Corporate Strategy Management Assignment

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Questions: 1.1

It is clear from the article that the healthcare industry is somewhat unique, which makes incorporating ideas from other industries complex. Formulate a position that addresses these complexities. Your position must rely on the need for corporate strategy and its benefits. You must present the reasons why corporate strategy is important and demonstrate how these can be used to incorporate ideas from other industries into the healthcare industry. (15)

 

1.1 Why is corporate strategy important?

Corporate strategy defines the destination towards which a business should move. That decision shapes all the strategies and activities in every other part of that business. A firm’s management must consider how to gain a competitive advantage in business areas the firm operates in. Furthermore, it also determines the businesses they should be in in the first place.

Corporate strategy is usually only necessary when a company operates in two or more business areas. If the company is organized as different business units that operate in different business areas (e.g., General Electric, Siemens), then these different business units require different strategies. The managers and leaders of such organisations should ensure that these strategies are consistently aligned with the overall corporate strategy. Hence, most multinational enterprises (MNE’s) or conglomerates usually have corporate strategy departments. Such specialized departments are not so often in small-medium enterprises (SME’s) and start-ups.

The goals set by an organization cannot be carried out unless there are sound financial and organizational plans set in motion. Unfortunately, understanding the healthcare market is tricky when the system is so volatile. The cost of medical technology and other funds necessary to run a functional healthcare business is not steady.

Changes in policy and law occur periodically, increasing the need for strategic planning in healthcare. Without the proper knowledge it is not easy to know where prices are going, and in which areas to save. Evaluating which investments are riskier than others is important to ensure every decision made is one that will be beneficial down the road.

In order for any business, especially a hospital or medical practice, to stay afloat, long term goals must be determined and eventually met for the longevity of the business. To do so, an analysis of the local markets and the industry as a whole must be conducted to predict the future of these markets.

Being able to accurately predict forecasts is imperative when dealing with multi-million-dollar funds. This is not an easy feat if data is not carefully considered, and strategic hospital and health planning has not been conducted thoroughly by those who fully know how to prepare for what is ahead.

The healthcare field is always changing and progressing at a rate unlike any other. Over the past few decades, it has become more and more important to plan for any healthcare practice to be successful for years to come. By planning for the unknown, hospitals, clinics, private practices, and other organizations in the healthcare field can be better equipped for whatever may come along down the road.

Strategic health planning involves creating objectives and setting goals for where a company would like to go in the future, and then constructing a plan to achieve these objectives. In this industry especially, healthcare planning must consider potential government policy changes, technological advancements and economic trends that could change an organization’s operations in a significant way.

The importance of strategic planning in healthcare should not go unnoticed by any hospital or health system looking to succeed not only in the short run, but long term as well.

One key factor that should be the basis to strategic planning in healthcare organizations is the organization of the institution. Understanding the organization of the institution and how this organization is necessary for the entire system to succeed is important in creating an effective plan with specific strategies.

Sometimes re-evaluating who controls which aspects of the business, and the hierarchy that follows, can be beneficial.

Having a sound foundation in which the organization is built upon is important so that communication and ideas can flow freely while implementing strategic healthcare planning. Designing company goals and a path to achieve these objectives allows staff at every level, from administrators to physicians, to have a drive and passion that is extremely important in the medical field.

The benefits of strategic planning in healthcare are numerous mainly because healthcare planning is composed of many components. Like most businesses, hospitals and healthcare institutions are operating at many levels. From patient care to financing, health systems need to plan for the future in more ways than one.

Unlike traditional plans, strategic planning considers what is to come for every sector of the organization, taking into account foreseeable changes for all departments.

The importance of strategic planning in healthcare is also seen when looking at an organization’s productivity. Most institutions believe that they are being as efficient as possible, however, taking a closer look at productivity can provide insight as to where improvements can be made, and more specific plans can be set.

Some of the key areas that a hospital strategic plan can significantly improve include:

• Company Culture
• Goals and Objectives
• Operating Budgeting
• Service Line Decisions
• Risk Management
• Capital Planning
• Cost Accounting
• Long Range Forecasting

 

Question 1.2

 

Apply Kotter’s eight-step model for understanding and managing change when implementing the checklist. Also refer to the article and dynamics that impact implementation of checklists (15)

Kotter’s 8-step change model is a change management model that empowers organizations to tackle organizational change and digital innovation by mobilizing their workers to drive rapid adoption and implementation of a new change initiative. Kotter first introduced his 8-step change management model in 1996 in his book, Leading Change, which was later updated (and published in the book Accelerate, in 2014) to accommodate evolving business requirements and help them speed up the transformation process in an increasingly fast-paced world.

How do you implement change with Kotter’s 8 step change model?

The 8 Steps in Kotter’s Change Model

 

1. 1) Create a Sense of Urgency. …
2. 2) Form a Guiding Coalition. …
3. 3) Create a Strategic Vision. …
4. 4) Initiate Change Communication. …
5. 5) Remove Barriers to Change. …
6. 6) Generate Short-Term Wins. …
7. 7) Make Change a Continuous Process. …
8. 8) Incorporate Changes in the Org Culture.

 

1) Create a Sense of Urgency

 

It’s human nature to maintain the status quo and have some form of resistance to the new change. However, a sense of urgency can often spark the initial motivation to initiate a change implementation process.

It’s crucial to communicate the need, and reason, for any change for employees to see change as a possible solution to an existing problem.

For example, suppose an organization is losing new customers due to a slow response time for inbound sales leads. In this case, reason out with evidence that a new sales CRM such as Salesforce will shorten the sales cycle and help them hit their sales goals easily.

It’s difficult to argue with this reasoning. It provides a solid explanation of why transitioning to Salesforce is an urgent need. Plus, it addresses Kotter’s ‘Head + Heart’ principle by framing the change in a way that highlights the benefits to the sales team.

