A total of 1154 people responded to the survey out of hospital staff strength of 9888 (or 11.7%). The largest proportion of respondents based on demographic characteristics were female (84.3%), Singaporean or Singapore Permanent Resident (88.2%), married (53.6%), and nurses (54.3%). The respondents were mostly staff with no supervisory roles (72.3%), had no direct contact with patients (73.9%), whose primary work location was in inpatient (non-isolation) wards (47.8%), and who were not directly involved in in treating COVID-19 patients (87.2%). The mean age of participants was 37.7 years (SD=11.5).
A large proportion of them obtained their sources of information on hospital management of COVID-19 from SGH senior management updates, guidelines and instructions (77.6%), department emails (62.6%), and their supervisors (62.2%). Only 34.6% of them drew information and updates from social media (hospital Facebook Workplace Group) (Table 1).
Perception of communication strategies
Overall, most of the respondents (close to 80%) responded to the survey questions with an ‘agree’ or ‘strongly agree’. Table 2 summarises the respondents’ responses to the survey questions. Most respondents found the hospital regular updates on the COVID-19 situation to be understandable and actionable (94.1%), and information released by hospital senior management to be accurate, concise and timely, and repeated enough to keep staff safe (92.5%). A large proportion of the respondents reported that the hospital had been clear in explaining the necessary actions they needed to take to keep themselves safe (92.7%). Only 79.4% of the respondents highlighted that SGH had been able to understand their challenges and to address their concerns during the outbreak. Of the respondents, 82.5% of them reported to be sufficiently engaged in preparedness planning, and 84.0% of them stated that platforms such as social media and emails provided useful avenues for sharing of information and feedback.
Sociodemographic characteristics on CERC perceptions
Chi-square test for independence was used to compare the CERC responses with sociodemographic characteristics (Table 3). Findings revealed that supervisory role, patient contact, and involvement in treating COVID-19 patients did not differ by sociodemographic characteristics on CERC. There were no differences between CERC questions 1 and 2 and the sociodemographic characteristics. Significant relationships were found between some of the responses to the CERC survey and sociodemographic characteristics, such as occupation, age, work experience in SGH, primary work location, marital status, and gender. These are discussed as follows.
Nurses, allied health professionals and administrative staff, as a group, endorsed every aspect of hospital CERC questions at a significantly higher percentage than doctors. The magnitude of difference ranges from 14% (94.3% vs. 80.1%) to 27% (86.4% vs. 59.1%). They were more likely to endorse the following statements: (1) the information released by the hospital senior management had been accurate, concise and timely and were repeated enough to keep staff safe (92.9 vs. 72.7%; p=0.002); (2) the hospital had been able to provide explanations of the risks associated to COVID-19 in a simple, concise and direct manner (91.2% vs. 59.1%; p<0.001); (3) they were clear about what the hospital was doing in response to COVID-19 (93.0% vs. 63.6%; p<0.001); (4) the hospital had been clear in explaining the necessary actions they needed to take to stay safe (93.4% vs. 72.7%, p=0.001); (5) constant updates from hospital senior management increased their trust in the credibility of the organization (91.1% vs. 68.2%; p=0.001); (6) platforms, such as emails and social media provided useful avenues for sharing of information and feedback (85.1% vs. 59.1%; p=0.002); and (7) the hospital had been able to understand their challenges and address their concerns during this outbreak (80.1% vs. 59.1%; p=0.03).
There were significant relationships between perceived hospital CERC and respondents’ age. Specifically, older staff (age 40 and above) were more likely to report that hospital crisis communication plans were clear (92.7% vs. 87.8%; p=0.01). Significantly higher percentage of them found the information released by the hospital senior management to be accurate, concise and timely and were repeated enough to keep staff safe (95.1% vs. 91.1%; p=0.02). Older staff were also more likely to report that constant updates from the hospital senior management increased their trust in the credibility of the organization (94.1% vs. 88.7%; p<0.01). A significant proportion of them found the hospital had been able to understand their challenges and address their concerns during the outbreak (83.1% vs. 77.8%; p=0.04)
Married staff were more likely to report that the hospital had been able to understand their challenges and address their concerns during the outbreak (83.7% vs. 75.7%; p=0.001). A significantly higher percentage of them reported that the hospital had been able to provide explanations of the risks associated with the COVID-19 situation in a simple, concise and direct manner (92.7% vs. 87.9%; p=0.007) as compared to non-married staff.
Work experience in SGH
There were significant relationships between perceived hospital CERC and respondents’ years of work experience in the organisation. Specifically, a lower percentage of them with ‘5 and more but less than 10 years of experience’ were more likely to report that crisis communication plans were clear (83.9%; p=0.04). Those with less than one year of work experience were less likely to report that platforms, such as emails and social media were useful avenues for sharing of information and feedback (78.4%; p=0.03).
