Introduction
Contemporary global society has developed an extensive domain of emergency response measures based on prior experiences, scientific knowledge, and technological development. The amount of tools capable of managing an emergency is expected to help humanity cope with challenges and contingencies. However, as the recently emerged COVID-19 pandemic illustrated, health care systems worldwide do not have adequate measures at hand to meet the requirements of a rapid outbreak of the disease capable of sustaining organizational stability and controlled performance under the pressure of an emergency. The planning for emergency response and crisis management preparedness guidelines require improvements based on the incorporation of resource management, human resources management, and risk factor mitigation.
COVID-19 first cases were detected in the city of Wuhan in China in December 2019 and spread fast across countries and continents due to the mobility of people. Soon, the World Health Organization declared COVID-19 a pandemic, which triggered the implementation of consecutive strict measures on an international level and within governments (Basahel et al., 2021). In Saudi Arabia, the first case was reported at the beginning of March 2020; the disease began spreading rapidly, reaching over 350,000 cases by November of the same year (Al-Mansour et al., 2021). While significant economic burden has been detected worldwide associated with the impact of lockdown on the performance of major businesses and industries, Saudi Arabia’s authorities claimed that the Saudi economy was “capable of absorbing the decline in revenues and of dealing with the budget deficit” (Basahel et al., 2021, p. 387). According to the government’s plan to overcome the challenges of the pandemic, it was intended to control the adversities of the crisis through managing public financing and budget deficit.
However, despite such a high level of preparedness for the emergency at the economic level, the difficulties in managing health care implications and medical system disruptions were insufficiently addressed. Moreover, since the COVID-19 pandemic imposed a significant burden on health care systems globally, which was manifested through the lack of human resources, knowledge, preparedness, medications, facilities, and other resources, all these and other risks must be incorporated in a preparedness plan (Al-Mansour et al., 2021; Rockwell and Gilroy, 2020). Such an array of challenges with thousands of people’s lives at stake necessitates relevant and effective response planning and contingency preparedness.
While the majority of scholarly literature concentrates on the investigation of the outcomes of COVID-19 on many levels and the future implications of the pandemic for Saudi Arabia’s economy and health care, little research is available on the assessment of preparedness of the Saudi health care system to respond effectively to a pandemic. Furthermore, there is an insufficient body of literature on the organizational contribution to readiness. Understanding the core elements of effective response planning within organizations and at the level of a national health care system would allow for identifying weaknesses and strengths for future implementation and emergency response improvements in Saudi Arabia. This literature review is designed to explore, synthesize, and assess available literature on the challenges faced by Saudi Arabia’s health care system within the framework of its response planning and preparedness. The review of scholarly articles is anticipated to contribute to developing effective crisis management practices applicable to organizational performance under emergency circumstances similar to those during COVID-19. The lessons learned from the experience of Saudi Arabia’s health care system during the pandemic will be applicable when planning and preparing for health care emergency response in the future.
Literature Review
The effectiveness of planning to respond to foreseeable risks in any critical or emergency situation predetermines the opportunities for maintaining organizational stability and crisis management success. While the majority of measures are based on prior knowledge, it is evident that the response to unprecedented outcomes and challenges of COVID-19 has been disruptive to the health care systems on a global scale, including Saudi Arabia. Overall, according to Coccia (2020), critical situations like emergencies or crises necessitate critical decision-making. It is the responsibility of organizational management and leadership to prioritize efficient modes of cognition to analyze the problem and apply a solution that mitigates the threats and envisions opportunities (Coccia, 2020). Therefore, crisis management must be an integrative part of organizational strategic planning, especially within the sphere of health care where time constraints and resource scarcity might threaten the lives and safety of people.
Contingency planning has been addressed by many scholars as a way of mitigating probable risks by predicting possible occurrences and planning for their prevention, response, and recovery. Indeed, Belford (2020) differentiates between three types of mitigation approaches, namely disaster recovery, contingency planning, and continuity planning. All of these measures necessitate evaluating risk factors, predicting possible outcomes, and plan proper response steps. However, the implementation of such measures is often ineffective due to incomplete assessment of risks, scarcity of resources, or the occurrence of other unforeseeable events.
Notably, at an organizational level, crisis management and contingency planning are particularly dependent on organizational strategy and leadership approaches. Multiple scholarly articles have been published on the topic of the role of organizational culture and leadership on the success of emergency preparedness and crisis management (Bhaduri, 2019; Bowers et al., 2017; Max, 2021). Bowers et al. (2017) conducted a case study research using a crisis response leadership matrix to validate the key role of a leader in organizational capability to overcome a crisis and transform threats into developmental opportunities.