 

2) Form a Guiding Coalition

 

Driving a change initiative isn’t a one-person job. The ‘Leadership + Management’ change principle stresses that organizational changes need multiple leaders’ opinions, ideas, and support. 

Your guiding coalition comprises people you choose as your support system, including managers and supervisors under effective change leadership. 

Another principle applicable here is ‘Select Few + Diverse Many’ principle. Designated change leaders (select few) delegate tasks to experienced individuals (Diverse Many). Educate them about the reason for the change to feel confident in its need, to ensure that you have support from various functions.  

 

3) Create a Strategic Vision

 

A change initiative is often challenging to understand at the lower hierarchical levels. Start with a change management plan that clearly outlines all project milestones and deliverables. When the vision is only in your head, it’s easy to underestimate how long the initiatives, such as training or data migrations, will take. A documented vision helps you balance various aspects of the change implementation and set more realistic timelines. 

For example, handling customer service in Salesforce will call for additional training. Change leaders acknowledge concerns about activity by assuring their team that they will be supported by self-guided training directly in Salesforce and through weekly one-on-one check-ins with their change leader, showcasing how change appeals to the ‘Head + Heart’ principle. 

 

4) Initiate Change Communication

 

Organizations often focus more on a change’s logistics over properly communicating the change. Change must be understood and supported for it to be successful – without effective change management communication, the change initiative is likely to fail. As a change practitioner, you must:

• Talk often about your vision and change implementation plan
• Address employees’ concerns transparently
• Apply your vision to all operational aspects – from training to performance reviews
• Lead the change by setting an example

 

5) Remove Barriers to Change

 

The top-to-bottom approach of change imposition is often met with employee pushback. To successfully drive the change, you must identify all the factors likely to reduce its chances for success. Whether it’s individuals, organization culture, or limited resources, there will likely be a few barriers to change. Identify these obstacles as early as possible and rely on available resources to break them down without disrupting other business areas.

 

6) Generate Short-Term Wins

 

Implementing change is a long and cumbersome process. To keep your employees motivated throughout their change journey, you must recognize and celebrate short-term wins and achievements. 

Try out innovative reward systems such as rewarding team members with gift cards or extra vacation days. Tools such as  Lattice or Honey allow you to publicly recognize employees for their efforts. These small acts can go a long way in keeping your team on track and motivating new members to adopt the change.

 

7) Make Change a Continuous Process

 

There is a large gap between implementation and complete adoption. A change initiative can easily fail if the people driving the change become complacent due to short-term success or get disheartened due to barriers. Therefore, change leaders must set SMART goals in advance and keep analyzing simultaneously to improve to reap long-term benefits.

 

8) Incorporate Changes in the Org Culture

 

Change initiatives require behavioural change, and for a change to be fully adopted, it must be deeply rooted in an organization’s culture and processes. According to Accelerate, “accelerators 1-7 are all about building new muscles.” The final aspect of Kotter’s 8-step change model is about maintaining those new muscles.

It’s crucial to offer continuous employee training methods until the change is reinforced as a habit. If you abandon your team members too soon, you risk them falling back into old practices and losing all the new muscle memory you fought so hard to build. Success stories keep employees on board with better and continuous process improvements.

Kotter’s Change Management Model Process Checklist

 

1. Introduction

Record checklist details

Overview the changes to be made

Step 1- Create a sense of urgency:

• Plan communication
• Lookout for common errors
• Step 1 meeting
• Request support
• Approval step

Assign a date for the step 1 meeting. This will utilize the dynamic due date feature.  You can then select the members to attend this meeting using the members form field given below.

 

Step 2 – Build a core coalition:

• Build your coalition team
• Look out for common errors
• Step 2 meeting
• Approval: step 2

For this, gather organization leaders and stakeholders and convince them of the need to change. During this meeting be sure to ask them for a commitment to these changes, since you will need a strong core of promoters who can reach every employee in your business.

 

Step 3 – form a strategic vision:

• Summarize your vision of changes
• Look out for common errors
• Approval: step 3

Once you have your strategy, you need to ensure you have the right resources for the effective implementation of this strategy. Use the subtask form field to guide you through the process of checking what resources you have.

 

Step 4 – Get everyone on board:

• Gather feedback
• Lead by example
• Look out for common errors
• Approval: step 4

With the successful completion of stage 4, all your employees should be eager to get started with your changes. Before that, however, take a moment to access what might block the progression of your change to be implemented.

 

Step 5 – Remove barriers and reduce friction:

• Identify the issues
• Limit issues
• Empower a broad base for people to act
• Look out for common errors
• Approval: step 5

Once the issue blockading change has been highlighted, you need to implement strategies to limit the issues as much as possible.

 

Step 6 – Generate short term wins:

• Document short term wins
• Look out for common errors
• Step 6 meeting
• Approval: step 6

During this meeting make sure you communicate the short-term wins from the changes made.

Step 7 – Sustain acceleration:

• Evaluate changes and set new goals
• Look out for common errors
• Approval: step 7

Step 7 is all about sustaining the momentum that was generated from the initial changes made.

 

Step 8 – Set changes in stone:

• Incorporate change in your business processes
• Look out for common errors
• Reflect on the changes made
• Approval: step 8

Your organizational culture plays a big part here, determining what gets done. This includes existing staff and new leaders that are bought in.

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• Leading change  – John Kotter
• Process Street – 8 Critical Change Management Models to Evolve and Survive
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1.3 Includes an examination of change management and the management strategies most suitable to the healthcare industry

Across publications, we often find Kotter’s 8-step model, Lewin ́s 3-step model, or the Soft System Methodology technique, but there is also the Adkar model developed by Prosci Research, or the McKinsey 7S framework.

Although Kotter ́s method is primarily known in the world of business, its core concepts can be applied also to the healthcare area. Small et al. [ 16] state that this approach is suitable for healthcare organizations especially because it offers a solid structure and is easily understandable by employees. Incorporating employee feedback and suggestions into the final concept of change implementation is a great benefit of this approach.

