During the worldwide COVID-19 pandemic, the functionality of institutions many take for granted—such as hospitals, schools, and libraries—is at the forefront of people’s minds. A University of Oregon professor is contributing to that understanding through an analysis he and his coauthors conducted of a potential Ebola outbreak in 2014 at a large hospital facility in Brisbane, Australia.
Lundquist College of Business Professor Emeritus Alan Meyer and his coauthors delve into the issue of how those administering care weigh the value of social inclusion, finite resources, and safety in a new research paper titled "Maintaining Places of Social Inclusion: Ebola and the Emergency Department," which was recently accepted to the top journal Administrative Science Quarterly and was published online Friday, March 20.
In the paper, the authors introduce the concept of “places of social inclusion”—which they describe as “institutions endowed by a society or a community with material resources, meaning, and values at geographic sites where citizens can access services for specific needs—places that are taken-for-granted, essential, and inherently precarious.”
Healthcare is an institution the public assumes will be there for them in their time of need. When it’s not, its absence may be perceived as the beginning of societal breakdown.
“The prospect of an Ebola virus outbreak triggered doctors’ and nurses’ fears for their own safety, and their families’ safety. This disrupted the Emergency Department to the point of near-calamity,” Meyer said, “but the Australian healthcare workers found a way forward by managing their fears and emotions. They delivered ethical care while taking measures for self-protection from the highly communicable disease.”
Ebola, like COVID-19, is not only potentially deadly but initially was not as well understood as other viruses. For some, this lack of understanding sparked panic due to the fear of unknown risks. The research may provide an outline for maintaining effective care in current and future pandemics.
The study, coauthored by April Wright of the University of Queensland, Trish Reay of Alberta School of Business, and Jonathan Staggs of Christian Heritage College, illustrates how two factors—robust information and training, and the moral call doctors and nurses feel to serve those in need—ultimately helped the healthcare workers to override their natural fear response and to provide ethical care.
The researchers, already onsite at the Australian hospital for an ethnography (a detailed account of social practices in delivery of healthcare), worked closely with doctors and nurses to understand how lessons learned about emergency care management during the Ebola outbreak may be applied to the current COVID-19 corona virus pandemic.
During data collection, the World Health Organisation declared an international public health emergency following an outbreak of Ebola in West Africa. With a mortality rate of 70 percent, doctors and nurses on the frontlines were understandably fearful. Yet during this time, essential care for heart attacks, strokes, and other emergencies needed to continue at their usual pace.
“They felt urgency because the public expected and needed them to serve,” Meyer explained. “The emergency workers were able to quell initial fear and respond normally and appropriately to mitigate harm because they felt they had received adequate training and information.”
The authors put forth a process model that caregivers, and others who interact with the public through institutions, may follow during these uncertain times.
"The most important lesson we draw from our study of Ebola leads us to implore citizens, public officials, and healthcare leaders to recognize, facilitate, and celebrate the role of ‘institutional custodians’ during a pandemic," Meyer said. "These doctors and nurses tend the embers, occupy the moral high ground, and model behavior for others. We should expect healthcare teams to experience fear and have doubts. But rest assured that when the dust settles, many doctors and nurses who have deeply identified with their custodianship role will rise to the challenge of preserving that ‘place of social inclusion.’ The rest of us just need to celebrate them and support them. That’s every bit as important as ‘flattening the curve’ with social distancing and travel restrictions."
The doctors who sponsored the research have written a translational piece that’s under expedited review at the Medical Journal of Australia.
—AnneMarie Knepper-Sjoblom ’05, Lundquist College Communications