Saudi Electronic University Effective Leadership in Healthcare Crisis Management Presentation

Live SessionModule #4
Patient Safety at a Glance: Ch. 5
Teamwork and Communication
HCM520
Quality and Patient Safety
Introduction
►
Leading, recognized cause of medical failure
►
Breakdown in teamwork and communication
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70% of events from ‘95-’03 caused by this breakdown
►
Training lacking for leadership
►
Variation in quality of non-technical skills
►
►
Communication
►
Situational awareness
►
Decision making
►
Teamwork
Effective communication, teamwork essential
►
Promotes culture of openness and safe care
Course Code and Title
Case Study
►
Three lapses in human factors were noted in this case
study, can you identify them? Let’s discuss
Communication
► Two approaches define communication
► Information Engineering
►
Defines communication as ‘linear transmission of messages
through a conduit’
►
Accurate transmission of information
►
Results in the receiver understanding message
►
Noise is main barrier
► Social construction
►
Examines how people work
►
Inter-relationships
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Behaviors in team context
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how this impacts quality of team communication
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Implies communication is social practice
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Efforts to improve only if team improvement is parallel
►
Not just transmitting information, but social process of receiving
information
Teamwork
► Key features of a team…
► Consists of 2 or more individuals
► Each individual has specific role or task
► Interacts/coordinates with other members
► Team makes decisions
► Functions with high workload
► Interdependencies of workflow, collective action, goals
► Part of larger organizational system
► Priority is for teams to be coordinated and cooperative
► Members must engage in tasks and team process
► Interdependent component of performance among multiple
members
► Multilevel process develops as members engage
Characteristics of Effective Teams
► Organizational structure
► Clear purpose
► Appropriate culture
► Team processes
► Specified task
► Coordination
► Distinct roles
► Communication
► Suitable leadership
► Cohesion
► Relevant members
► Decision making
► Adequate resources
► Conflict
► Individual contribution
► Self-knowledge
► Trust
► Commitment
► Flexibility
management
► Social relationships
► Performance
feedback
Tools to Improve
►
►
►
Briefings
►
Crucial to determine how cohesive team is
►
Initiated at start of task
►
Set tone for team interaction
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Ensures care providers have shared mental model
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Can establish predictability, reduce interruptions, prevent
delays, build better working relationships
Debriefings
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Short exchanges at end of task
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Identifies what happened, what was learned, possible
improvements
SBAR
►
Situation, Background, Assessment, Recommendation
►
Structured approach to convey information to colleague
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Regular use reduces number of incidents
Conclusion
►
Quality of clinical skills or discrete clinical interventions
not root cause
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Evidence suggests major cause of avoidable harm…
►
Cumulative impacts of poor communication
►
Sub-optimal teamwork
Health Administration Press
Chapter 6: Physician Profiling and Provider Registries
Chapter Outline
• Physician Profiling
• Provider Registries
• The Physician’s Role in Improving Quality
• Use in Healthcare Organizations
• Examples of Profiles and Report Cards
• Benchmarking
• The Measurement and Implementation Process
• Keys to Success and Challenges
• Physician Profiling and Provider Registries in a Changing Healthcare Landscape
• Study Questions
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Physician Profiling
• Physician profiling is the collection of provider-specific
and practice-level data used to analyze physician practice
patterns, utilization of services, and outcomes of care.
• The goals of physician profiling are to:
• Improve physician performance through accountability and feedback
• Decrease practice variation through adherence to evidence-based standards of
care
• Profile development enables a physician’s treatment
pattern to be assessed.
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Provider Registries
• Provider registry: “An electronic system for uniform
collection of information used to evaluate specified
outcomes for a patient population defined by a
particular disease, condition, or exposure”(McIver
2017)
• List
• Dashboard
• Scorecard
• Table
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The Physician’s Role in Improving Quality
• In a study of healthcare system performance, the US ranked
last, while having by far the highest costs (Commonwealth
Fund 2017).
• Adhere to clinical guidelines and best practices.
• Address unexplained clinical variation in healthcare.
• Physician profiling gives providers the opportunity to make
changes to their practice patterns and to improve patient
outcomes.
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Use in Healthcare Organizations
Value-Based Purchasing
• The provision of healthcare in the US is increasingly
associated with greater emphasis on value.
• Value is the relationship between quality and cost.
• Private insurers are following the government’s lead by
providing financial incentives for high-quality care.
