Challenges of primary health care leadership during the COVID-19 pandemic in Sweden: a qualitative study of managers’ experiences

Abstract

Purpose At the outbreak of the COVID-19 pandemic, health care was at the centre of the crisis. New demands made existing organizational practices and services obsolete. Primary health care had a great deal of responsibility for COVID-19-related care. The pandemic demanded effective leadership to manage the new difficulties. This paper aims to explore experiences and perceptions of managers in primary health care in relation to their efforts to manage the COVID-19 crisis in their everyday work. Design/methodology/approach The authors used a qualitative approach based on 14 semi-structured interviews with managers in primary health care from four regions in Sweden. The interviews were conducted during September to December 2020. Data were analysed using conventional qualitative content analysis. Findings Data analysis yielded three categories: lonely in decision-making; stretched to the limit; and proud to have coped. The participants felt lonely in their decision-making, and they were stretched to the limit of their own and the organization’s capacity. The psychosocial working conditions in primary care worsened considerably during the pandemic because demands on leaders increased while their ability to control the work situation decreased. However, they also expressed pride that they and their employees had managed the situation by being flexible and having a common focus. Originality/value Looking ahead and using lessons learnt, and apart from making wise decisions under pressure, an important implication for primary health-care leaders is to not underestimate the power of acknowledging the virtues of humanity and justice during a crisis. Continuing professional education for leaders focusing on crisis leadership could help prepare leaders for future crises.

A qualitative study of leaders’ experiences of handling challenges and changes induced by the COVID-19 pandemic in rural nursing homes and homecare services

“…Previous research on primary healthcare services during COVID-19 support several of the findings identified here. Similar challenges requiring leaders to adapt their ways of working such as insufficient contingency plans and infection control, lack of staffing, changing guidelines and routines and challenges related to information flow were found [17,31,[54][55][56]. Leader strategies to handle these challenges included reallocation of staff, providing support, provide training and distill and distribute information [16,31,55,57].…”

“…Similar challenges requiring leaders to adapt their ways of working such as insufficient contingency plans and infection control, lack of staffing, changing guidelines and routines and challenges related to information flow were found [ 17 , 31 , 54 – 56 ]. Leader strategies to handle these challenges included reallocation of staff, providing support, provide training and distill and distribute information [ 16 , 31 , 55 , 57 ]. Some findings in this study, particularly related to the rural context, has not been found elsewhere.…”

“…Providing support to employees was an important leader task during the pandemic [ 55 , 66 ] and have further, been found to be particularly vital in rural areas, where employees have a smaller network of colleagues to turn to [ 84 ]. Other vital leadership tasks, recognizable from crisis leadership literature and also found in this study, were the importance of organizing, directing and implementing actions, forging cooperation, enabling work- arounds or adaptation, direct and guide and the importance of communication and dissemination of information [ 85 , 86 ].…”

Primary healthcare in the aftermath of the COVID-19 pandemic: a qualitative interview study in Sweden

“…For the current study, we emailed the participants (n=46) from the earlier studies, 7 9 all of whom had approved renewed contact after 2 years, asking them if they would like to participate again. Of the 46 original participants, 29 accepted ( table 1 ).…”

“…The adaptations in PHC during the pandemic have been discussed regarding opinion-based lessons learnt 4 11 12 and in empirical studies based on data from frontline providers or managers in countries such as Brazil, 13 Benin, 14 UK 15 and Sweden. 7 9 Furthermore, multinational studies 16 17 have identified common challenges in PHC, such as managing information flows, and highlighted the differences in the approaches taken by PHC workers when dealing with patients with COVID-19 symptoms. However, the experiences of the pandemic among PHC providers and the impact on PHC operations in different countries may vary considerably depending on cultural and health system differences, emphasising the importance of national studies.…”