In particular, the study found that leaders must adhere to leadership styles that envision time as a factor, act according to a plan without unnecessary framing of the situation for publicity, and incorporate emergency readiness into the organizational culture (Bowers et al., 2017). These implications have been tested within the contexts of several case studies and have a significant practical value for other organizations. However, the generalizability of the leadership principles outlined in the article does not comply with the particularities of health care organizations and the complexity of medical crisis management. Nonetheless, the emphasis on the importance of the recognition of time as a decisive factor in effective crisis management has been identified in other research studies. For example, Rodrigues (2021) identified that “the speed of reaction to the speed of spread of the virus has become the decisive criterion for assessing the good or bad management of public and private organizations” (p. 56). Consequently, efficient time use is only possible if proper planning and preparation are in place, which necessitates adequate emergency response planning.
Similarly, the role of organizational culture in crisis management and emergency preparedness has been addressed in a qualitative interview-based study by Max (2021). The scholar based his investigation of emergency response planning effectiveness on the shifting nature of organizations to more publically transparent entities. Indeed, organizations become more socially responsible because they function within a given social environment, which might be used as a beneficial element in crisis management. As stated by Max (2021), “disaster management performance depends on organizational cognition abilities, that is, to adjust and adapt organizational structures to the demands of its social environment” (p. 4). On the other hand, the close connection with the social domain allows for cooperation with volunteers who might be an invaluable help under the circumstances of scarce human resources during an emergency.
When investigating the contingency planning for the COVID-19 pandemic, another group of researchers found that the global community demonstrated utter unpreparedness to the outbreak of COVID-19 regardless of numerous predictions of scientists that a pandemic is likely to occur (Timmis and Brüssow, 2020). As a result of insufficient preparedness and response planning, the World Health Organization evaluated global readiness to withstand the pandemic as low. In particular, in 2011, the World Health Organization made an official statement indicating that the world was “ill-prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public-health emergency” (Timmis and Brüssow, 2020, p. 1). Ultimately, the disruptive influence of the COVID-19 pandemic on global health care systems and the medical infrastructure of Saudi Arabia, in particular, indicates the lack of proper preparedness plans to prevent and mitigate the organizational crisis.
Scholarly research on the issues of organizational crisis management unveils some particularities and important elements that might be applicable to medical organizations’ performance during an infectious disease outbreak. According to Bundy et al. (2017), “an organizational crisis – an event perceived by managers and stakeholders as highly salient, unexpected, and potentially disruptive – can threaten an organization’s goals and have profound implications for its relationships with stakeholders” (p. 1662). Indeed, since health care organizations are particularly responsible for the delivery of competent and timely care to the victims of the pandemic, the flawlessness of planned steps implementation, the feasibility of mitigation measures, and timeliness of crisis management practices play an important role in effective emergency response with minimal losses.
Furthermore, health care crisis management incorporates multiple disciplines that address the multifaceted nature of the organizations involved in care delivery. This particularity of health care contingency planning has been addressed by researchers who assessed the reasons for the rapid disease outbreak and the diminished efficacy of mitigation measures during the COVID-19 pandemic. In particular, Shangguan et al. (2020) argue that crisis management involves “multiple disciplines, including psychology, sociology, political science and management science” with the application of the “analytical methods of systemic approaches and resilience engineering” (p. 2). The authors conducted an analytical study by examining relevant literature and documents and found that the failure to manage the crisis caused by the COVID-19 outbreak was caused by poor information distribution for populations’ preparedness, diminished transparency of government in China, and untimely application of strict measures (Shangguan et al., 2020). Thus, risk awareness and time prioritization are essential for effective health care crisis mitigation.
Similarly, several research studies have been conducted to evaluate the influence of communication initiated by officials with the general public through different media on the crisis management outcomes. Rao et al. (2020) conducted a study using statistical analysis for officials’ Twitter posts to investigate the quality and impact of crisis communication amidst COVID-19. The results of this research showed that the balance between alarming and reassuring messages might provide the general public and organizations with a proper understanding of the situation and adequate response planning. Although this study contributes to the understanding of the importance of communicative means during crisis mitigation, it lacks a proper organization-based perspective that would validate the application of different communication strategies at the institutional level for emergency overcoming.
On the contrary, a study by Wodak (2021) provides valuable insights on crisis communication as an essential element in effective emergency response. In comparison to the study on communication conducted by Rao et al. (2020), Wodak (2021) uses a compelling mixed method of comparative and qualitative discourse-historical analysis. Such a specific methodological approach allowed the researcher to evaluate and compare governmental crisis communication from different countries of the world to identify the most effective measures. Indeed, the scholar identified that the majority of communicative approaches were aimed at encouraging the public to follow the strict measures of social distancing and quarantining (Wodak, 2021). Moreover, an important organizational implication of the study is that the lessons from the past should be incorporated when planning for future crises, where appropriate communication strategies should be well-planned and developed for coordinated and organized mitigation actions. In addition, ‘what’ and ‘how’ elements of crisis communication have been emphasized in research studies to indicate the necessity of clear strategic planning and information exchange during a health care emergency where time and clarity of messages are essential (Marsen, 2020; Sanders et al., 2020).