 

Kotter [17] states that the method also allows for an early identification of potential errors, badly designed processes, and subjects not ready for the change. To see how widespread this approach is, one can just look at the high number of case studies focusing on the healthcare sector. Maclean and Vannet [18] applied Kotter’s model to introduce new diagnostic techniques based on imaging technologies and concluded that the approach is a suitable tool for increasing healthcare standards. Dolansky et al. [19] used Kotter ́s model in the context of increasing treatment effectiveness in patients after heart failure. Ellsbury et al. [ 20] successfully applied the approach to increase outcomes for preterm newborns. One of the key activities in healthcare is the communication among various actors during provision of healthcare services. Several authors including Baloh et al. [ 21] or Small et al. [16] have focused their research on this direction (e.g., efficient information sharing between nurses during shift handover).

 

According to W. Edwards Deming, the father of modern quality theory and the science of process management, higher quality outcomes eliminate waste, and value is the best quality result at the lowest necessary cost. In other words, Deming taught that by adopting the appropriate principles of management, organizations can increase quality and simultaneously reduce costs.

The key to Deming’s strategy is to practice continual improvement and think of the manufacturing or business process as a holistic system, not as separate departments. In healthcare, this holistic system is known as team-based care, a collaborative, goal-oriented approach to patient-cantered care with a direct impact on a health system’s bottom line.

 

The following are the 3 most effective healthcare change management models:

 

• The ADKAR Change Management Model. The ADKAR model is one of the two foundational change management models created by Prosci Methodology. …
• The McKinsey 7-S Change Model. …

The Kotter Change Management Model. Managing organizational change is complicated. Leaders must align people to the reason for the change, often working against long-standing habits and beliefs. Organizations are more likely to succeed when they plan change initiatives proactively and engage employees before, during and after the change. Below are the seven ways leaders can effectively manage change in their organizations.

 

1. Put people first

 

Successful change management prioritizes people. People fuel change and sustain its momentum. Change initiatives fail when the people involved don’t understand, believe in or engage in the change.

Leaders make change easier when they engage employees in the change. Leaders accomplish this through proactive change management communication that creates a desire to change across the workforce.

This aligns with the Prosci change methodology, Beehive’s change model of choice. Prosci’s methodology is based on more than 20 years of research, with 45,000 people trained and certified globally, making it a strong option for global businesses.

Change initiatives will fail if people don’t believe in the change and aren’t mobilized by others to act.

 

2. Work with a change management model

 

Leaders are up against company culture, organizational momentum and human psychology when enacting change. To make change happen, they need the right tools to guide them. Change management models help leaders connect business strategy to action, which increases the likelihood of success.

There are a variety of change management models from which to choose (e.g., Prosci’s ADKAR model, Lewin’s Change Management Model, Kotter’s Change Management Model). Each model varies, but all follow similar core tenants of identifying needs and planning for and implementing change. Prosci’s methodology is Beehive’s change management model of choice because it: 1) blends the psychology of individual change with organizational change, 2) is globally backed with more than 20 years of research and 3) clearly addresses the role of communication in change.

 

3. Empower employees through communication

 

Communication is an essential part of effectively managing organizational change. A vision for change is only as powerful as the communication that supports it. Effective change management communication provides clarity for why the change is needed and mobilizes employees with a sense of urgency for the change. Companies fail to drive meaningful change when they fail to communicate.

Change management communication isn’t a one-time transfer of information. It requires commitment, clarity and consistency. It should engage employees through two-way communication methods like surveys, focus groups and informal feedback collection. When leadership involves employees, they feel valued. When employees feel valued, they are more likely to embrace change and participate in making it happen.

Two-way communication also helps leaders identify barriers to change before they become a problem. Proactively identifying barriers can enable the organization to respond to and dissolve issues that create change resistance.

 

4. Activate leadership

 

A recent Prosci survey cited “active and visible executive sponsorship” as the top reason change initiatives succeed. Leadership’s impact on change is well-understood. The problem is that many leaders don’t understand the vital role they play in change. Educate leaders on their roles, and you’ll enable them to advance change successfully.

Leaders:

• are responsible for achieving change goals from start to finish.
• help the organization understand and interpret what the change means for their teams, the organization, and the marketplace.
• ensure those who enable organizational change stay actively involved.
• keep the train on the tracks and are ready to switch directions, choose a new path or create a new approach if necessary.

 

5. Make change compelling and exciting

 

Employees can better understand the rationale behind a change when organizations prioritize purposeful, clear and consistent communication. This targeted communication strategy provides the context to understand the why, what and so what of the change. Effective communication answers the most important question people are thinking: What does this mean to me; how will it impact my work? With a deeper, clearer understanding of the change, employees are much more likely to ask, “How can I help?”

The shift from rote compliance to true engagement and belief is powerful. Strong employee support deters change resistance that could hold the organization back.

 

6. Pay attention to high and low points in momentum

 

There will be both high and low points during change initiatives. Leaders can proactively manage and leverage these points in time. During the high points of change, leaders should celebrate wins to fuel momentum. At the low points, leaders can reset communication strategies to listen to employee input and build trust and support. Being proactive helps leaders manage momentum for the greatest success.

 

7. Don’t ignore resistance

 

Change resistance is poisonous to an organization’s transformation. Resistance is much easier to counter when it’s identified early. Leaders should pay attention to the signs of change resistance, including inaction, procrastination, withholding information and the spread of rumours. Communication is the key to identifying resistance. Create feedback loops with employees, like surveys, feedback channels and input sessions to proactively identify signs of resistance, then take fast action.

Change is the lifeblood of successful, growing organizations, and the heart of change is people. Leaders position themselves and their companies for managing organizational change effectively when they proactively engage employees and ensure communication is clear, consistent, and transparent.

