Lessons from the frontline: Leadership and governance experiences in the COVID-19 pandemic response across the Pacific region

Background Universal access to safe, effective emergency care (EC) during the COVID-19 pandemic has illustrated its centrality to healthcare systems. The 'Leadership and Governance' building block provides policy, accountability and stewardship to health systems, and is essential to determining effectiveness of pandemic response. This study aimed to explore the experience of leadership and governance during the COVID-19 pandemic from frontline clini-cians and stakeholders across the Pacific region. Methods Australian and Pacific researchers collaborated to conduct this large, qualitative research project in three phases between March 2020 and July 2021. Data was gathered from 116 Pacific regional participants through online support forums, in-depth interviews and focus groups. A phenomenological approach shaped inductive and deduc-tive data analysis, within a previously identified Pacific EC systems building block framework. Findings Politics profoundly influenced pandemic response effectiveness, even at the clinical coalface. Experienced clinicians spoke authoritatively to decision-makers; focusing on safety, quality and service duty. Rapid adaptability, past surge event experience, team-focus and systems-thinking enabled EC leadership. Transparent communication, collaboration, mutual respect and trust created unity between frontline clinicians and 'top-level' administrators. Pacific cultural assets of relationship-building and community cohesion strengthened responses. Interpretation Effective governance occurs when political, administrative and clinical actors work collaboratively in relationships characterised by trust, transparency, altruism and evidence. Trained, supported EC leadership will enhance frontline service provision, health security preparedness and future Universal Health Coverage goals. Funding Epidemic Ethics/World Health Organization (WHO), Foreign, Commonwealth and Development Office/ Wellcome Grant 214711/Z/18/Z. Co-funding: Australasian College for Emergency Medicine Foundation, Interna-tional Development Fund Grant. Copyright Crown Copyright (c) 2022 Published by Elsevier Ltd. This is an open access article under the CC BY-NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Automated summary

This study explores the experience of leadership and governance during the COVID-19 pandemic from frontline clinicians and stakeholders in the Pacific region. The findings highlight the profound influence of politics on pandemic response effectiveness, with transparent communication, collaboration, mutual respect, and trust playing key roles in effective governance. The cultural assets of the Pacific region enhance the ability to respond to the pandemic.