Formal and informal hospital emergency management practices: managing for safety and performance amid crisis.

Although formal preparedness for unexpected crises has long been a concern of health care policy and delivery, many hospitals struggled to manage staff and equipment shortages, precarious finances, and supply chain disruptions among other difficulties during the Coronavirus disease pandemic. Our purpose was to analyze how hospitals used formal and informal emergency management practices to maintain safe and high-quality care while responding to crisis. We conducted a qualitative study based on 26 interviews with hospital leaders and emergency managers from 12 US hospitals, purposively sampled to vary along geographic location, urban/rural delineation, size, resource availability, system membership, teaching status, and performance levels among other characteristics. In order to manage staff, space, supplies, and system- related challenges, hospitals engaged formal and informal practices around planning, teaming, and exchanging resources and information. Relying solely only on formal or informal practices proved inadequate, especially when prespecified plans, the incident command structure, and existing contracts and communication platforms failed to support resilient response. We identified emergent capabilities-imaginative planning, recombinant teaming, and transformational exchange-through which hospitals achieved harmonious interplay between the formal and informal practices of emergency management that supported safe care and resilience amid crisis. Managing emergent challenges for and amid crisis calls for health care delivery organizations to engage creative planning processes, enable motivated workers with diverse skill sets to team up, and establish rich inter- and intra-organizational partnerships that support vital exchange.

Analyzing Alternative Behavioral Crisis Response Models in the U.S.

In the U.S., communities often rely on the criminal justice system to respond to, house, and treat individuals with mental health and substance use problems. This has resulted in a crisis response system that relies on police officers to respond to mental and behavioral health crisis due to a lack of options. Unfortunately, these encounters can be dangerous for individuals in need of help. Additionally, this has led to a disproportionate number of individuals with mental illness and substance use disorders being housed in prisons. Alternatives to our current crisis response system already exist in the form of community-based mobile crisis response teams that rely on mental health workers instead of law enforcement. This review examines such programs that have been enacted in multiple cities across the country. Analysis of these alternative crisis response models shows that community-based programs are more effective, efficient, and safer than the current standard that relies on law enforcement. This analysis highlights the need for the establishment of community-based crisis response teams as the national standard.

Engaging communities as partners in health crisis response: a realist-informed scoping review for research and policy.

BACKGROUND: Health is increasingly affected by multiple types of crises. Community engagement is recognised as being a critical element in successful crisis response, and a number of conceptual frameworks and global guideline documents have been produced. However, little is known about the usefulness of such documents and whether they contain sufficient information to guide effective community engagement in crisis response. We undertake a scoping review to examine the usefulness of conceptual literature and official guidelines on community engagement in crisis response using a realist-informed analysis [exploring contexts, mechanisms, and outcomes(CMOs)]. Specifically, we assess the extent to which sufficient detail is provided on specific health crisis contexts, the range of mechanisms (actions) that are developed and employed to engage communities in crisis response and the outcomes achieved. We also consider the extent of analysis of interactions between the mechanisms and contexts which can explain whether successful outcomes are achieved or not. SCOPE AND FINDINGS: We retained 30 documents from a total of 10,780 initially identified. Our analysis found that available evidence on context, mechanism and outcomes on community engagement in crisis response, or some of their elements, was promising, but few documents provided details on all three and even fewer were able to show evidence of the interactions between these categories, thus leaving gaps in understanding how to successfully engage communities in crisis response to secure impactful outcomes. There is evidence that involving community members in all the steps of response increases community resilience and helps to build trust. Consistent communication with the communities in time of crisis is the key for effective responses and helps to improve health indicators by avoiding preventable deaths. CONCLUSIONS: Our analysis confirms the complexity of successful community engagement and the need for strategies that help to deal with this complexity to achieve good health outcomes. Further primary research is needed to answer questions of how and why specific mechanisms, in particular contexts, can lead to positive outcomes, including what works and what does not work and how to measure these processes.

