maree Herron⁴, Sarah Kὃrver⁷, Deepak Sharma⁸, Gerard O'Reilly^{1

6}, Penisimani Poloniati⁹, Berlin Kafoa¹⁰, Megan Cox^{11

12

13}

Affiliations

¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
² Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Australia.
³ Port Moresby General Hospital, Papua New Guinea.
⁴ School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
⁵ Centre for Policy Futures, Faculty of Humanities and Social Sciences, The University of Queensland, Brisbane, Australia.
⁶ Emergency & Trauma Centre, Alfred Health, Australia.
⁷ Australasian College for Emergency Medicine, Melbourne, Australia.
⁸ Emergency Department, Colonial War Memorial Hospital, Suva, Fiji.
⁹ Emergency Department, Vaiola Hospital, Nuku'alofa, The Kingdom of Tonga.
¹⁰ Public Health Division, Secretariat of the Pacific Community, Suva, Fiji.
¹¹ Faculty of Medicine and Health, The University of Sydney, Australia.
¹² The Sutherland Hospital, NSW, Australia.
¹³ NSW Ambulance, Sydney, Australia.

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.

Grants and funding

WT_/Wellcome Trust/United Kingdom