Perceptions of postoutbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study

Al Knawy, Bandar Abdulmohsen; Al-Kadri, Hanan M F; Elbarbary, Mahmoud; Arabi, Yaseen; Balkhy, Hanan H; Clark, Alex

Strong consensus existed among participants that the organization's "growing reliance on ED boarding" was a main contributor to the outbreak. While some lamented that this build up was permitted by senior decision-makers to occur over the long-term, others saw the contributing factors as being more upstream. These factors are related to the high trust patients had for the NGHA, the relative lack of primary care services and problems associated with patient flows at the level of the city, communication and teamwork between the city hospitals, and the lack of a national plan that allows hospitals across different sectors to share the burden of the growing patient population. Another leading factor to the outbreak was the "inadequate implementation of IPC guidelines" within the extremely busy ED and the suboptimal recognition of the importance of IPC principles across the organization. empowering HCWs to work collaboratively to address the outbreak, involving staff in outbreak control and stimulating staff resilience and teamwork. The culture was one of "collective leadership practice" (table 1) with leaders being seen to have practiced high levels of availability, visibility, empowerment of middle management and strong links with frontline staff.