Conflict, COVID-19, and crisis response: shifting from 'pivoting' to preparedness.

This paper assesses the extent to which the COVID-19 (Coronavirus disease 2019) pandemic directed the attention and resources of the international community away from peacebuilding, and the potential impact of this on conflict-affected environments. It draws from a global survey, interviews, and conversations with peacebuilding practitioners, publicly available information on peacebuilding funding, and real-time data on conflict events from the Armed Conflict Location & Event Data Project. The paper argues that resources and attention have 'pivoted' away from peacebuilding to tackle the threat presented by COVID-19, and that this can-but does not always-adversely affect conflict dynamics. It contends that this pivoting belies the interconnectedness of crises, leads to 'forgotten crises' and escalating threats, and exposes deficiencies in peacebuilding funding and, more broadly, preparedness and crisis response. Crises do, however, provide opportunities for reflection and change, including how to address these deficiencies and, in so doing, advance more efficient, effective, and ethical practice.

Mobile Crisis Teams' Implementation in the Context of new Medicaid Funding Opportunities: Results from a National Survey.

This cross-sectional survey study describes characteristics of mobile crisis teams (MCTs) in the United States. Mobile crisis teams (MCTs) are increasingly recognized as essential responders to help those experiencing mental health crises get urgent and appropriate care. Recent enhanced federal funding is designed to promote adoption of MCTs, but little is known about their current structure and function and whether teams meet new Medicaid rules governing their utilization. Survey participants (N = 554) are a convenience sample of MCT representatives recruited through professional organizations, listservs, and individual email contacts from October 2021 - May 2022. Respondents most frequently identified themselves as MCT program director/manager (N = 237, 43%). 63% (N = 246) of respondents reported billing insurance for services provided (including Medicaid), while 25% (N = 98) rely on state or county general funds only. Nearly all respondents (N = 390, 98%) reported including behavioral health clinicians on their teams, and 71% (N = 281) reported operating on a 24/7 basis, both of which are required by Medicaid's enhanced reimbursement. Just over half of respondents (N = 191, 52%) reported being staffed with 11 or more FTE staff members, our estimated number required for adequate 2-person coverage on a 24/7 basis. MCTs are a popular policy initiative to reduce reliance on law enforcement to handle mental health emergencies, and enhanced federal funding is likely to expand their utilization. Federal rule makers have a role in establishing guidelines for best practices in staffing, billing, and outcomes tracking, and can help ensure that stable financing is available to improve stability in service delivery.

Developing a Suicide Crisis Response Team in America: An Islamic Perspective.

Suicide is a critical public health issue in the United States, recognized as the tenth leading cause of death across all age groups (Centers for Disease Control and Prevention, 2020). Despite the Islamic prohibition on suicide, suicidal ideation and suicide mortality persist among Muslim populations. Recent data suggest that U.S. Muslim adults are particularly vulnerable, with a higher attempt history compared to respondents from other faith traditions. While the underlying reasons for this vulnerability are unclear, it is evident that culturally and religiously congruent mental health services can be utilized to steer suicide prevention, intervention, and postvention in Muslim communities across the United States. However, the development of Suicide Response toolkits specific to Muslim populations is currently limited. As a result, Muslim communities lack a detailed framework to appropriately respond in the event of a suicide tragedy. This paper aims to fill this gap in the literature by providing structured guidelines for the formation of a Crisis Response Team (CRT) through an Islamic lens. The CRT comprises of a group of individuals who are strategically positioned to respond to a suicide tragedy. Ideally, the team will include religious leaders, mental health professionals, healthcare providers, social workers, and community leaders. The proposed guidelines are designed to be culturally and religiously congruent and take into account the unique cultural and religious factors that influence Muslim communities' responses to suicide. By equipping key personnel in Muslim communities with the resources to intervene in an emergent situation, provide support to those affected, and mobilize community members to assist in prevention efforts, this model can help save lives and prevent future suicide tragedies in Muslim communities across the United States.