The analysis of the literature shows that the application of digital tools and technological platforms plays an important role in effective crisis management planning and implementation. As found by the study conducted by Krausz et al. (2020), the development and application of web-based solutions to health care crises is an effective measure of emergency response, especially under the burden of time constraints and scarce resources. In particular, the study was aimed at developing an innovative platform that would assist health care workers with triaging, monitoring, and delivering remote services to patients by means of eHealth methods (Krausz et al., 2020). While this study demonstrates the application of digital instruments during the pandemic, they fail to address the implementation of digital tools at the stage of crisis preparedness.
This gap is filled by the narrative case study conducted by Ardito et al. (2021), who applied technological methods to the improvement of preparedness for a medical breakdown. Specifically, the process of technological exaptation as a way of adopting the methods to crisis management in spheres for which those methods have not been originally developed. In such a manner, a less time-consuming and effective measure to mitigate the adverse outcomes of the COVID-19 pandemic is the usage of technologies developed for other pandemic situations (Ardito et al., 2021). Overall, the use of information technologies and digital tools is essential for adequate emergency response planning.
The vital importance of these elements to crisis management has been proven by a statistical analysis conducted by Vukajlović et al. (2019), who claimed that the means of information exchange within an organization are pivotal. Moreover, the study found that “the quality of crisis management is determined by the crisis management activities, professional staff, informing process, internal and external communication, timely information sharing, information accuracy and knowledge and capabilities of employees and managers to use information” (Vukajlović et al., 2019, p. 49). Thus, a proper contingency plan should incorporate adequate information exchange strategies and digital tools application for a more efficient and successful immediate response to an emergency.
Several studies have emphasized the core elements of adequate health care crisis management procedures. According to Stephens et al. (2020), cooperation and coordination constitute the essence of effective crisis management in health care systems where standard planned procedures are disrupted, and the priority is shifted toward emergency plans. Indeed, effective crisis management plans incorporate adequate resource use control and units’ cooperation and coordination guidelines with proper protocols in place. Another research conducted in the form of a qualitative inductive field study investigated how coordination predetermines health care crisis response effectiveness (Wolbers et al., 2018). The study found that when responding to rapidly changing critical circumstances, crisis managers “coordinated their actions across organizational boundaries by using three interrelated practices: working around procedures, delegating tasks, and demarcating expertise” (Wolbers et al., 2018, p. 1530). Moreover, studies by Medina (2016) and Leta and Chan (2021) investigated the value of the shift from reactive organizational crisis preparedness to a proactive or risk management approach. These studies validate the assumption that proper risk mitigation allows for crisis prevention and more effective overcoming of the emergency aftermath, which is why it should be integrated into organizational culture.
Moreover, as stated by Abbas (2021) and Williams et al. (2017), resilience plays an important role in effective crisis management. Indeed, the resilience of the health care system and human resources embodies the ability of organizations and employees to adjust rapidly to new circumstances and challenges with effective solutions and skillful problem-solving. During COVID-19, multiple organizations worldwide have encountered “a huge number of patients who poured into hospitals at the same time which determined increased workload and physical exhaustion in contrast with the scarce in-formations about the virus itself that brought to make ethically difficult decisions on the rationing of care” (Buselli et al., 2021, p. 1). Given the complexity of burden on both individuals involved in the undertaking of proper response measures and organizations, specially trained crises managers with relevant leadership and emergency management skills should be employed to ensure effective strategic planning, stress minimization, resource management, and employee guidance during a health care crisis (Pallivathukkal, 2021). Thus, in the case like COVID-19 pandemic outbreak, detailed contingency plans and effective preparedness of health care organizations are essential to ensure proper management of the numerous challenges faced by the health care system.
Research shows that Saudi Arabia’s situation during the COVID-19 pandemic has been associated with common globally observed challenges, as well as unique particularities contributing to the difficulty of crisis management. As the study conducted by Baloch et al. (2020) demonstrates, the Middle East countries, including Saudi Arabia, are in a particularly vulnerable position “geographically, economically, politically, culturally and religiously,” which complicates health care emergency response (p. 1247). Indeed, the issues that disrupt contingency planning and adequate level of preparedness involve the region’s frequent wars and military conflicts, common religious gatherings, and compromised imbalanced health care systems (Baloch et al., 2020). In such a manner, the study’s authors recommend “to leverage the communication and cooperation between political leaders, health care authorities, religion scholars and the general public” to ensure adequate crisis management (Baloch et al., 2020, p. 1249). However, it is important to explore and evaluate the preparedness measures that have been implemented throughout the epidemic in Saudi Arabia to identify the strengths and weaknesses in crisis management.
