Table 4 Subthemes for theme 3, Enablers to resource sufficiency descriptions and quotes, Participant ID_SexAge_Region_InstitutionType

1. Sufficient equipment and supplies

Resources such as ventilators, staff, space and single use resources such as PPE and medication

“… You need the physical supplies that would allow healthcare providers to safely be in the room with somebody who’s got some sort of novel viral pathogen. So, that would be like adequate PPE.” – Participant 9_F42_Atlantic_ Tertiary

“There’s infrastructure, so there’s places to care for these patients if they grow to a volume that’s greater than our current ICU capacity, which is what’s expected. In addition to that there’s ventilators that are required to ventilate the people that [have] the most severe form of the disease.” – Participant 1_M40_Prairies_ Tertiary

“The most publicized one would be the ventilators, but even also things like monitors and IV pumps are the ones that come to mind and even the physical [ICU] beds” – Participant 12_F35_Prairies_ Tertiary

2. Comprehensive planning and communication

Planning and communication in response to optimizing resource supplies including PPE guidelines vary across institutions in messaging, clarity, degree of protection and excessiveness

“I do think that had we been in certain country or certain cities in the state, we’d have been in much bigger trouble. But although at the beginning, yeah, we had nothing. Zippo, zilch. There was nothing learned from SARS in our region. There was no plan. I think that’s it.” – Participant 9_F42_Atlantic_ Tertiary

Initially the recommendations were that we didn’t have to wear masks in the hospital and now it’s changed that everybody has to wear their mask. It changed from enhanced PPE for certain procedures, whereas before it was just regular PPE. So they’ve increased the amount or the level of protection as we’ve gone on from even last week, and I think that’s in response to health care workers demanding that for their own safety” – Participant 4_F49_Central_ Tertiary

“The tubing is heavy and sometimes the connections just come apart. And so in order to protect the health care providers, once you are caring for a patient who has known or suspected COVID, then you need to be in your N95 in that room all the time […] which is tricky because we do have a shortage of appropriate PPE.” – Participant 9_F42_Atlantic_ Tertiary

“for a physician or a nurse who was going in [to the patient room] for maybe just one or two minutes just to check on something briefly with the patient, whether we need to have full PPE on if they’re within a closed circuit, I do question that as opposed to just using the usual precautions for patients who have COVID and are not undergoing an aerosol generating medical procedure. So yeah, I have questioned that.” – Participant 11_F40_Prairies_ Tertiary

3. Adequate human resources

Includes factors that support different health care providers, hospital staff, family members and the communication between the different stakeholders in service of resource sufficiency

“People talk about, the number of ventilators that we have, how many patients we could have to ventilate, and they even talk about beds. It doesn’t really matter if you don’t have the people to manage the patients in those beds.” – Participant 9_F49_Central_ Tertiary

“The most important things are going to be obviously staff, so that’s going to include physicians, nurses, RTs, and then all the allied health care workers that includes the people that clean the rooms, nursing aids, dieticians.” – Participant 2_F40_Prairies_Tertiary

4. Early pandemic preparation

Early preparation on the part of the institution, unit, leadership or individual physicians to prepare for potential surges in patients with COVID-19

“Our ICU has been very proactive in terms of being able to gather different types of PPE that would replace the PPE that we would use in a normal setting. I’ll give an example. The N95 masks were on a very, very severe shortage, almost like a week left of some of the masks that were available. So our ICU plus the hospital ended up buying respirators, which are the N100s. They’re the industrial ones that people use for painting or welding, working with asbestos and stuff like that. So they actually procured somewhere between 50 and 100 masks for all personnel to use in the ICU. We all get our own filters basically. So that was great.” – Participant 13_M36_Central_Community