• As stakeholders, large employers will encourage their
employees to select high-quality care providers identified
through profiling of hospitals and providers.
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Examples of Profiles and Report Cards
• Physician Compare is CMS’s profiling of physicians’
performance on certain quality metrics.
• Scorecards are used by payers to look at elements of quality
and cost.
• Financial bonuses or penalties could be applied based on
results.
• Scorecards may be used to compare performance at the
individual provider level or at the practice level.
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Benchmarking
• A concept that uses a standard against which to compare a
physician’s performance on a quality measure.
• Often represented as the “goal” on the scorecard.
• Ideally, the goal has been risk-adjusted.
• When compared to the best of their peers, underperforming
physicians may be more willing to change their practice
patterns.
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The Measurement and Implementation Process
• A quality improvement committee should
• identify the areas most appropriate for profiling and the
areas in which it wants to improve performance;
• identify the techniques it will use to gather and disseminate
data;
• develop an objective and appropriate way to interpret the
results;
• communicate the results in a way that will be most valuable
for physicians; and
• schedule meetings on a monthly or quarterly basis so that
physicians have the opportunity to provide input on how the
profiling system is working.
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Keys to Success
• Work closely with physicians.
• Involve many different specialists.
• Determine a time frame for all physicians to review the
information before the profile becomes an official tool
of the organization.
• Organize multiple educational sessions.
• Provide physicians with incentives.
• Use a profile system that is not threatening.
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Challenges
• No consensus exists as to what constitutes a profile, what
it should measure, and the groups to which the
information should be targeted.
• Different stakeholders have different preferences for what
should be measured.
• Many physicians are skeptical of profiling.
• Profiling may have unintended consequences.
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Physician Profiling and Provider Registries in a
Changing Healthcare Landscape
• Many attempts have been made to constrain the rapid
growth in healthcare spending.
• Increasing emphasis on value has led to the creation of
numerous quality and value-based programs.
• CMS spearheaded PQRS in 2006.
• This was later followed by the Electronic Health Record
Incentive Program and the Value-Modifier.
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Physician Profiling and Provider Registries in a
Changing Healthcare Landscape
• In 2015, the Medicare Access and CHIP Reauthorization
Act (MACRA) became law.
• Established the Quality Payment Program (QPP).
• Value-based purchasing is a key component of MACRA.
• Physician reimbursement will be directly tied to
performance on quality metrics.
• Pay-for-performance programs will remain a focus of
healthcare in the foreseeable future.
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Study Questions
1. What are quality measures?
2. Describe the strengths and weaknesses of the
profiles discussed in this chapter.
3. What challenges might a quality improvement
committee encounter when attempting to measure
physician performance?
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Ethics, Medicine and Public Health 18 (2021) 100705
Available online at
ScienceDirect
www.sciencedirect.com
ORIGINAL ARTICLE
The impact of crisis and disasters risk
management in COVID-19 times: Insights
and lessons learned from Saudi Arabia
R. Jaziri a,b,∗, M.S. Miralam a
a
College of Business, University of Jeddah, Asfan Road 285, P.O. Box: 42801, Jeddah 21551,
Saudi Arabia
b
LAREMFIQ Laboratory, University of Sousse, Tunisia
Received 26 January 2021; accepted 25 June 2021
Available online 16 July 2021
KEYWORDS
COVID-19 pandemic;
Crisis management;
Disaster risk
management;
Disaster risk
reduction;
Saudi Arabia
Summary
Background. — All countries all over the world strive to fight the outbreak of COVID-19 pandemic and their governments are facing unprecedented strains and challenges. Since COVID-19
has engendered socioeconomic recession and the deterioration of health systems, Insights and
lessons from some countries can illustrate various approaches designing their people-centric
health and socioeconomic policies. The kingdom of Saudi Arabia has implemented various
measures and strategies to mitigate the spread of pandemic and to save the lives of people.
Therefore, we investigate the role of the Saudi disaster risk reduction system (DRRS) to fight
the virus outbreak and provide a safe environment for the well-being of its inhabitants.
Methodology. — We use a qualitative case study methodology to document and analyze the
crisis and disasters risk management framework within the hazard management process. The
case study methodology is suitable in investigating a phenomenon in its real-life settings and
contexts. Thus, we outline lessons learned from Saudi disaster risk management experience in
combating COVID-19 pandemic.
