TABLE 1.
Focus Group Excerpts Regarding 4 Domains: In Situ Practical Experience, System Design, Exposure to Diverse Views on Patient Experience, and Protocols and Checklists
| Factor | Excerpts |
|---|---|
| In situ practical experience | “Under the leadership of our director they made the most amazing plan of how we were going to handle the pandemic. So, I think we had many challenges on the way and that plan had to be revised, but I think it was a brilliant plan.” (South Africa) |
| “As the head of a department I have reflected on whether there were any deficiencies in the early days, from the end of January to March. It is far from a perfect job, with flaws on work force allocation to the patient administration…there cannot be a one‐size‐fits all approach.” (China) | |
| “I think we responded pretty operationally effectively, since we started preparing for it before, the strain was registered in the system database, before the first case of Coronavirus. When we found out that the virus had entered our country, we were already ready for it.” (Belarus) | |
| “I think St. Jude did a really good job and I was very pleased to see that as things evolved, St. Jude changed with those. So, you know, it was the land of the unknown and I think that they responded very well.” (United States) | |
| “I think…many of the hospitals ‐‐ actually tried to emulate the practices in Philippine General Hospital, even our infographics got disseminated to the other hospitals and…even our decisions such as which PPE we choose to recommend for our staff, people are really paying attention.” (Philippines) | |
| System design | “In the beginning most orders came from the health ministry. Next, the centers made key decisions. Then, the hospitals determined, adapted, and implemented the recommendation based on the local statistics. Every department head then implemented these recommendations, and the teams followed suit.” (Belarus) |
| “The hospital administration reported to us and we were communicating it to everyone in charge of their work…. we created a WhatsApp group with the head of the department and all staff, hematology and oncology units, each head of hematology, oncology, or pediatric unit…any decision or any notification is shared via the WhatsApp group. Then it is officially shared in the general departments of the hospitals. Then each department manager shares it to his staff members in his unit.” (Egypt) | |
| “In the oncology department there was always a doctor… in the morning, he would have a small meeting with the staff available on site to see the effect of the pandemic from the data published by the Ministry of Public Health; and then we would talk about the statistics of Saint Damien Hospital, because we also have a bulletin at the hospital on COVID made by [Infection Control leads] that we publish every week, and we would talk about it, we would discuss for 10 minutes and then the message we were getting across; so the nurse educator and the nurse would meet with the parents, the patients, to sensitize them, to educate them.” (Haiti) | |
| “Just now, we discussed how the information is conveyed. We share accurate scientific knowledge and guidelines from official channels or We Media through WeChat groups.” (China) | |
| Exposure to diverse views on the patient's situation | “We decreased our outpatient visitors…we postponed their visits and called them…we made a WhatsApp group on which patients used to get their CBC done at a nearby laboratory…Similarly our blood bank had a mobile blood bank services and they used to visit different places in the city and used to collect the blood at their doorstep…. |
| In terms of our psychosocial services what we did was we started tele‐counseling for the patients…we were able to contact them on‐call and talk to them and their families…one of our services is that we have a school for our oncology patients…what we started was a distance learning program.” (Pakistan) | |
| “It seems it's going to be a long way until they can give this support again, which was a support to caregivers, to propose activities to children, to offer this fresh air, this connection with the healthiest part of the child…all that totally stopped. I think this part, the most playful one that is very particular to pediatric patients, in this case oncology, and all the help to caregivers who have a baby, an older boy but they cannot leave anyone in charge as they did before… this entire part has been seriously affected.” (Spain) | |
| “Before COVID‐19, these waiting homes used to be full because cancer patients who live far away from the hospital would stay there. Since COVID‐19, however, residents living around the waiting homes became hesitant to have patients in those homes. Everything about the hospital, especially Sardjito Hospital, became a source of fear.” (Indonesia) | |
| “We had these wards full to the capacity in that when we talk of distancing, we had no distance in between, since they're more than crowded…Though these days it is improving but still we are still crowded because most of the time hostels are full. We try to work with them, we work with them. When there's space, we find space for those who can go to hostel.” (Uganda) | |
| Protocols and checklists | “We've had charts put around the wards on the use of personal protective equipment by staff. There has been training specifically…and there is a plan and duty rosters at various service provision points for swapping of the outpatients as well as inpatient [staff].” (Zambia) |
| “We had changed our way of working, not everyone comes at the same time, we do shifts where the doctors work four consecutive days after going into quarantine for 10 days. We also made changes with groups and the way people work, we made arrangements for isolation, we only used masks, caps, and we made signs all over the hospital…these are protective measures we must have: checking the temperature before entering the hospital and before leaving each department.” (Haiti) | |
| “I worked for two weeks in the COVID isolation; I was following this protocol. It facilitates the work, it's like a flowchart to make things clear.” (Egypt) | |
| “But now, we already have the flowcharts, more protection equipment, we feel more secure, even though there are still several things to improve.” (Peru) | |
| “I have to say every single thing is an algorithm. So, there's nothing it's left chance. We realized that if you have algorithms in place then it's much easier to import policies and it also makes more sense, it also makes it easier for people to follow the algorithms.” (Philippines) | |
| “There have been a lot of modifications and a lot of algorithms, management pathways and things were like formatted. The good thing was our team was constantly meeting, discussing, improvising, learning, and trying to incorporate the day‐to‐day basis research which was guiding us which way to go.” (Pakistan) |
Abbreviations: CBC, complete blood count; COVID, coronavirus disease; COVID‐19, coronavirus disease 2019; PPE, personal protective equipment.