 

Question two (2)

 

Construct an analysis of the most important factors that can impact on the performance of healthcare workers in the workplace during COVID-19 pandemic

 

High Workload

 

Participants indicated that the health sector faces a shortage of medical workers. Moreover, many registered doctors do no practice medicine, resulting in higher workload by the active medical workforce in public as well as in private facilities. In the private facilities, doctors were usually provided with a 1-day break each week. Doctors were working for long shifts in their working days and during holidays via telecommunication.

Apart from enduring tremendous physical pressure, excessive workload also leads to increased mental stress. Medical facilities also have few nurses, who had to work 16–17 h shift per day. Additionally, fear of infection prevented workers from joining their workplace. Healthcare professionals who were younger and working in Dhaka-based hospitals reported of higher workload in this study. This might be due to a higher work assignment for younger people and a greater outbreak of COVID-19 in the capital city.

 

Lack of PPE

 

Participants repeatedly pointed out that PPE supplied by their hospitals were either inadequate or of low-quality. Though the government demanded on the mass media that every hospital has been provided with the required numbers of PPEs, the fact on the ground was different. Especially, study participants in private medical facilities need to buy their own PPEs as they were not sure of the availability in the health facilities.

The PPEs provided by the authority were made of plastic-type material. The shortage of PPE also declined to some extent with time. An additional complaint came from the nurses that they had to face acute shortage of PPEs as doctors were the primary focus here and the need for an adequate supply of PPEs for nurses was relatively ignored.

 

Low Social Acceptance

 

Social stigma was another challenge for the healthcare professionals during the COVID-19 pandemic. The neighbors perceived them as a nuisance and usually avoided communication for fear of infection. In some cases, landlords raised monthly house rents of the medical workers and evicted them from their property if they were tested COVID-positive. Sometimes, their maintenance of social distance became rather cruel, and this disturbed the healthcare professionals. Two of the statements represent this condition:

Parents of healthcare professionals remained concerned about their children working in such a risky environment. They often tried to bargain with them to stay home, but it was merely parental concern, and the participants continued work after pacifying them. Generally, their relatives maintained a social distance and refrained from visiting their houses. But participants considered this as positive to ensure the safety of both their relatives and their family members.

 

Mental Health Problems

 

People working in the medical sector are trained to think and act steadily in any medical emergency. Regardless of that training, participants mentioned that they had to cope with different psychological challenges, including anxiety, depression, insomnia, and fear of sudden death during the COVID-19 pandemic.

Healthcare givers serve in an atmosphere where the fear of infection prevails at its largest. Despite that, participants were more concerned about family members being infected by them rather than themselves being infected, leading to further mental stress.

Witnessing sudden death of colleagues created a feeling of helplessness among the healthcare professionals, leading to many of them to experience insomnia. The lack of appreciation by colleagues also caused psychological pressure. One of the nurses mentioned that doctors do not appreciate them enough.

 

Lack of Incentives

 

All participants were aware that there was no extra-incentive for them despite working extra hours. Some incentives were promised by the government, such as providing treatment cost in case of infection and providing an isolation room to ensure safe inhibition. But none was implemented in the real life. Further, participants strongly believed that these initiatives were not going to be implemented shortly.

While the incentives provided by the authority for the employees in the government facilities were not satisfactory, the condition of the healthcare professionals working in private facilities was even worse. There was no monetary incentive for the healthcare professionals working in private facilities if they got infected or died during their service. The participants were depressed about this discrimination between public and private employees. Moreover, they were also deprived of basic amenities such as break between work shifts or provision of meals raising frustrations.

 

Lack of Coordination and Direction

 

The WHO and government guidelines were changing continuously given the disease is new and previous knowledge is little. Consequently, doctors remained uncertain about the line of treatment. These uncertainties created additional mental stress for medical professionals.

The participants reported that patients were unaware of any safety protocols. COVID-19-positive patients often come to medical facilities to receive standard medical consultation, which put COVID-negative patients as well as the medical workers at-risk. In several cases, doctors and nurses got infected because patients did not reveal that they were COVID-19-infected. A high-level coordination failure was prevalent in the healthcare administrations.

Moreover, healthcare workers were dissatisfied about some discriminatory initiatives taken up by the authority. Participants mentioned the case of the bank sector, where employees worked for only 20 days in April and May. In contrast, healthcare professionals did double or triple shifts, which was frustrating. Besides, they did not have any training regarding how to function correctly in a virus outbreak. It was also perceived that the authority involved more administrators and fewer specialists to tackle down this pandemic.

 

Coping Strategies

 

All of the participants expressed that belief upon God kept them relaxed. Support from family members and colleagues was also an essential coping mechanism. The healthcare professionals maintained regular conversations with colleagues maintaining social distance and tried to be benevolent with each other in their workplace. This supportive environment helped them a great deal in reducing their mental stress. Keeping their sacred oath in mind, they were always more concerned about their patients than their well-being. This concern for the well-being of mass people served as a coping mechanism on its own.

Apart from taking mental support from friends and families, healthcare professionals tried to follow every medical rule and regulation in their ability to keep safe from infection. The study protocol was approved by the Ethical Clearance Committee of Khulna University. Other participants reported meditation as means to increasing mental strength. Overall, participants put faith in a greater force in this crisis and keep reminding themselves that as they were working for the well-being of humanity.

 

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Question three (3)

 

3.1 analyse the external factors that influence the management of healthcare that could have resulted in Africa experience a shortage of ventilators during the Covid-19 pandemic.

 

Ventilators are not the answer in Africa

 

For medical staff in low-resourced settings in Africa, the challenge will be first making a diagnosis of coronavirus disease 2019 (COVID-19) and then knowing how to manage it. There may not be time or resources to transfer all seriously ill patients to central hospitals. By the time patients are presenting at peripheral (district and provincial) hospitals, it is likely that central hospitals are overwhelmed with cases.