Despite the unique particularities characteristic to Saudi Arabia’s geopolitical, religious, and cultural contexts, the country faced an array of health care challenges similar to those faced by medical organizations and national health care systems globally. Multiple research studies have investigated the scope of problematic issues and the approaches to their resolution in the Saudi Arabian health care context. In particular, Arafa et al. (2021) conducted a cross-sectional study using a Google-based survey to investigate the mental health burden of the pandemic’s challenges on the Saudi health care workers. The results of the study indicated that the majority of surveyed participants who worked as physicians or nurses in COVID-19 hospitals reported depression, anxiety, impaired sleep, and stress due to the increased workload, duration of shifts, and emotional burden related to enhanced responsibility (Arafa et al., 2021). Research implies that the psychological burden on workers should be an integrative part of the effective pandemic management measures at the stage of planning, implementation, and recovery.
Similar findings indicating the burnout and exhaustion of health care professionals involved in the pandemic response in Saudi Arabia have been presented in a descriptive cross-sectional study by Khan et al. (2021), a cross-sectional survey by Al Ammari et al. (2020), and a scoping review by Moitra et al. (2021). The studies emphasized the exposure of first responders to the infectious disease was a significant burden in addition to distress. Indeed, the literature demonstrates that the COVID-19 pandemic-related issues have triggered multiple mental health problems for workers who were exposed to dealing with a multitude of stressful factors with limited capacity and diminished preparedness. Therefore, as argued by Assari and Habibzadeh (2020), a response to COVID-19 is incomplete without proper inclusion of mental health components capable of mitigating burnout, techniques for coping with stress, and relevant individual protection from infections. These studies emphasize the importance of proper psychological training and the development of adequate crisis management systems and algorithms that would maintain health care workers’ effectiveness and safety during the process of overcoming the crisis.
In addition, an extensive body of literature is comprised of case studies investigating the coping strategies and crisis management challenges of particular health care organizations or medical units in Saudi Arabia. Research has been devoted to evaluating the effectiveness of measures and problematic issues in managing scheduled operations under the burden of facilities’ occupation with COVID-19 patients (Alyami et al., 2020). Another study evaluated the blood supply division of the healthcare system in Saudi Arabia within the context of COVID-19 (Yahia, 2020). The researcher emphasized the need for blood transfusions in times of pandemics and the necessity to incorporate the drawbacks of the Saudi health care system experienced in the previous SARS-CoV epidemics into the future pandemic response measures (Yahia, 2020). Despite the specialty-oriented nature of these research studies, their implications might be applicable to the overall COVID-19 crisis management situation since the adaptation of the health care units to the needs of the pandemic demonstrates the importance of organizational flexibility during an emergency.
Conclusion
In summation, as the review of current scholarly literature on the topic of Saudi Arabia’s health care system’s preparedness to crisis management and effective response to a pandemic during the COVID-19 outbreak shows, the majority of literature is devoted to the challenges, both general and specific to particular spheres of medicine. However, limited research has been devoted to the evaluation of the effectiveness of the applied measures. Multiple studies have been detected and examined in relation to their investigation of the role of leadership and organizational culture in the overall crisis management capability. However, there is no available body of studies that would assess the competencies of leaders and workforce in the time of COVID-19 in Saudi Arabia. Communication, technology application, resilience, and coordination have been broadly addressed within the context of either the global community managing crises or particular cases outside Saudi Arabia. Consequently, an insufficient amount of literature is devoted to these elements of emergency preparedness for the Saudi health care system during COVID-19.
Furthermore, the issues of preparedness and planning have not been sufficiently addressed by the scholarly community. Available case studies have investigated industry-specific issues without broader application of contingency planning at a national scale. Moreover, separate elements of crisis management and emergency preparedness have been addressed in the reviewed literature without integrative research investigating a multitude of elements. These elements include communication within organizations and between governments and the public, resilience development, mental health issues resolving, resource management, the use of digital tools and technologies, and others. However, to ensure that the lessons from the past are learned and applied in the future, specific findings on the crisis management planning and emergency preparedness to COVID-19 in Saudi Arabia’s health care system are needed. Therefore, the present study aims to explore Saudi Arabia’s healthcare services regarding its compelling crisis planning and preparation effectiveness when dealing with the COVID-19 pandemic.
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