"Well, what we can do is [ ] to organize data, to evaluate studies"-Self-images of public health academics in Germany during the COVID-19 pandemic: a qualitative study.

BACKGROUND: Despite the significant role of scientific knowledge pertaining to public health, the discipline of public health remained outside the centre stage within the pandemic discourse. Against this background, we investigated the role of German public health academics during the pandemic in our study, focusing on their orientations and associated values. METHODS: We interviewed 21 public health scholars from Germany and collected 36 documents published by public health scientific societies. We analyzed data by grounded theory and situational mapping. RESULTS: We identified five types of self-images identified among healthcare academics: the scientific study supplier, the expert facing political issues, the restrained scholar, the public informer and the changemaker. The typology yields insights into the multiple dimensions of public health and its role in times of crisis. CONCLUSIONS: The findings provide implications to inter- and transdisciplinary interaction and to managing the expectations of public health professionals in relation to crisis management.

COVID-19 healthcare success or failure? Crisis management explained by dynamic capabilities.

INTRODUCTION: This paper presents a structured review of the use of crisis management, specifically examining the frameworks of surge capacity, resilience, and dynamic capabilities in healthcare organizations. Thereafter, a novel deductive method based on the framework of dynamic capabilities is developed and applied to investigate crisis management in two hospital cases during the COVID-19 pandemic. BACKGROUND: The COVID-19 pandemic distinguishes itself from many other disasters due to its global spread, uncertainty, and prolonged duration. While crisis management in healthcare has often been explained using the surge capacity framework, the need for adaptability in an unfamiliar setting and different information flow makes the dynamic capabilities framework more useful. METHODS: The dynamic capabilities framework's microfoundations as categories is utilized in this paper for a deductive analysis of crisis management during the COVID-19 pandemic in a multiple case study involving two Swedish public hospitals. A novel method, incorporating both dynamic and static capabilities across multiple organizational levels, is developed and explored. RESULTS: The case study results reveal the utilization of all dynamic capabilities with an increased emphasis at lower organizational levels and a higher prevalence of static capabilities at the regional level. In Case A, lower-level managers perceived the hospital manager as brave, supporting sensing, seizing, and transformation at the department level. However, due to information gaps, sensing did not reach regional crisis management, reducing their power. In Case B, with contingency plans not initiated, the hospital faced a lack of management and formed a department manager group for patient care. Seizing was robust at the department level, but regional levels struggled with decisions on crisis versus normal management. The novel method effectively visualizes differences between organizational levels and cases, shedding light on the extent of cooperation or lack thereof within the organization. CONCLUSION: The researchers conclude that crisis management in a pandemic, benefits from distributed management, attributed to higher dynamic capabilities at lower organizational levels. A pandemic contingency plan should differ from a plan for accidents, supporting the development of routines for the new situation and continuous improvement. The Dynamic Capabilities framework proved successful for exploration in this context.

How well prepared are hospitals for future crises? Board members perceive their hospitals as resilient for acute crises.

Resilience is an organizational capacity in day-to-day practice and crisis situation performance. A one of a kind crisis for hospitals is the COVID-19 pandemic. The long duration and magnitude of this crisis offers the opportunity to gain insight into the complexity of crisis management and organizational resilience of hospitals. This interview study therefore explored the organizational resilience of Dutch hospitals during the first 14 months of the COVID-19 pandemic. Nine board members of nine Dutch hospitals were interviewed by means of a semi-structured interview that was built on thirteen indicators of organizational resilience. The results showed that board members considered their hospitals as resilient on almost all indicators. Their judgments varied about how prepared and ready for future crises they considered their hospital. According to board members, hospitals are mainly prepared for "acute" short-term crises, thanks to good crisis leadership, open communication and strong networks. A crisis as long as the COVID-19 pandemic was unprecedented and therefore more difficult to deal with. In between the infection waves, work processes were reflected upon to learn, anticipate and respond more smoothly to successive waves. However, the enduring nature of the COVD-19 crisis presented complex organizational challenges. Crisis operations were eventually scaled down and hospitals had to manage the crisis and regular care as two companies side by side. Each crisis manifests differently. Fostering trust in healthcare staff and allowing them to act autonomously during crises, while diligently monitoring external influences and potential future crises, are therefore paramount in developing organizational adaptive capacities.

