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The devastating 2014 Ebola outbreak caused human and economic loss, but it also resulted in remarkable improvement in healthcare leadership. The impact is most evident in the affected West African countries of Guinea, Liberia and Sierra Leone. In this chapter, the Ebola experience is used as a framework to explore the essential elements of healthcare leadership, with particular attention to healthcare crises in under-resourced communities. Overall, healthcare leadership presents unique challenges. In common with leaders of other industries, healthcare leaders must inspire others, create a sense of purpose, make difficult decisions and collaborate with a range of people. But, because their focus is on complex systems that aim to improve people's physical and mental well-being, expectations of healthcare leaders are especially high. Their work can be a matter of life or death. For the leader in an under-resourced area, the challenge and expectations are even higher, particularly in the face of new or emerging health threats. The key to effective healthcare leadership is systems thinking which involves looking at the entire system of care as an integrated whole, rather than discrete parts that operate in isolation. Healthcare leaders must understand that health means mobilizing multisectoral knowledge and resources and applying innovative and multiactor approaches to prevent, detect and address health problems. Since the 2014 Ebola crisis, healthcare leaders are increasingly using a systems approach by looking at the culture of health systems, the impact of diseases locally and globally, and the applicability of health interventions in different environments. In the post-Ebola era, steps to strengthen the healthcare system are described which includes the roles of healthcare leaders. These steps include deployment of field epidemiologists and community health agents, community education and fuller use of the One Health Platform, which allows actors from different sectors (human health, animal health and environmental health) to collaborate. Finally, suggestions for healthcare leadership training are offered.

Administering healthcare within developing contexts of Africa presents a myriad of challenges. This includes competing priorities, cultural differences, language barriers, resource limitations, supply chain management disruptions, and an infinite array of ever-changing political, social, environmental, and economic dynamics. However, leadership and more specifically, intentional relationship development grounded in strategic diffusion networks have the potential to mitigate these challenges and maximize the adoption of life-saving technologies, pharmaceuticals, and treatment plans. This chapter provides context for the systemic healthcare challenges facing developing contexts across Africa, utilizes the theoretical frameworks of adaptive leadership and complexity leadership to create a holistic approach to relationship-building within these contexts, and illuminates the strategic influence, agency, and adoption and diffusion strategies that ultimately have the potential to create pathways to promise and save lives within underserved and under-resourced communities.

High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented regulations to target critical components of NH care outcomes. Simultaneously, our delivery system continues to change the role of NHs in patient care. For example, more acute patients are cared for in NHs, and the Center for Medicare and Medicaid Services (CMS) has implemented value payment programs targeting NH settings. As a part of these growing pressures from the broader healthcare delivery system, the culture-change movement has emerged among NHs over the past two decades, prompting NHs to embody more person-centered care as well as promote settings which resemble someone's home, as opposed to institutionalized healthcare settings.

Researchers have linked culture change to high-quality outcomes and the ability to adapt and respond to the ever-changing pressures brought on by changes in our regulatory and delivery system. Making enduring culture change within organizations has long been a challenge and focus in NHs. Despite research suggesting that culture-change initiatives that promote greater resident-centered care are associated with several desirable patient outcomes, their adoption and implementation by NHs are resource intensive, and research has shown that NHs with high percentages of low-income residents are especially challenged to adopt these initiatives.

This chapter takes a novel approach to examine factors that impact the adoption of culture-change initiatives by assessing knowledge management and the role of knowledge management activities in promoting the adoption of innovative care delivery models among under-resourced NHs throughout the United States. Using primary data from a survey of NH administrators, we conducted logistic regression models to assess the relationship between knowledge management and the adoption of a culture-change initiative as well as whether these relationships were moderated by leadership and staffing stability. Our study found that NHs were more likely to adopt a culture-change initiative when they had more robust knowledge management activities. Moreover, knowledge management activities were particularly effective at promoting adoption in NHs that struggle with leadership and nursing staff instability. Our findings support the notion that knowledge management activities can help NHs acquire and mobilize informational resources to support the adoption of care delivery innovations, thus highlighting opportunities to more effectively target efforts to stimulate the adoption and spread of these initiatives.