Of the patients diagnosed with COVID-19, 15% are estimated to have essential critical care in hospital, whilst 3% – 5% of patients require advanced critical care. Those with advanced respiratory distress who have ended up on ventilators were extremely sick and had a high mortality. The experience of managing critically ill patients with COVID-19 in China and Italy led to media and public speculation on the preparedness of other countries for managing the pandemic by the stock of ventilators each had. Ventilators have become a crucial tool needed to fight the COVID-19 pandemic, despite their cost and scarcity. The shortage of ventilators and intensive care capability in Africa has been a significant limitation in saving critically ill lives for some time. Few provincial or district hospitals in African countries have critical care capability in the public sector.

From the perspective of a district hospital, the preoccupation with ventilators is misplaced. Ventilators alone do not save lives. In addition to the functioning machines and equipment, what is required is the whole package: skilled medical and nursing staff to manage the patients, biomedical staff to manage the necessary equipment, a reliable power supply and oxygen. Ventilators consume vast quantities of oxygen, up to 60 000 L per day per patient. The mortality of patients on ventilators is high, even with the best care available, particularly in older patients and those with co-morbidities. There are considerable opportunity costs in that attention, and resources are focused on the few who benefit from ventilation, at the expense of a larger number of patients who would do well with supportive care and oxygen.

China mobilised thousands of health workers from across the country and thousands of ventilators, a feat that seemed herculean. In Italy, this was achieved by using a regional critical care network of 74 hospitals and intensive care units. In China, Europe and North America, the oxygen demand was high but was achieved, even for patients needing high-flow oxygen of 60 L/min. Hospitals have oxygen tanks, plant or cylinder replacement systems, and regular supplies from oxygen manufacturers, although even these became stressed at peak use.

From an African perspective, these interventions are not feasible. In normal times, peripheral hospitals manage perioperative patients who require short-term support or patients who require stabilisation before transferring to a higher level, usually central or tertiary hospitals. Once central hospitals are overwhelmed with COVID-19 patients, peripheral hospitals will have to develop local coping strategies. The single most important intervention in severely ill COVID-19 patients in African countries is sustaining oxygen supplies, currently a scarce resource in most hospitals. The challenge lies in how to improve oxygen supplies for peripheral hospitals so that patients could be managed closer to their communities rather than being transferred to overwhelmed central hospital critical care units. Focusing on oxygen therapy is more feasible and likely to save more lives.

In high-income countries, clinicians observed that COVID-19 patients developed a silent hypoxia with pneumonitis without shortness of breath, and therefore they did not realise the seriousness of their condition. By the time they presented to hospitals with breathing problems, their oxygen levels were very low, and they were already in a critical condition. An early warning system is needed so that staff members in peripheral hospitals in Africa can start identifying patients suspected of having COVID-19-related hypoxia on oxygen in order to help them avoid serious complications. Oxygen therapy can be escalated from low flow (2 L/min – 5 L/min) via nasal canulae or face mask to high flow (10 L/min – 15 L/min) with a non-rebreathing mask and addition of a reservoir bag. Higher flows (40 L/min – 60 L/min) may not be sustainable where oxygen supplies are limited but are increasingly being used to delay or prevent intubation.

Pulse oximeters are small devices that are clipped to the finger and are especially useful for early detection of hypoxia and abnormal heart rates. Oximeter technology can be made available for every district hospital in Africa, an initiative already in progress through donations made through the Lifebox scheme, facilitated by a global tender issued by the World Federation of Societies of Anaesthesiologists (WFSA) (https://www.lifebox.org/purchase-oximeter). Lifebox pulse oximeters, which are equipped with long-lasting batteries and able to survive severe voltage fluctuations when plugged into electric mains, are relatively inexpensive and suitable for use in under-resourced environments. The Lifebox website houses a decision and triage tool to help clinicians during the COVID-19 pandemic, using oxygen saturation measurements from a pulse oximeter to determine when oxygen support is needed (https://www.lifebox.org/covid-19-decision-tool/).

Another intervention useful in low-resource settings is ‘proning’ or patient positioning manoeuvres (having patients lie on their stomach and sides) which open up the lower and posterior lungs most affected in COVID-19 pneumonia. Studies have shown that oxygenation and positioning improved patients’ breathing and prevented progression of the disease in many cases.

The poor oxygen infrastructure in many African countries needs urgent attention. Few countries manufacture oxygen and rely on importing it. In southern Africa, this would be mainly from South Africa. Oxygen is usually distributed to peripheral hospitals in oxygen cylinders, which is an expensive route. Oxygen concentrators rely on electricity, whose supply is often erratic. Manufacture of essentials like oxygen from scratch is unlikely to be sufficiently established in time to respond to this epidemic, but the conversation around local manufacture has been escalated. There are several examples of small-scale local production of oxygen supplies for hospitals that can be used as models. Assist International has partnered with governments in several African countries to develop access to oxygen (https://assistinternational.org/global-health/access-to-oxygen/). In January 2020, the Kilimanjaro Christian Medical Centre in Tanzania opened up an oxygen plant to supply itself and distribute some for local hospitals nearby. In Kenya, a similar approach has been used by Hewa Tele (https://hewatele.org/) since 2014 to build an oxygen plant next to a regional hospital and then supply to local hospitals nearby. Similar developments have been seen in Ethiopia and Rwanda.

Oxygen concentrators come in portable bedside machines and hospital-sized oxygen plants. They are simple to use but need careful assessment for local suitability. Flow rates are up to 5 L/min – 10 L/min, and the oxygen concentration achieved may vary depending on environmental temperatures, humidity and power fluctuations. Concentrators have been used with reservoir tanks to maintain oxygen supply during short power outages and high demands.

The focus on critical care equipment and its maintenance should also raise discussions about strengthening and extending local qualifications in Biomedical Engineering to enhance the skilled workforce for this field.