Local management of the COVID-19 pandemic in Norway: a longitudinal interview study of municipality chief medical officers.

OBJECTIVE: To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses. DESIGN: Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data. RESULTS: Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality. CONCLUSIONS: The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience.

The Norwegian Infection Control Act gave comprehensive responsibility and authority for local COVID-19 pandemic management to the municipalities and the Municipality Chief Medical Officers (MCMOs).The MCMOs highlighted several challenges and shortcomings of the municipal crisis preparedness, of which lack of detailed organizational plans was the most prominent.Teamwork, digital networking and collective sensemaking seemed to enhance pandemic collaboration and resilience within and across municipalities.Most MCMOs gained a leading role at a higher organizational level within the municipality through the COVID-19 pandemic.To strengthen future crisis management, arrangements must be made, both organizationally and financially, for preparedness to remain on the agenda even between epidemics and pandemics.

Linking water stress and measures of crisis management - A systematic review of emergency drinking water management in Germany.

Hydrogeological effects of climate change will continue to affect water reservoirs worldwide. Some regions are experiencing and will experience severe decline in their water resources due to prolonged periods of drought. Since emergency practices such as the provision of emergency drinking water and forest firefighting depend on regional surface and groundwater resources, the safety of the hydro geosphere's of a region is of fundamental importance, especially in times of crisis. The study uniquely addresses the integration of emergency water management within broader sustainable practices, particularly in the German context where such an analysis has not been previously consolidated. Using the example of emergency drinking water management, the paper elaborates the extent to which measures of emergency response are currently recognised as part of sustainable water management. In an analysis, 79 documents addressing emergency drinking water management of both water supply companies and crisis management authorities in Germany were analysed. The findings revealed a general lack of documents addressing the long-term dependencies between water resources and emergency measures currently applied. Furthermore, the documents do not elaborate on how to implement these measures in a sustainable way recognising the distinctive characteristics of a region. Since response measures can potentially intensify water stress in a region, emergency water management must be consequently included in a holistic water management process to protect landscapes and communities for the future. This paper provides a first comprehensive compilation of essential documents dealing with emergency drinking water management in Germany. It furthermore introduces a new approach to emergency water management and identifies necessary research that could serve as a baseline for future crisis decision making to strengthen national and international initiatives on water resource protection.

Naturalistic observations of multiteam interaction networks: Implications for cognition in crisis management teams.

Interaction has been recognised as an essential lens to understand how cognition is formed in a complex adaptive team such as a multidisciplinary crisis management team (CMT). However, little is known about how interactions within and across CMTs give rise to the multi-team system's overall cognitive functioning, which is essential to avoid breakdowns in coordination. To address this gap, we characterise and compare the component CMTs' role-as-intended (RAI) and role-as-observed (RAO) in adapting to the complexity of managing informational needs. To characterise RAI, we conducted semi-structured interviews with subject matter experts and then made a qualitative synthesis using a thematic analysis method. To characterise RAO, we observed multiteam interaction networks in real-time at a simulated training environment and then analysed the component CMTs' relative importance using node centrality measures. The resulting inconsistencies between RAI and RAO imply the need to investigate cognition in multiple CMTs through the lens of interaction.Practitioner summary: When a disaster occurs, multidisciplinary CMTs are expected to serve their roles as described in written or verbal guidelines. However, according to our naturalistic observations of multiteam interaction networks, such descriptions may be (necessary but) insufficient for designing, training, and evaluating CMTs in the complexity of managing informational needs together.

[The SCATTER project: computer-based simulation in the strategic transfer of intensive care patients]. / Das SCATTER-Projekt: Computerbasierte Simulation zur Unterstützung bei der strategischen Verlegung von Intensivpatienten.