Results. — During COVID-19 disaster, we found that the Saudi disaster risk reduction system
(DRRS) is structured into three main levels: strategic, operational and tactical. The strategic level represents the strategic planning division and runs audit and monitoring of overall
decentralized units of crisis management at operational and tactical levels. The findings show
that there are three policy implications: keep vigilance at the public national level, remaining
flexible in a national management structure and good governance at local administration level.
∗ Corresponding author at: College of Business, University of Jeddah, Asfan Road 285, P.O. Box: 42801, Jeddah 21551, Saudi Arabia.
E-mail addresses: rmjaziri@uj.edu.sa (R. Jaziri), mmiralam@uj.edu.sa (M.S. Miralam).
https://doi.org/10.1016/j.jemep.2021.100705
2352-5525/© 2021 Elsevier Masson SAS. All rights reserved.
R. Jaziri and M.S. Miralam
Conclusion. — The application of disaster risk reduction framework in COVID-19 times requires
the use of multi-level strategies to protect vulnerable peoples during the four stages of mitigation (readiness), preparedness, response (implementation) and recovery (post-COVID).
© 2021 Elsevier Masson SAS. All rights reserved.
Introduction
well as from international organizations, literature reviews,
quantitative and qualitative analysis of economic effects.
We have used the case study method to illuminate Saudi
Arabia’s approach to managing disaster risk while fighting
COVID-19 pandemic.
Referring to the hazard approach adopted by KSA, the
case study seems to be suitable to explain contextual socioeconomic disparities. The aim of this case study is to illustrate
the lessons learned from experiences in a particular context
and timeline from which we can concentrate more on the
risks’ nature and the impacts of both disaster risk management and public policies intervention. We also conducted
interviews with principal health policy decision-makers and
experts for more understandings of the phenomenon. Our
main objective is to guarantee via this rigorous methodology
consistent and operating recommendations.
We think that our contribution is interesting as it provides empirical evidence of the public policies taken by
Saudi government to combat risk extenuation of COVID-19
pandemic. The dominant viewpoint states that the government must be able to exert brute force and enforce its will
on the population [2]. Furthermore, as our paper demonstrates, this dominant viewpoint is incomplete, because the
government’s exercise of authority and control is not automatically sufficient to contain transmission of transnational
communicable disease Success in fighting epidemics, as one
would agree, is also based on a concerted collaborative
effort between governmental authorities and inhabitants.
This article is divided on four main parts. The first part
offers background on the historical framework of disasters
in Saudi Arabia. The second part, scrutinize the regulatory
framework and public funds distribution to alleviate disaster
risk in KSA. Third part is dedicated to outline a case study
on the experience of Saudi Arabia in combating COVID-19
pandemic and the socioeconomic effect of the pandemic
on the kingdom. The last part reveals recommendations to
public decision-makers to improve disaster risk management
policies and further insights for future studies.
Given its strategic geographic position at the crossroads of
three continents: Asia, Europe and Africa, Kingdom of Saudi
Arabia (KSA) is lucky enough to be safeguarded from main
natural disasters such as storms, tsunami, seismic and volcanic activities. Nevertheless, this does not imply that the
kingdom is secured from disasters. In 2020, the population of
Saudi Arabia is 34,898,530, based on United Nations data.1
Over the past decade, KSA’s GDP (gross national product) has
grown by about 520 billion USD due to its positive trade balance. Moreover, Saudi Arabia is considered as the heart of
the Arab and Islamic worlds. The Kingdom is honoured as the
land of the two holy mosques and the preferred destination
of all Muslims all over the world for Hajj pilgrimage. The serious deadliest Hajj pilgrimage disaster in history have taken
place in Mina, on 24 September 2015, owing to a ‘‘crush and
stampede’’ caused deaths of 717 pilgrims. Furthermore, KSA
is additionally at risk of both health and natural disasters
such as flooding and epidemics [1].
During his history of 90 years, Saudi Arabia has been vulnerable and subjected to several natural disasters (floods,
epidemic, earthquakes) and man-made crisis (overcrowding,
terrorist attacks). Moreover, the kingdom has experienced a
little number of health disasters such as the Middle East respiratory syndrome coronavirus (MERS-CoV), which appeared
in January 2019 and the novel Coronavirus pandemic (COVID19) emerging in March 2nd 2019. Fortunately, the outbreak
was eventually contained through a series of risk-mitigating
measures introduced by the Saudi government and therefore the responsiveness of all citizens and residents. It is
imperative to illustrate that these risk-mitigating mechanisms, together with the public’s compliance, were quickly
used to deal with the unpredictable conditions especially
when additional epidemiological cases were revealed.