The Development and Implementation of a Custom-Tailored Suicide Response Training for Muslim Communities.

Research indicates that the suicide attempt rate among American Muslims is at least twice the rate of the national US average and follows a different trend of suicide behavior compared to other groups. Religious leaders, such as Imams, are commonly sought out for support, but many lack training in mental health crisis management. The Stanford Muslim Mental Health and Islamic Psychology Lab created the Muslim Community Suicide Response Manual and its accompanying training modules to address this issue. This paper describes the creation, evolution, and future directions of the Suicide Response Training from an Islamic perspective to reduce suicide risk in Muslim communities.

Creating Comprehensive Crisis Response Systems: An Opportunity to Build on The Promise of 988.

The implementation of a national suicide prevention hotline is imminent and will need to be supported by comprehensive crisis systems, which are currently rarely implemented in part due to their cost. In this Commentary paper we identify three core components of a high-functioning, integrated crisis service system. We identified regional crisis call centers, mobile response teams, and crisis receiving and stabilization centers as core components of an integrated crisis service system. We then outline how this approach has been used in Arizona. Building out these systems and sustainable funding models to support these systems is necessary to ensure that 988 implementation lives up to the promise of creating a lifeline to support services for individuals in crisis.

Responding to Acute Mental Health Crises in Black Youth: Is It Safe to Call 911?

Mental health professionals routinely advise the public to call 911 in case of an acute mental health crisis to access emergent care and ensure safety. Although there is no national database collection process, available data shows that individuals experiencing an acute mental health crisis and Black youth are both at a significantly elevated risk of being harmed or killed by law enforcement during any encounter. This brief analytic essay explores whether advising the public to call 911 is truly the best practice recommendation for Black youth in a mental health crisis. An alternative to the traditional law enforcement response is a mobile unarmed crisis response program. The authors describe successful existing programs and advocate for more widespread adoption of such teams, which likely would provide safer, cost-effective, evidence-based alternatives during acute mental health crises.

First responder perceptions of the system of care and people who use drugs: Spanning boundaries.

Addressing the beliefs of first responders about people who use drugs and the system of care with which they interact must be part and parcel to addressing the opioid crisis. Using a boundary spanning framework, we examine how first responders perceive community behavioral health. With qualitative methods, we asked: What are first responders' lived experiences on the frontlines of the opioid crisis? In sum, it is important to consider that there is a critical role that first responders could play in brokering services when they are not themselves behavioral health practitioners but are, importantly, boundary spanners.

Firms' responses to the COVID-19 pandemic.

The COVID-19 pandemic requires firms to adequately respond. In this study, we first explore in our empirical data how firms responded to the COVID-19 crisis and identify five tactical response types, operational, digitalization, financial, supportive, and organizational responses. Furthermore, our findings indicate that responses vary in scope; Some firms act on their own, while others engage in collaborations. Finally, we find that the response angle is different across firms, as some firms leverage potential and others primarily mitigate risk. Second, we follow an event study design to measure the financial implications of these responses. We find that responses to the COVID-19 pandemic generally entail a positive stock market reaction. Financial and digitalization responses, as well as risk mitigation responses, are consistently evaluated positively. We discuss our findings in context of different theoretical lenses, substantiating the emerging literature on the COVID-19 crisis, and the established literature on crisis response management.

A public health crisis in the university: Impact of crisis response strategies on universities' transparency and post-crisis relationships during COVID 19 pandemic.

During the COVID 19 pandemic, one of the most critical tasks of the university was to effectively communicate with students, faculty, and staff members. This study aims to explore perceived universities' crisis response messages during the pandemic and examine the effectiveness of each response strategy on public relations outcomes. A survey with 346 university students in the U.S., results showed how defensive and accommodative response strategies differently affected PR outcomes. Accommodative strategies generated higher OPR and greater perceived transparency efforts among students, while several defensive strategies affected students' negative evaluations on post-crisis OPR and perceived transparency of their universities. Such results revealed valuable insights that make significant contributions to theory and practices in university crisis communication and management, especially when dealing with public health crises that are seen as external locus of control.