BACKGROUND: The need for a concept for the nationwide strategic transfer of critical care patients in Germany was highlighted during the COVID-19 (coronavirus disease 2019) pandemic. Despite the cloverleaf concept developed specifically for this purpose, the transfer of large numbers of critical care patients represents a major challenge. With the help of a computer simulation, the SCATTER research project uses a fictitious example to test, develop, and recommend transfer strategies. METHOD: The simulation was programmed after collecting procedural and structural data on critical care transports within Germany. The simulation allows altering various parameters and testing different transfer scenarios. In a fictitious scenario, nationwide transfers starting from Schleswig-Holstein were simulated and evaluated using predetermined criteria. RESULTS: In the case of ground-based transfers, it became apparent that, depending on the selected target region, not all patients could be transferred due to the limited range of ground-based vehicles. Although a higher number of patients can be transferred by air, this is associated with additional gurney changes and potential risk to the patient. A distance-dependent transport strategy led to the identical results as purely air-bound transport, since air-bound transport was always chosen due to the long distances. DISCUSSION: The simulation can be used to develop recommendations and to draw important conclusions from different transfer strategies.

[Legal, clinical and structural aspects of modern intensive care for children and adolescents with mental disorders]. / Rechtliche, fachliche und strukturelle Aspekte einer modernen akutstationären Versorgung von Kindern und Jugendlichen mit psychischen Störungen.

Recent years have seen a continuous rise in the proportion of emergency contacts across all mental health-related care structures for children and adolescents. Treatment in a protective intensive care unit constitutes an essential element of care and primarily serves the immediate protection of children and adolescents during mental health crises. Protective intensive care is subject to strict legal requirements. Those requirements were amended in 2017 via changes to § 1631b BGB (German Civil Code), leading to a clear separation of the stay in protective intensive care per se and the use of coercive measures. Using the restructuring of the intensive care unit of the Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy at the University Hospital Würzburg as an example, the article illustrates the requirements for modern acute care of children and adolescents with mental disorders.Following the modernisation at the university hospital Würzburg we could drastically reduce the duration of stays in the intensive care unit to a mean of 1.5 days across around 500 admissions per year. Consequently, the risk of hospitalism especially for patients with chronic suicidality is practically non-existent anymore. Since 2017, our cooperation with other clinics in the region has made it possible to care for all underage patients requiring treatment in a protective intensive care unit in child and adolescent psychiatric settings. Long-term treatment over many months in a protective intensive care unit no longer occurs in cases of chronic suicidality.

Tension between local, regional and national levels in Norway's handling of COVID-19.

AIMS: This study aimed to explore the tension between local, regional, and national authorities evoked by some rural municipalities' decisions to impose local infection-control measures during the first weeks of the COVID-19 pandemic in Norway. METHODS: Eight municipal Chief Medical Officers of Health (CMOs) participated in semi-structured interviews, and six crisis management teams participated in focus-group interviews. Data were analysed with systematic text condensation. Boin and Bynander's interpretation of crisis management and coordination and Nesheim et al.'s framework for non-hierarchical coordination in the state sector inspired the analysis. RESULTS: Uncertainty in the face of a pandemic with unknown damage potential, lack of infection-control equipment, patient transport challenges, vulnerable staff situation and planning of local COVID-19 beds were some of the reasons for rural municipalities imposing local infection-control measures the first weeks of the pandemic. Local CMOs' engagement, visibility and knowledge contributed to trust and safety. Differences in perspectives between local, regional and national actors created tension. Existing roles and structures were adjusted, and new informal networks arose. CONCLUSIONS: Strong municipal responsibility in Norway and the quite unique arrangement with local CMOs in every municipality with the legal right to decide temporary local infection-control measures seemed to facilitate a balance between top-down and bottom-up decision making. Tension between rural, regional and national actors that arose due to local infection-control measures, and the following dialogue and mutual adjustment of perspectives, led to a fruitful balance between national and local measures in Norway's handling of the COVID-19 pandemic.