Throughout this article, we present the hazard management system of Saudi Arabia as well as the lessons taken
from the risk management experience of the kingdom with
relevant references to the COVID-19 pandemic. We used a
triangulation technique of different research methodologies
to attain our research objective. To recognize the values
and procedures of Saudi’s disaster response to disaster risk
management, we conduct a retrospective study by collecting data from specific Saudi government departments as
Historical framework of disasters in Saudi
Arabia
Different international instances have adopted the same
definition of disaster. For example the United Nations International Strategy for Disaster Reduction’ (UNISDR) have
defined the concept of disaster as ‘‘a serious disruption
of the functioning of a community or a society causing
1 https://www.worldometers.info/world-population/saudiarabia-population/.
2
Ethics, Medicine and Public Health 18 (2021) 100705
◦ risk transfer,
◦ preparedness;
• during-disaster: it is to guarantee that the wants and
requirements of victims are satisfied to minimize distress.
This stage encompass emergency reaction including salvage, relief and recovery;
• post-disaster: this phase covers resilience and reconstruction. When the disaster is over, it’s about quick retrieval
to avoid the reproduction of vulnerable circumstances.
widespread human, material, economic and environmental
losses which exceed the ability of the affected community/society to cope using its own resource’’ [3].
Since its establishment in 1932, The Kingdom of Saudi
Arabia has undergone a number of health and natural disasters (Table 1). As a result, we describe concisely the
historical background of the disaster risk in Saudi Arabia such
as floods, pandemics and earthquakes.
The Centre for Research on the Epidemiology of Disasters
(CRED) has been founded 35 years ago, to focus on international disaster and to conduct epidemics studies. CRED [4]
have classified a disaster as a catastrophe only if it fulfils the
following circumstances: 10 or more dead victims, 100 persons are affected, invoke a national state of emergency and
an international call for help. Table 1 illustrates an overview
of the disasters experienced in the KSA from 1941 to 2019,
as well as the number of dead victims, affected people and
injuries [1,5].
According to the Emergency Events Database (EM-DAT),
which published historical disaster statistics, Saudi Arabia
has experienced only two epidemic-caused disaster events
[6]. In 2012, Saudi Arabia suffered from the largest Middle
East respiratory syndrome coronavirus (MERS-CoV), which
has affected over 1030 people and caused 453 deaths. In
September 2012, The World Health Organization (WHO) has
reported 1626 confirmed cases of Middle East respiratory
syndrome coronavirus (MERS-CoV) infection from 26 countries causing 586 deaths. Reported cases have essentially
been from Middle East countries and a few number of European and East Asian countries have reported individuals who
had travelled to the Middle East [7].
While, in 2020, COVID-19 pandemic has affected 321,456
inhabitants in Saudi Arabia and killed 4107 victims. The
novel Coronavirus disease has infected more than 34 million people around the world and has caused more than one
million deaths, 21% in USA. Facing the exponential augmentation of COVID-19 victims and the lake of ICU Beds and
ventilators, the pandemic has imposed an ever seen ethical dilemma related to medical triage decision-making [8].
As a result, COVID-19 pandemic was deemed as the most
destructive disaster in Saudi Arabia to date.
The main purposes of DRM comprise firstly the deployment of resilience against disasters. Secondly, is to reduce
damages via the establishment and improvement of sustainability. Thirdly, DRM aims to diminish disaster risks, fight
vulnerabilities and set both an institutional and an organizational context. Finally, DRM outline attributions, duties
and responsibilities of all the stakeholders.
Enemark [9] argued that the International Federation of
Surveyors [10] reported that DRM is a process or a cycle
composed of the seven steps. In relation to disaster management, Chirisa et al. [11] argued the cycle is a sequential
process made up of four steps: mitigation, preparedness,
response and recovery. However, the lessons learnt will
be investigated using four stages from the framework and
guidelines of WHO [12]. These stages are:
• readiness: to ready disaster response systems, for instance, to rise the capability to identify and treat COVID-19
patients and to guarantee that hospitals provides the
required healthcare services;
• preparedness: to prepare a response in order to reduce
the spread of the disaster and to prevent the outbreak of
COVID-19;
• implementation: to evaluate the risk of health disaster
and to implement promptly the required actions;
• post-COVID 19: to decrease the pandemic effect on
healthcare systems and on socioeconomic activities.