In conclusion, COVID-19 has highlighted the deficiencies in critical care management and infrastructure, particularly in provincial and district hospitals. Financial investment in procuring reliable oxygen supplies, oxygen concentrators and oximeters would be far more viable than manufacturing ventilators. Decentralising oxygen production to regional hospitals could lay the basis for critical care infrastructure. This investment would benefit other services for surgery, respiratory illnesses and critical care medicine after the COVID-19 pandemic is gone.

Medical oxygen is the single most important medicine for treating patients with COVID-19. Yet this effective and lifesaving treatment for critically ill patients has been scarce in many health facilities in countries where MSF has been responding to the pandemic. This is not new. MSF has witnessed these structural issues for some time in places where healthcare is under-resourced.

MSF has responded to the COVID-19 pandemic in both high-income and middle- to low-income countries. Whilst some hospitals in the US and Europe have struggled with a shortage of ventilators for critical patients, oxygen in highincome countries is piped to patients’ hospital bedsides, and supply has mostly been able to keep up with demand.

In low and middle-income settings, the lack of medical oxygen and supply shortages during the COVID-19 pandemic have caused patients to face delays in receiving critical assistance. MSF teams have witnessed first-hand the avoidable deaths and complications these delays have led to. Health workers – in desperate attempts to save lives – have had the impossible task of rationing oxygen, leaving them to carry the mental health burden of being unable to provide essential care to all their patients.

More than a year since COVID-19 first swept the globe, attention and hopes are pinned on the roll-out of COVID-19 vaccines. However, the countries most affected by the lack of medical oxygen are also the ones with the least access to vaccines. This is why it is critical to ensure the sufficient supply of medical oxygen for those people who will still become ill.

Governments must not only consider oxygen supply when patients are gasping for air in overflowing hospital beds when cases peak. Long-term solutions are needed to secure supply. But, in the meantime, medical oxygen supplies must be urgently made available to health facilities battling COVID-19, particularly when the virus surges.

This briefing paper describes MSF’s experience of the critical role of medical oxygen in treating COVID-19; the challenges of accessing it, particularly in rural settings, and of ensuring its proper use; and the impact oxygen shortages have on patients and healthcare workers.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of any affiliated agency of the author.

 

Footnotes

 

How to cite this article: Madzimbamuto FD. Ventilators are not the answer in Africa. Afr J Prm Health Care Fam Med. 2020;12(1), a2517. https://doi.org/10.4102/phcfm.v12i1.2517

 

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3.2 formulate a framework that could be used to effectively evaluate the change efforts aimed at global Covid-19 recovery efforts.

ICC has issued a warning that the world’s richest economies risk imposing major costs to the global economy absent of a step-change in their approach to managing the Covid-19 pandemic.

In a statement issued ahead of this week’s meeting of G20 Finance Ministers, ICC Secretary General John W.H. Denton AO said:

“The finance ministers of the world’s richest economies are taking a huge gamble with their domestic economic fortunes if they fail to take concerted action to vaccinate the world. As demand rebounds in many western economies, we’re already seeing damaging supply shortages in many important sectors – stunting growth and fueling a worrying spike in domestic inflation.

“The only way for any government to guarantee a durable economic recovery from the Covid-19 crisis is to invest in a major collaborative effort to vaccinate the world. The business case for the investment needed to do this is crystal clear.”

While G7 leaders last month committed to provide one trillion doses of proven vaccines to emerging economies over the next two years, ICC – the institutional representative of more than 45 million businesses – has cautioned that these commitments still fall short of the major collaborative effort needed to lift the grip of the virus on the global economy.

Mr Denton said:

“A coordinated global action plan is urgently needed to get the virus under control. To mitigate the clear downside risks to the global economy of a prolonged pandemic, G20 finance ministers must deliver something far more credible than the gestures on offer from G7 leaders last month.

“A good place to start this week would be a cast iron commitment to provide up-front financing to support a further scaling of vaccine production capacity and accelerate roll-out across the developing world. The IMF has estimated that US$50 billion is required to do this – a minor investment compared to the potential returns from expeditiously defeating the pandemic.”

The global business institution also called for the G20 to set out a comprehensive action plan to enable emerging markets to recover from the effects of the pandemic – encompassing both short-term liquidity support and longer-term debt relief.

Mr Denton concluded:

“The fiscal position of many emerging market governments remains a first-order concern for global business. It’s vital that the G20 provides its full backing to get a new issuance of Special Drawing Rights completed in August. We remain firmly of the view that this must incorporate a transparent mechanism to enable advanced economies to reallocate their allowances to countries in need: the liquidity on offer to developing nations otherwise risks being nothing more than a drop in the ocean compared to their genuine fiscal needs.

“The issue of sovereign debt may have faded from the headlines in recent months but it would be a mistake for the G20 not to double down on its earlier efforts to avert the risk of a – potentially contagious – emerging market bond crisis. We are deeply concerned about the potential effect of a possible tightening of US monetary policy on the fiscal position of emerging market sovereigns with dollar denominated debt – including a range of middle-income countries that don’t currently qualify for the G20’s debt relief programmes.

“Preemptive action on debt is needed from the world’s largest economies to set the foundations for a durable recovery from the pandemic in the years ahead.”

 

An unprecedented pandemic crisis
The World Health Organization (WHO) declared a Public Health Emergency of International Concern for the 2019 novel coronavirus on 30 January 2020. Since the SARS-CoV-2 virus was first recognized in December of 2019, it has spread across the world. In March 2020, the WHO assessed that the outbreak had become a global pandemic – the first pandemic ever assessed to have been caused by a coronavirus (World Health Organization 2020a). In the first year of the pandemic, the virus has infected more than 70 million people. More than 1.5 million lives lost have been attributed to coronavirus disease 2019 (COVID-19), the disease caused by the SARS-CoV2 virus (World Health Organization 2020i).