Alcohol consumption and closed borders - how COVID-19 restrictions have impacted alcohol sales and consumption in Europe.

BACKGROUND: The closing of bars, restaurants and international borders during the COVID-19 pandemic led to significant changes in alcohol availability. This study provides a first systematic overview of the monthly development of alcohol sales in Europe during the pandemic in order to determine the effect of closed borders on the sales and consumption of alcohol. METHODS: The study covers 72 months from January 2015 to December 2020 in 14 countries from northern, central and western Europe with excise revenue data for beer, spirits, wine separately and summed, converted into litres of pure alcohol per capita 15+ as a proxy for alcohol sales. March-December 2020 is seen as the pandemic period. The analyses consist of (1) descriptive trends of sales before and during the pandemic, (2) assessment of the pandemic impact on sales by time-series analyses and (3) case studies of countries and a region with substantial cross-border inflow or outflow of alcohol. RESULTS: The result shows an overall reduction in alcohol sales with 3.6% during the pandemic. Nevertheless, the results differ based on the level of cross-border purchasing flows pre-pandemic, as countries with high cross-border inflow saw an increase in domestic sales as the pandemic hit. Norway, for example, saw a 23% increase in domestic sales during the pandemic period March-December 2020 compared to the same period in 2019. CONCLUSION: The closing of intra-European borders had a significant redistributing effect on alcohol sales. While noting sales increases, cross-border inflow countries generally saw a decrease in total amount of alcohol consumed per capita as not all cross-border purchases were replaced by domestic sales. This has important policy implications as large volumes of cross-border inflow of alcohol can negatively affect excise revenue as well as public health outcomes. The methodology can be used to further explore the reliance of different purchasing streams in a domestic alcohol market.

Investigating the influence of institutions, politics, organizations, and governance on the COVID-19 response in British Columbia, Canada: a jurisdictional case study protocol.

BACKGROUND: Research on public health responses to COVID-19 globally has largely focused on understanding the virus' epidemiology, identifying interventions to curb transmission, and assessing the impact of interventions on outcomes. Only recently have studies begun to situate their findings within the institutional, political, or organizational contexts of jurisdictions. Within British Columbia (BC), Canada, the COVID-19 response in early 2020 was deemed highly coordinated and effective overall; however, little is understood as to how these upstream factors influenced policy decisions. METHODS: Using a conceptual framework we developed, we are conducting a multidisciplinary jurisdictional case study to explore the influence of institutional (I), political (P), organizational (O), and governance (G) factors on BC's COVID-19 public health response in 2020-2021. A document review (e.g. policy documents, media reports) is being used to (1) characterize relevant institutional and political factors in BC, (2) identify key policy decisions in BC's epidemic progression, (3) create an organizational map of BC's public health system structure, and (4) identify key informants for interviews. Quantitative data (e.g. COVID-19 case, hospitalization, death counts) from publicly accessible sources will be used to construct BC's epidemic curve. Key informant interviews (n = 15-20) will explore governance processes in the COVID-19 response and triangulate data from prior procedures. Qualitative data will be analysed using a hybrid deductive-inductive coding approach and framework analysis. By integrating all of the data streams, our aim is to explore decision-making processes, identify how IPOG factors influenced policy decisions, and underscore implications for decision-making in public health crises in the BC context and elsewhere. Knowledge users within the jurisdiction will be consulted to construct recommendations for future planning and preparedness. DISCUSSION: As the COVID-19 pandemic evolves, governments have initiated retrospective examinations of their policies to identify lessons learned. Our conceptual framework articulates how interrelations between IPOG contextual factors might be applied to such analysis. Through this jurisdictional case study, we aim to contribute findings to strengthen governmental responses and improve preparedness for future health crises. This protocol can be adapted to and applied in other jurisdictions, across subnational jurisdictions, and internationally.