Are the good spared? Corporate social responsibility as insurance against cyber security incidents.

Despite the increasing consensus that socially responsible behavior can act as insurance against externally induced shocks, supporting evidence remains somewhat inconsistent. Our study provides a clear demonstration of the insurance-like properties of corporate social responsibility (CSR) in preserving corporate financial performance (CFP), in the event of a data (cyber) breach. Exploring a sample of 230 breached firms, we find that data breaches lead to significantly negative CFP outcomes for low CSR firms, with the dynamic being particularly pronounced in consumer-sensitive industries. Further, we show that firms increase their CSR activities in the aftermath of a breach to recover lost goodwill and regain stakeholder trust. Overall, our results support the use of CSR as a strategic risk-mitigation tool that can curtail the consequences of data breaches, particularly for firms operating in consumer-centric environments.

Organisation of cross-sector collaboration and its influence on crisis management effectiveness among pharmaceutical supply chain stakeholders during the COVID-19 pandemic.

OBJECTIVES: To investigate the organisation of cross-sector collaboration and how it influenced crisis management effectiveness among pharmaceutical supply chain stakeholders in Finland during the COVID-19 pandemic. STUDY DESIGN: Qualitative semi-structured interview study. METHODS: Purposeful selection was used to obtain the study sample consisting of leaders and specialists from the pharmaceutical industry and wholesalers (n = 9), community pharmacy owners (n = 9), hospital pharmacy heads (n = 6), government agency directors and officials (n = 5) and advocacy organisation representatives (n = 2). Inductive content analysis was performed to examine the data from the semi-structured individual (n = 29) and paired (n = 2) interviews in March-May 2021. RESULTS: A new conceptual model was developed to describe the organisation of collaborative crisis management. Without a predefined crisis management organisation, cross-sector collaboration was organised based on previous collaboration structures, channels and relationships and through the establishment of issue-specific groups by government agencies as per legal mandates. Crisis dynamics and related issues guided the group formation and meeting frequency. Advocacy organisations and government agencies acted in bridging role between stakeholders. Shared knowledge among pharmaceutical supply chain stakeholders enabled anticipation and preparedness during crisis; shared resources fostered maintenance of core functions; and shared problem-solving facilitated cross-sectoral solutions. CONCLUSION: This was the first study exploring cross-sector collaboration among pharmaceutical supply chain stakeholders during a crisis. Sharing knowledge, resources and problem-solving increased the crisis management effectiveness. The study presented a new illustration of organising for collaborative crisis management and added knowledge about private-third sector collaboration and issue-specific groups to the cross-sector collaboration and crisis management literature.

Why time matters when it comes to resilience: how the duration of crisis affects resilience of healthcare and public health leaders.

The meaning of time, especially in crisis, where situations are likely to become even more complex, uncertain, and disruptive, is crucial. Incorporating previous research on organizational crises, organizational resilience, extreme context, and individual resilience, we know that leaders do play a crucial role when it comes to handle adversity in organizations but also that leaders might influence organizational resilience and employee resilience. Intensified by the COVID-19 pandemic, the leaders' ability to effectively deal with a critical situation becomes even more important in healthcare organizations. We argue that time is not only important when it comes to crisis management but also that it is highly significant when it comes to leaders' resilience. Considering the aspect of time implies that different temporal demands, especially regarding the persistence of adversity, require different resilience strategies applied by the leader. Therefore, we call for future research on examining how different leaders' resilience strategies (short term vs. long term) affect crisis management outcomes as well as the resilience in healthcare and public health organizations.

Identification of behavioural changes in reporting adverse events early during COVID-19: An ambulatory care perspective in Israel.