The largest ever outbreak of Ebola virus disease (EVD), which began in December 2013, profoundly impacted not only the West African countries of Guinea, Sierra Leone, and Liberia, and to a lesser extent Nigeria, but also the rest of the world because some patients needed to be managed in high-resource countries. As of March 29, 2016, there were 28,616 confirmed, probable, and suspected cases of EVD reported in Guinea, Liberia, and Sierra Leone during the outbreak, with 11,310 deaths (case fatality rate of 39.5%). An unprecedented number of healthcare workers and professionals, including physicians, nurses, logistic and administrative personnel, housekeepers, epidemiologists, statisticians, psychologists, sociologists, and ethics experts in many countries, were directly or indirectly involved in the care of EVD patients.

The provision of medical care to critically ill EVD patients would have been challenging in any setting but was especially so in the remote and resource-limited areas where patients were stricken by EVD. Limited health personnel, medical supplies, and equipment, along with inadequate knowledge and skills for minimizing the risks of transmission to healthcare workers, could have led to the de-prioritization of patient care. However, ethical considerations demanded aggressive patient care (intensive care, dialysis, central vascular catheter indwelling, etc.) to produce positive outcomes without increasing the risks to healthcare workers and caregivers.

A major ethical consideration was that healthcare workers have a double obligation: while providing the best medical care to improve EVD patient survival, with symptom relief and palliation as required, they must also protect themselves and minimize further transmission to others, including their colleagues. During the 2014–2015 EVD epidemic, another ethical and clinical problem arose in relation to the management of healthcare workers deployed in Africa who acquired EVD while caring for infected patients. As of June 24, 2015, a total of 65 individuals had been evacuated or repatriated worldwide from the EVD-affected countries, of whom 38 individuals were evacuated or repatriated to Europe. The need for evacuation and repatriation, together with associated ethical issues, is discussed in this chapter.

Bangladesh has an outdated healthcare system that has not changed since its independence in 1971. The aim of this paper is to look into how the Bangladesh healthcare system can be reformed.

This paper is literature‐based and a personal reflection on one country's health system.

Widespread dissatisfaction exists in the population and amongst doctors about healthcare delivery.

Major issues causing healthcare user dissatisfaction are discussed and recommendations for reform are suggested.

The paper provides an independent account of one country's healthcare policy and practice.

The purpose of this paper is to propose and test a healthcare framework of service quality, perceived value, and satisfaction in Ghana. More specifically, this study investigates the role and effect of service quality on patient satisfaction and perceived value in Ghana’s healthcare delivery.

Data were gathered through surveys administered to 113 healthcare patients in Ghana. partial least square-structural equation modeling analysis was used to empirically test the research model.

Results show healthcare quality significantly influences satisfaction and perceived value of healthcare delivery. Additionally, perceived value’s impact on satisfaction and behavioral intention shows that increasing perceived benefits while reducing perceived costs leads to repeat behavior and paves the way for retention strategy for healthcare management.

This study yields a series of limitations in its results and conclusions. These limitations and future research are discussed in Section 7 of the study.

This study contributes to the literature by examining the effects of healthcare service quality on patient satisfaction and perceived value, determining the effect of healthcare service quality on patients’ behavioral intention, and testing the proposed framework in Ghana, a fast growing and economically liberalized emerging country in Sub-Saharan Africa.

The institutional conditions of primary care provision remain understudied in low- and middle-income countries. This study analyzes how primary care doctors cope with medical uncertainty in municipal clinics in urban India. As street-level bureaucrats, the municipal doctors occupy two roles simultaneously: medical professional and state agent. They operate under conditions that characterize health systems in low-resource contexts globally: inadequate state investment, weak regulation and low societal trust. The study investigates how, in these conditions, the doctors respond to clinical risk, specifically related to noncommunicable diseases (NCDs).

The analysis draws on year-long ethnographic fieldwork in Pune (2013–14), a city of three million, including 30 semi-structured interviews with municipal doctors.

Interpreting their municipal mandate to exclude NCDs and reasoning their medical expertise as insufficient to treat NCDs, the doctors routinely referred NCD cases. They expressed concerns about violence from patients, negative media attention and unsupportive municipal authorities should anything go wrong clinically.

The study contextualizes street-level service-delivery in weak institutional conditions. Whereas street-level workers may commonly standardize practices to reduce workload, here the doctors routinized NCD care to avoid the sociopolitical consequences of clinical uncertainty. Modalities of the welfare state and medical care in India – manifest in weak municipal capacity and healthcare regulation – appear to compel restraint in service-delivery. The analysis highlights how norms and social relations may shape primary care provision and quality.