Educational adaptation to clinical training during the COVID-19 pandemic: a process analysis.

BACKGROUND: The COVID-19 pandemic is unprecedented in terms of the extent and rapidity of the disruption forced upon formal clinical education, most notably the extensive transition of clinical skills learning to interactive video-based clinical education. METHODS: In a phenomenologic study, we used thematic analysis to explore the COVID-19 disruption to clinical training and understand processes relating to adaptation in a large academic medical center. We conducted semi-structured interviews with 14 clinical teachers and 16 trainees representing all levels of clinical learning. Interviews occurred within the initial three months of the crisis, and data were analyzed following a thematic analysis coding process. RESULTS: We constructed eight themes synthesizing our participants' perceptions of the immediate unanticipated disruption, noting in the process their alignment with a change management framework. These included: urgency in adapting, with an obvious imperative for change; overcoming inconsistent involvement and support through the formation of self-organized frontline coalitions; attempts to develop strategy and vision via initially reactive but eventually consistent communication; empowering a volunteer army through co-creation and a flattened hierarchy; and efforts to sustain improvement and positive momentum with celebration of trial, error, and growth. The majority of participants found positive outcomes resulting from the tumultuous change process. Moreover, they were now more readily accepting of change, and tolerant of the ambiguous and iterative nature inherent in the education change process. Many anticipated that some innovation would, or would at least deserve to, continue post- crisis. CONCLUSIONS: The COVID-19 pandemic afforded an opportunity to study the content and process of change during an active crisis. In this case of clinical education, our findings provide insight into the ways an academic medical system adapts to unanticipated circumstances. We found alignment with broader organizational change management models and that, compared with crisis management models (and their shorter term focus on resolving such crises), stakeholders self-organized in a reliable manner that carries the potential advantage of preserving such beneficial change.

Physician and executive collaboration on rapid development of pandemic needs response to support physicians and medical staff during the COVID-19 pandemic in an academic medical center: a descriptive review.

Dialogue on physician well-being was concerning even prior to onset of the COVID-19 pandemic, which introduced additional unprecedented strain on healthcare workers compounded by increased personal and family stress. This paper describes our process for a rapid needs assessment and creation of a pandemic resiliency and well-being support infrastructure for physicians and healthcare staff at an academic medical center. In March 2020, executive leadership from our health system and physician group created a Resiliency and Support Steering Committee (RSSC) for rapid development of a pandemic needs response for our healthcare providers. RSSC identified key priorities: psychological care, medical care, basic care, and communication. A brief pandemic-focused needs survey was designed and distributed to healthcare professionals and targeted efforts focused on initiatives prioritized by respondents. A shared drive database allowed initiatives and outcomes to be communicated in real time. A wellness webpage was rapidly built and disseminated. Psychological support initiatives included proactive and reactive support. Providers were offered rapid access scheduling for primary medical care. Vetted resources were shared for regional grab-and-go food, grocery delivery, laundry services, and childcare. Additional resources included personal protective equipment (PPE) supply chain information, PPE guideline updates and training and access to scrubs/scrub laundering. Our pandemic support will fold into ongoing wellness initiatives that will be tailored and intentionally communicated. Multimodal and intentional communication processes will continue with a focus on enhancing bidirectional platform functionality. Cultural awareness of the importance of mitigating distress and supporting well-being will be prioritized through partnership with frontline members and leadership.

Opportunities to improve behavioral health crisis response: Results of a large urban county's community status assessment.