This study examined adverse event reporting centred on three significant dates in the months before the pandemic arrived in Israel. On these dates, broad media coverage exposed citizens and health care providers with indications about the forthcoming pandemic. The current study tracked whether parameters related to reporting adverse medical events provided early indications that a large crisis was unfolding. The method for analysing the data was based on a statistical test called Regression Discontinuity Design, which helped identify parameters related to medical reporting patterns which significantly changed. The examination indicated nurses' reports were unique in relation to others and indicated three phases: (1) upon declaration of the upcoming pandemic, there was a rise in reporting; (2) when the disease was named, there was moderation and maintenance in a steady quantity of reports, and finally, (3) when the first case arrived in Israel, a slight decrease in reporting began. Nurses' behaviours manifested as changes in reporting patterns. In this process of increase, moderation and decrease, it can be concluded that these are three stages that may characterise the beginning of a large event. The research method presented reinforces the need for forming tools by which significant events such as the COVID-19 pandemic can be identified quickly, and aid in proper planning of resources, optimise staffing and maximise utilization of the health systems.

Flood-Related Multimedia Benchmark Evaluation: Challenges, Results and a Novel GNN Approach.

This paper discusses the importance of detecting breaking events in real time to help emergency response workers, and how social media can be used to process large amounts of data quickly. Most event detection techniques have focused on either images or text, but combining the two can improve performance. The authors present lessons learned from the Flood-related multimedia task in MediaEval2020, provide a dataset for reproducibility, and propose a new multimodal fusion method that uses Graph Neural Networks to combine image, text, and time information. Their method outperforms state-of-the-art approaches and can handle low-sample labelled data.

Implementation of a Multimodal Interdisciplinary Massive Transfusion Protocol Educational Bundle Improves Knowledge and Self-Efficacy.

PURPOSE: Critical events in the operative setting require rapid management to prevent adverse outcomes. This article describes a multimodal educational bundle that was designed and implemented to improve readiness to respond to crises involving significant blood loss. Intended outcomes of this project were to increase knowledge and self-efficacy of anesthesia providers and perioperative staff members related to the use of the massive transfusion protocol (MTP). DESIGN: This is a quality improvement (QI) project. METHODS: A two-part educational bundle consisted of pre-education and low-fidelity simulation (LFS) via computer-based training (CBT) modules followed by hands-on skills sessions. Anesthesia providers, registered nurses, and technicians in the operative suite completed the educational intervention. Knowledge and self-efficacy were measured pre-and-post intervention. FINDINGS: After completing the educational bundle, the aggregated mean score on a knowledge test increased by 5.65%. Self-efficacy related to role-specific responsibilities and confidence regarding the team's ability to carry out the MTP significantly increased for all participants (n = 62). CONCLUSIONS: This project serves as an example of how a multimodal educational bundle can improve knowledge, confidence, and readiness to respond to critical events. This model demonstrates how pre-education and LFS enable crisis management training to be readily accessible for an entire interdisciplinary team.

Analyzing the emotional impact of COVID-19 with Twitter data: Lessons from a B-VAR analysis on Italy.

The novel coronavirus 2019 revolutionized the way of living and the communication of people making social media a popular tool to express concerns and perceptions. Starting from this context we built an original database based on the Twitter users' emotions shown in the early weeks of the pandemic in Italy. Specifically, using a single index we measured the feelings of four groups of stakeholders (journalists, people, doctors, and politicians), in three groups of Italian regions (0,1,2), grouped according to the impact of the COVID-19 crises as defined by the Conte Government Ministerial Decree (8th March 2020). We then applied B-VAR techniques to analyze the sentiment relationships between the groups of stakeholders in every Region Groups. Results show a high influence of doctors at the beginning of the epidemic in the Group that includes most of Italian regions (Group 0), and in Lombardy that has been the region of Italy hit the most by the pandemic (Group 2). Our outcomes suggest that, given the role played by stakeholders and the COVID-19 magnitude, health policy interventions based on communication strategies may be used as best practices to develop regional mitigation plans for the containment and contrast of epidemiological emergencies.

Effect of changing threat conditions on police and military commanders' preferences for urgent and offensive actions: An analysis of decision making at the operational level of war.