The pandemic has become much more than a public health crisis. The pandemic has had severe socioeconomic consequences. In the immediate term, global economic activity has stalled, and has led to the greatest global economic downturn in a century. In the longer-term, the pandemic’s socioeconomic consequences are likely to outlast the pandemic, particularly for the most vulnerable, disadvantaged groups that have suffered disproportionately from the impacts of the pandemic (UNCTAD, 2020). The pandemic threatens to unravel decades of development progress, and to derail global prospects for achieving the Sustainable Development Goals by 2030.

Simultaneously, countries around the world are being forced to confront the challenges of managing compound risks from natural hazards and the COVID-19 pandemic. Since the onset of the pandemic, countries have had to deal with both COVID-19 and natural hazards such as cyclones in India and the Pacific, floods in Japan and Vietnam, heatwaves in the United States and Europe, among many others. Climate-related hazards threaten to exploit many of the same vulnerabilities, amplifying disaster risk and its potential impacts as the public health emergency continues.

An unprecedented crisis will demand an unprecedented recovery
The pandemic and the unprecedented, wide-ranging severity of its consequences will demand an unprecedented recovery. Countries and communities have grappled with the challenges of initiating socioeconomic recovery, as they continue to struggle with containing the spread of the virus and minimizing loss of life in a pandemic with an uncertain end. Even as the prospects of therapies and vaccines against the virus begin to become a reality, they will have to continue to navigate a challenging path toward recovery, while managing health and safety concerns, and the threat of and potential impacts from other hazards. Countries and communities will have to not only prepare to recover and build back better from the pandemic, but also to address compound risks.

Governments and communities must also plan for a longer-term, sustainable recovery. They have a unique opportunity to do so. Unlike sudden-onset disasters, the pandemic crisis will have unfolded over the course of more than a year by the time the threat of the virus has passed. They have an opportunity to invest time and resources in rigorously assessing needs, forming the institutions, policies, and mechanisms needed to finance recovery and to engage all stakeholders in recovery planning. At a global scale, solidarity and collaboration are required to address the exposed systemic risks and underlying vulnerabilities in today’s connected societies.

Priority Four of the Sendai Framework for Disaster Risk Reduction 2015-2030 calls on governments to build back better in recovery from disasters. It represents a global consensus view that recovery presents an opportunity to not only restore what was lost, but to build greater resilience and even to make progress across the development sphere. Importantly, it also presents an opportunity to reduce disaster risk as societies recover, rebuild, and rehabilitate.

There has perhaps never been a more pressing mandate to build back better than from this pandemic crisis. On its way to becoming a global socioeconomic catastrophe, the pandemic has exposed and exploited vulnerabilities and inequalities that have been at the root of much of the virus’ most severe and disproportionate consequences. Preventing future outbreaks from becoming pandemics, and preventing future shocks from causing the scale and scope of damage across the development spectrum, will depend on addressing these root vulnerabilities in recovery. It is not just a moral imperative to do so, it is necessary to ensure the durability of recovery and to build resilience to future global shocks.

8 Guiding Principles for Recovery
The global nature of this pandemic and the severity of its consequences demands that every country plan for recovery and building back better. Every country and community will have had its own experience with this pandemic, and shall have its own unique challenges and enablers for recovery. The heterogeneity of experiences and circumstances defy cookie cutter approaches and demand tailored recovery strategies. However, as in previous disasters, there are broadly applicable disaster recovery tools and guidelines, and a wealth of lessons and evidence from previous disaster recovery experiences that can be adapted and applied by any recovering community to the COVID-19 crisis.

This publication offers a set of guiding, action-oriented principles and practical cases to support each of these recovering communities as they plan and implement recovery from this crisis. The principles focus on key cross-cutting issues for recovery such as building back better and greener, inclusive and people-centred recovery, and preserving development gains, among others. It is derived from this wealth of experience, tools, and guidance for disaster recovery. It follows in the tradition of the International Recovery Platform’s Guidance Notes on Recovery. As such, it offers a roadmap of options to help guide recovery efforts, based on applied disaster recovery experience, and established methods and evidence. It is the third in a series of publications from the International Recovery Platform to support recovery from the pandemic. The first in the series, Applying IRP Disaster Recovery Tools and Guidelines to Pandemic Recovery, offered a compendium of relevant, existing disaster recovery tools that could be immediately mobilized and adapted toward recovery efforts. The second publication in the series, the COVID-19 Recovery Policy Brief, offered readers an introduction to eight guiding principles for recovery, and nine key actions for governments. This publication builds on the COVID-19 Recovery Policy Brief, expanding on the eight guiding principles and bringing previous recovery knowledge, experience, and emerging practices from the COVID-19 crisis to support recovery. It shall be followed by a fourth publication, expanding on the nine key government actions highlighted in the COVID-19 Recovery Policy Brief.

This publication was produced by the International Recovery Platform (IRP), a global partnership working to strengthen knowledge, and share experiences and lessons on building back better in recovery, rehabilitation, and reconstruction. IRP is a joint initiative of United Nations organizations, international financial institutions, national and local governments, and non-governmental organizations engaged in disaster recovery, and seeking to transform disasters into opportunities for sustainable development.

The scramble to both stop the community spread of COVID-19 (coronavirus) and mitigate its economic impacts continues to consume the attention of business leaders. Indeed, the very nature of this pandemic – it being a fluid, continuous emergency vs. a one-time event – demands extreme agility and creativity from executives. Yet as they debate the possibility of employees working from home and impacts on supply chains, they are losing valuable time to plan their recovery. Though businesses are currently in the response phase, it is not too early to start planning for the recovery phase.

Much remains unknown about the coronavirus and its economic impacts. Will transmission of the virus start to wane as flu season ends in the Northern Hemisphere? Will the recovery be a relatively short-term return to business-as-usual, or will the pandemic provoke a global recession? As the situation continues to evolve, and business continuity plans specific to prevention and response are increasingly deployed, it is vital that business leaders divert some attention now to how they will return to full capacity.