A comprehensive community status assessment of an Ohio urban county's crisis response (CR) system explored the experiences of its behavioral health services' clients and providers to surface themes characterizing the system's responsiveness and identifying opportunities for improvements. Forty-eight focus groups and two online surveys were conducted. Data were analyzed using qualitative content analysis and descriptive statistics. The greatest areas of needed improvement ascertained by this effort are in increased CR system resources, more efficient use of resources, and capacity enhancements in nine areas: the mobile crisis team, CR protocols, psychiatric inpatient and crisis stabilization beds, stabilization admission for eligible persons, stabilization services for in-crisis but admission-ineligible persons, continuity of care, research into child versus adult CR systems, Provider Emergency Support Program, and first responder crisis intervention training. The assessment provides a foundation for the county to identify further opportunities for system scale-up.

[Situational Awareness of Public Response for effective crisis management]. / Lagebild Bevölkerungsverhalten für ein effektives Krisenmanagement.

The Coronavirus pandemic, in which public response was and still is central to damage control, has demonstrated how significant psychological and social science insights are for crisis management. Currently, knowledge of public response is often not incorporated into situational reports and, therefore, cannot be sufficiently considered by crisis management teams.With the intent of supporting change, the project "Situational Awareness of Public Response", conducted by the Division of Psychosocial Crisis Management within the Federal Office of Civil Protection and Disaster Assistance, is currently designing a framework for including public response knowledge in crisis management decision-making. The main focus of this paper is this project. A strategic objective is to integrate public response knowledge more strongly into governmental crisis management. On the basis of evidence-based assessments, the needs and demands of the population can be identified and coping capacities can be better supported by crisis management measures.Several BBK-funded research projects are affiliated to the aforementioned main project, with the objective of strengthening human-centric civil protection. In a test phase, the situational picture of public response was compiled every two weeks on the basis of data and findings from publicly available studies and made available to various stakeholders.

Victim crisis communication strategy on digital media: A study of the COVID-19 pandemic.

The COVID-19 pandemic and the lockdown bore a devastating impact on organizations across the globe. In this crisis, organizations belonged to the victim cluster, with a low crisis responsibility. Nevertheless, organizations needed to strategize their crisis responses and communicate with stakeholders to reduce the threat to reputational capital and manage stakeholder reactions in the pandemic. In this paper, we studied organizational Twitter communication during the COVID-19 crisis through the lens of the situational crisis communication theory (SCCT). We analyzed 325,627 tweets collected from the Twitter pages of 464 organizations belonging to the Fortune 500 list. The Twitter data reflected organizational COVID-19 crisis response strategies and demonstrated organizational use of Twitter for crisis communication. We applied lexicon-based emotion mining to identify and measure emotions, and topic mining to measure crisis response topic scores from this large multi-organization dataset. We performed path analysis to test our research model derived from the SCCT. The analysis showed that instructing and adjusting information can minimize threats to organizational reputation in a victim crisis and manage stakeholder reactions. Positive emotions showed a stronger association with behavioral outcomes. Emotion neutral tweets generated more favorable stakeholder reactions. The paper contributes to the literature on situational crisis communication for a victim crisis. The multi-organization data addresses the sensitive inter-organization dependencies and improves the understanding of crisis communication. It provides practitioners an insight into the effect of the COVID-19 crisis response strategies on stakeholder emotions and behavior.

Religion Protected Mental Health but Constrained Crisis Response During Crucial Early Days of the COVID-19 Pandemic.

This study demonstrates that religion protected mental health but constrained support for crisis response during the crucial early days of the COVID-19 pandemic. Data from a national probability-based sample of the U.S. population show that highly religious individuals and evangelicals suffered less distress in March 2020. They were also less likely to see the coronavirus outbreak as a crisis and less likely to support public health restrictions to limit the spread of the virus. The conservative politicization of religion in the United States can help explain why religious Americans (and evangelicals in particular) experienced less distress and were less likely to back public health efforts to contain the virus. We conclude that religion can be a source of comfort and strength in times of crisis, but-at least in the case of the COVID-19 pandemic-it can also undercut efforts to end the root causes of suffering.