A simulation was conducted to examine the decision making of 102 high-ranking police and military commanders (male/female = 88/12, mean years of employment = 22.15) engaged in a simulated hybrid attack on Norway. Four 2 × 3 repeated-measures ANOVA tests were performed, with two groups (police, military) and three phases (peace, war, and post-conflict) as independent variables. The decision tasks of force posture and mission urgency, along with Subject Matter Expert (SME) ratings of decision-making performance, served as dependent variables. By using social cognitive theory as the theoretical framework, the analysis demonstrated within-group effects indicating how the transition from peace to war caused more offensive postures, higher urgency levels, and increased performance in wartime. Between-group differences were also found, illustrating that police commanders had higher levels of urgency than military commanders in general. Regarding force posture, within-group differences were only found in the post-conflict phase, when police commanders returned to pre-war levels, while military commanders showed less offensive postures than in peacetime. No significant between-group differences were found in decision-making performance. The analysis demonstrated new empirical findings about how crisis management is impacted by change and the backgrounds of those in charge. The findings have implications for designing interagency frameworks that improve police-military interoperability in collaborative efforts.

The role of capital structure management in maintaining the financial stability of hotel firms during the pandemic-A global investigation.

Due to the detrimental effects of the Covid-19 pandemic on the hotel sector, pandemic crisis management research has received lots of academic attention, from studies in sales-marketing to human resource management. However, financial management has been largely overlooked in the agenda of pandemic crisis management and hotel resilience. Therefore, this paper aims to address the research gap by exploring the role of capital structure management in maintaining financial stability and resilience capacities of hotel firms during this evolving and unpredictable Covid-19 pandemic. Using a database of 1882 firm-quarter observations of 196 hotel firms in 30 countries from Quarter 3 2018 to Quarter 2 2021, it is found that low debt capital structure mitigates the adverse impact of the pandemic on hotel firms' financial stability during this turbulent time; particularly the negative impacts caused by government restrictions on both domestic and international travel. The benefit of low debt levels is more pronounced for more vulnerable hotels such as small, less diversified, and slow growing hotel firms. Also, hotel firms that have less long-term debt are more financial stable and resilient during pandemic period. Research outcomes suggest that financial management, in particular capital structure policies should be a critical part of hotel resilience building and crisis management strategy for hotel firms.

Examining employees' affective and behavioral responses to internal crisis communication in times of COVID-19.

Communication is an essential component of crisis management strategies in hospitality and tourism. This study aimed to build on the integrated internal crisis communication framework. This study employed qualitative and quantitative data collection methods. Following a preliminary qualitative study, a conceptual model was developed and tested with a total of 806 responses. The results showed that the approach and content of internal crisis communication messages directly affected employees' evaluations of their organizations' crisis management efforts and their psychological safety, both of which further affected their perceived social resilience and turnover intentions. Furthermore, the results of multigroup analyses revealed the different impacts of internal crisis communication on participants who were in full-time positions vs. part-time positions and salaried employees vs. hourly employees. Finally, theoretical and practical implications were provided based on the research findings.

Preference for utilitarian or hedonic value options during a pandemic crisis: The moderation effects of childhood socioeconomic status and sensation-seeking.

This research investigated hospitality consumers' relative preferences for utilitarian or hedonic value under COVID-19 pandemic conditions. A series of four experiments and one secondary data analysis showed that the salience of the infectious disease threat increased consumers' preferences for hospitality options that provide relatively more utilitarian than hedonic value. Additionally, we identified two individual differences (i.e., childhood socioeconomic status (SES) & sensation-seeking) that moderated the effect of the infectious disease threat on the preferred hospitality consumption value. Specifically, the higher the childhood SES, the higher was the preference for the utilitarian value option, and the lower the level of sensation-seeking, the greater was the preference for the utilitarian value option. This research extends our understanding of the influence of the infectious disease threat on preference changes in hospitality decisions.