Table 4 Challenges
Main Challenges | CASE 1 Urban, centralized municipality. Population: 100 000+ High infection pressure | CASE 2 Rural, decentralized municipality. Population: 5000–10 000 Low infection pressure | CASE 3 Rural, centralized municipality. Population: 5000–10 000 Low infection pressure | CASE 4 Urban, centralized municipality. Population: 100 000+ Medium infection pressure |
|---|---|---|---|---|
Shortage of healthcare staff | Healthcare personnel working part-time at several employees. Lack of personnel due to quarantine (infection, symptoms, travel and national lock-down). Employees being home with children due to lock down of non-essential services (school, child day care). | Finding resources to new pandemic related tasks (related to geographical location). Balancing resources and competence when reallocating. High absence rate (quarantine) due to travel restrictions (related to geographical location) | Finding resources to new pandemic related tasks. Limited access to resources due to travel restrictions and recommendations of working in one municipality. Balancing resources and competence when reallocating | Lack of personnel due to quarantine (infection, symptoms, travel and national lock-down) |
Lack of preparedness, infection prevention and control | No practical experience with emergency preparedness and response. Rooms and buildings were not designed in accordance with current infection control measures. Homecare recipients become in need for higher level of care (e.g., nursing home) Lack of infection control equipment | Climatic challenges due to infection control tasks (testing). Long distance between essential healthcare services within the region (e.g., intensive care, PCR-test analysis and transportation). Stressful to handle long term preparedness Home care recipients’ experiences loss of life quality due to lock down of non-essential services. Lack of infection control equipment/date expire on current equipment | Challenging to plan for uncertainty. Unclear roles and responsibility. Challenging to practice user participation. Homecare recipients at nursing home residents became lonely due to lock down of essential services and restrictions due to physical meetings. Lack of understanding due to national infection control measures (low local infection rate). Lack of infection control equipment | Adjusting guidelines, plans and regulations into local context (e.g., the municipality also has a rural part with a healthcare centre). Stressful to handle long term preparedness Homecare recipients experienced loss of health due to lockdown of non-essential services and become in need for higher level of care (e.g., nursing home). Lack of infection control equipment Demanding to handle infection control outbreaks in homecare services. Difficult to split workforce into teams in rural areas |
Information, collaboration, dialogue across units and levels. | No plans for collaboration across units and departments. Lack of common guidelines for public and private sector | Was not heard and lack of understanding from National Health Authorities due to challenges related to geographical location | Was not consulted and invited to dialogue to discuss local challenges by National Health Authorities in an early phase in the pandemic. Challenging to be a part of a large region due to local differences and challenges | Constantly changing national guidelines led to challenges with information flow across levels. Digital platforms not suitable for dialogue in groups |
Remote leadership | Home office and remote leadership. High workload for managers | Lack of knowledge about nursing leadership (managers with other types of education) | Remote leadership made it challenging to interact with employees and colleagues | Managers had high workload. Remote leadership made it difficult to support employees |