In the recent Operational Risk Management survey, conducted by dss⁺, it was discovered that executives are prioritizing immediate crisis management response and failing to prepare for long-term recovery. While 70 percent of business leaders are confident that their business disruption plan will protect them from the immediate effects of a major incident, 25 percent are unsure of its quality and 33 percent admit that there is a possibility that a single point of failure could bring the entire plan crashing down. This tells us that companies are not sufficiently prepared for impacts of the current pandemic.

This lack of preparedness may foretell their demise: according to the United States Federal Emergency Management Agency, more than 40% of businesses never reopen after a disaster, and for those that do, only 29% were still operating after two years.

 

How can your company recover from the coronavirus pandemic?

Take care of your people

 

For any operation, the most important resource is people; therefore, they should be the first priority. During the response phase, companies should establish a robust and frequent communications channel with all employees, one that includes a monitoring mechanism to understand whether the employees or their families have been infected or impacted by the virus. Consider remote or partially remote working environments with a portion of employees working in the office and the rest working from home. Businesses must be sensitive to employees’ families and their safety and health. Be proactive and give frequent advice to families on how to best continue to protect themselves at home and in public to prevent recontamination. Most people get their health news from social media, a place very susceptible to rumor and misinformation. No employee can function properly if they are afraid for their family.

When planning for the Recovery phase, develop protocols that ensure that employees are healthy before returning to the office. And provide a safe, sanitary work environment when they return. All workstations and equipment should be sterilized to ensure that no further transmission is possible.

 

Establish a clear governance system

 

One of the first priorities for recovery planning is to have a clear governance model that prioritizes quick decision-making. This is particularly important for larger, more hierarchical companies with an abundance of processes. An Executive Recovery Committee (ERC) should be established for the corporation, one that cascades responsibility to regional and local organizing committees. Each should be given authority to take decisions at the local level related to personnel and operating assets as needed. Be prepared for a phased recovery. Most likely, it will take time to return to full operations; that means you need to prepare to bring people and operations back up in a reasoned, planned, and structured way. Game out various scenarios and roadblocks to help prepare.

 

Run new risk assessments

 

Given the uncertainty inherent to this pandemic – transmissibility and seasonality, for example – it is critical that companies re-run any risk assessment that they have in place, using three different scenarios:

 

• 1-2 months of circulating virus and a shortterm financial impact to your company
• More than 2 months of viral impact and a global economic slowdown
• A far-reaching pandemic and sustained global recession

 

The risk assessment should first focus on critical business operations—this especially includes people. The human, financial, technological and operational implications within each scenario should be fully understood. For example, within a food company, companies should ensure that full sterilization of all assets take place during the recovery, to proactively manage any concerns about product contamination. And they should be prepared to prove it, thus preempting public doubt or fear.

These are distinct from any impact assessments during the response phase, and thus should be run as a separate exercise.

 

Develop a realistic view of supply chain disruptions and customer implications

 

The pandemic has wreaked havoc on the supply chains of many companies. For example, Hyundai suspended production in South Korea because of a shortage of parts manufactured in China, and that was before the coronavirus hit the country itself. Even Apple, which earns about a quarter of its operating income in China, temporarily closed its stores and assembly plants and faces supply chain problems as 290 of its 800 suppliers are based in China.2 As more companies take measures to contain community spread, supply shortages will become more pronounced and far-reaching. As such, it is critical that companies get a realistic picture of the inputs that they can expect from existing suppliers, and what can be sourced elsewhere in order to deliver according to production targets. Companies may be optimistic in their ability to deliver, so efforts to get a realistic picture will be paramount. Companies do not just face supplier fulfilment problems but the actual transport of goods may be even more heavily impacted.

Concurrently, companies must also provide realistic projections to their customers, and not over-promise. It is natural that companies want to reassure their customers, but over promising breeds distrust. There may be staff shortages, should staff still be under quarantine or recovering from any illness or family matters related to the disease.

 

Review operational risks and asset integrity

 

During any unplanned shutdown, there are risks that are inherent to startup; indeed, process safety incidents are five times more likely to occur during startup than during normal operations.3 To mitigate such risks, a full restart assessment should be done on all critical risks to ensure integrity of all assets and processes before restart. Policies and procedures should be updated and fully documented as well. Some of the assets were likely not maintained according to schedule, so they should be fully checked in accordance with all lockout/tagout procedures, and any maintenance work completed before startup. Control processes that have been digitized should also be tested. Finally, a detailed prestartup safety review should be completed.

 

Use the down time productively

 

As operations slow or come to a halt, there is an opportunity to harness home-bound staff to maximize the preparedness of your operations for the recovery stage. They can update procedures and training; review contractor planning and potentially onboard new contractors for the surge of work during startup; create startup checklists; conduct people planning, and how to staff the scaleup of operations. It is also an ideal time to build skills among the workforce on how to better manage and mitigate operational risk by deploying virtual training or relevant eLearning modules.

 

Focus on external communication

 

If the virus has impacted your company – be it an impacted employee, confirmed transmission in the workplace, an imposed quarantine or even a perception that the company has not done enough – there may be some reputational damage. As such, proactive measures to reassure all customers, stakeholders, community members and the general public should be deployed. External audiences want to know what happened, what mitigation efforts were put in place and how the company can ensure that they will be able to deliver in line with expectations. By showing that the company is “open for business”, it reassures employees, communities and investors, thus contributing to improvement of the wider economic outlook.

 

Conclusion

 

While many companies believe that they are prepared to respond to a business disruption, sufficient time is not placed on recovery. And this is even more prevalent for coronavirus because response blends into recovery. It’s never too early to begin planning for recovery. The actions recommended in this paper should be an extension of response efforts, rather than a new or separate initiative. While it may be the same team executing the work, recovery efforts are distinct from response efforts. During the response phase, the goal is to limit the impact on your people and operations. In the recovery phase, the focus is on resuming critical business functions quickly and minimizing loss of customers. It is critical that companies place ample focus on recovery planning and turn risk into opportunity by being prepared and proactive.