Interestingly, a substantially lower percentage of staff with ‘5 and more but less than 10 years of experience’ endorsed several aspects of the hospital CERC statements. They were less likely to agree that (1) information released by the hospital senior management had been accurate, concise and timely and repeated enough to keep staff safe (88.1%; p=0.015); (2) the hospital senior management possessed the necessary knowledge and expertise on the situation and had been consistent in the delivery of their message (86.7%, p=0.036); (3) they were sufficiently engaged in the preparedness training (78.0%; p=0.002); (4) the hospital had been clear in explaining the necessary actions they needed to take to stay safe (89.2%; p=0.026); and that (5) constant updates from the hospital senior management increased their trust in the credibility of the organization (87.1%; p=0.03).
Primary work location of staff
Staff who worked in inpatient areas were more likely to agree that their direct supervisor had consistently provided them with accurate, concise and timely information for them to navigate in this disease outbreak (86.9% vs. 82.0%; p=0.028).
Females were more likely to report that platforms such as emails and social media provided useful avenues for sharing of information and feedback (86.2% vs. 76.0; p=0.001).
Five themes emerged from the open-ended question to explore how the hospital could better support them and address their concerns. There was a total of 251 responses. Overall, the findings were generally positive. However, there were communication challenges at local leadership or middle management levels and in executing resource reallocation plans, and on human resource and staff welfare matters and general communication approaches.
Accurate, concise and timely information as enabler (n=72)
Most respondents reported favourably that the hospital had been clear in its instructions and the daily routine instructions were helpful. Many felt that the hospital was reasonably well-prepared and that it had done enough in its communication. For example, a respondent (P132) stated: “Current measures and communication channel are good enough to support and address concerns if any”. Another (P198) highlighted: “SGH is doing a good job. With constant updates and contact with nurses and other healthcare workers to the ground, this boosts the energy to keep us giving our best contribution to our patients”. These results support the quantitative findings, where 92.5% of the respondents indicated that information released by the hospital senior management had been accurate, concise and timely, and were repeated enough to keep them safe.
Local leadership and middle management as barrier (n=18)
Some respondents reported challenges at local leadership or middle management level. They stated that a lack of clear communication from direct supervisors to staff to translate some of the hospital updates to actionable plans created anxiety in them. They were also less adequately engaged and there was low level of empathy from the local leaders and middle management (i.e., direct supervisors, head of departments). Respondent 11 asserted: “Direct supervisors need to be more in touch and show concern for staff”.
Resource reallocation and logistics as barriers (n=33)
Some respondents raised the need for clearer instructions to ensure staff safety, particularly for those involved in patient screening at thermal scanner points. “The schedule for screening is not communicated properly and neither were the details of changes in the screening hours and the change of screening location were discussed”, highlighted respondent 56. They reported that the schedule for screening of patients and visitors at various entrances and exits in the hospital had to be communicated properly. Respondents suggested that as COVID-19 would likely be here for some time, it would be necessary to communicate plans that describe a reasonable mechanism that would not tax existing volunteers, who were hospital staff with other duties. Others reported that meeting mechanisms in the hospital could be improved, and there could be clearer communication on viable, secure and acceptable alternatives on how staff could carry out meetings instead of having face-to-face meetings. “To me, meeting mechanisms should be improved. We need clear instructions in terms of how to organize our meetings to ensure safety of meeting attendees”, stated respondent 61.
Human resource and staff welfare as barrier (n=72)
More than a quarter of the respondents indicated that communication of instructions in terms of human resource policies and staff welfare related to COVID-19 could be improved. For example, respondents perceived communication of ‘no leave taking’ instruction to be unreasonable, lacking empathy and argued that clearer explanations would be necessary. “In the area of manpower management and leave freezes, it could have been made clearer right at the start. Moving forward, it would be good to document and work out a better plan regarding leave and leave freezes when the next emergency happens”, asserted respondent 63. Staff welfare, including for those who were not directly involved in the care of COVID-19 patients should also be looked into, as the overflow effects in terms of roles and duties would mean they were indirectly supporting the hospital in this endeavour. “All healthcare workers play a part in day-to-day operations in hospital regardless of whether patient fronting or not patient fronting. There should be a fair appreciation for all staff”, stated respondent 129. Additionally, they indicated that there would be a need to psychologically support staff to better adhere to social segregation and distancing precautionary measures and this needs to be communicated.
Communication as barrier (n=72)
More than a quarter of the respondents who provided qualitative feedback felt that the hospital could provide clearer instructions, instead of just rules, and to have a go-to-person for any clarification on procedures and protocols related to COVID-19. They reported that an anonymous feedback channel would be useful to improve communication. Some suggested clearer explanations on hospital priorities in terms of balancing the disease outbreak measures and ensuring continuity of service would be necessary. For example, respondent 82 stated: “Senior management needs to communicate better to staff about the hospital’s general strategy for working, what the priorities are, how they envision balancing disease outbreak measures against continuing to provide care and other essential services to patients”. Other respondents reported being overwhelmed by the barrage of information and stated that urgent messages should be sent via secure text messaging application(s), rather than email, which could provide more real-time updates, instructions and directions on the COVID-19 development in the hospital.