Fig. 1 summarizes all the above elements as a continuing loop of activities associated with the previous
circumstances (risk identification, prevention, alertness and
preparedness), through (emergency rescue plan) and postdisaster (recovery, reconstruction and resilience). Moreover,
the reaction conducts to amelioration and resilience of
vulnerable populations and contribute to decrease potential forthcoming risks leading to sustainable development
[5,13].
It shows that both good governance and capacity building are the cornerstone of the implementation of DRM and
of sustainable development [14]. Furthermore, the usage of
early alerting systems providing a real time relevant information is deemed as the basis of the capability and reactivity
to manage natural disasters. Moreover, the implementation of institutional structures and regulatory frameworks
are keystones of establishing political commitment for he
application of disaster risk reduction (DRR) into the administration systems.
Institutional framework of disaster risk
management in Saudi Arabia
Conceptual framework of disaster risk
management (DRM)
Disaster risk management is defined by United Nations
International Strategy for Disaster Reduction [3] as ‘‘The
systematic process of using administrative directives, organizations, and operational skills and capacities to implement
strategies, policies and improved coping capacities in order
to lessen the adverse impacts of hazards and the possibility
of disaster’’.
The DRM includes three stages: pre-disaster, duringdisaster and post-disaster:
• pre-disaster: this phase encompasses four steps:
◦ identification and valuation of the risk,
◦ risk prevention, mitigation and reduction,
The current disaster risk reduction system
(DRRS) in KSA
Disaster risk reduction (DRR) strategy system has progressively becoming among the most crucial topics of the
3
R. Jaziri and M.S. Miralam
Table 1
Major disasters in KSA from 1964—2019.
Year/disaster
Nature of disaster
Number of
affected persons
Number of dead
victims
1964/Flash flood
1975/Fire during Hajj
1979/Occupation of Mosque
in Makkah
1985/Floods in Northwest of
Kingdom
1990/Pilgrims Stampede
inside tunnel
1994/Pilgrims Stampede
inside tunnel
1997/Yanbu and Asir floods
1997/Fire during Hajj (Mina)
2000/Rift Valley fever
epidemic
2002/Makkah floods
2005/Medina floods
2009/Jeddah floods
2011/Jeddah floods
2012/Middle East respiratory
syndrome coronavirus
(MERS-CoV)
2012/Riyadh truck crash
2013/Floods
2019/COVID-19 pandemic
Natural
Human
Human/terrorist attack
1000
N.A.
600
20
200
250
Natural
5000
32
Human
N.A.
1426
Human
N.A.
270
Natural
Human
Natural
N.A.
1555
1700
26
343
179
Natural
Natural
Natural
Naturel
Natural
N.A.
43
11,640
5000
1030
31
29
163
10
453
Human
Natural
Natural
135
—
334,605
26
25
4768
KSA: Kingdom of Saudi Arabia. NA: not available. Source: authors’ elaboration based on data from United Nations Office for Disaster
Risk Reduction (https://www.undrr.org/).
United Nations conference on Sustainable Development 2012
(Rio+20) which took place in Rio de Janeiro, Brazil from
20 to 22 June 2012 [15]. Being aware of the importance
and repercussion of this issue, the kingdom of Saudi Arabia has made of DRR one of its priorities. The government
of the kingdom has always showed a strong political willingness to implement both the Hyogo Framework in 2015
and the Arab Strategy for Disaster Risk Reduction 2020
[15,16]. Furthermore, under the patronage the Council of
Arab Ministers Responsible for the Environment (CAMRE),
the Socioeconomic Council of the League of Arab States have
approved the strategy of DRR deployment in 2011. Moreover,
the Gulf Cooperation Council (GCC) adopts an anticipatory
mechanism in order to enhance and implement a Disaster Risk Reduction System (DRRS) (Table 5). Consequently,
the secretary-general of the GCC called for a sustainable
regional engagement in DRR by diminishing vulnerability and
reinforcing recovery and resilience to disasters of all GCC
members. As a result, it is legitimate to ask the following
question: How the government of Saudi Arabia have faced
and managed the COVID-19 pandemic hazards. Even though
disaster risk reduction is vital and essential to realize sustainability in the kingdom, there is necessity to elucidate
the concept of DRR and assess the level of readiness of the
kingdom to fight COVID-19 pandemic and to enable good
reactivity management of future disasters.
The disaster risk reduction (DRR) is defined by [3] as
‘‘The concept and practice of reducing disaster risks through
systematic efforts to analyze and manage the causal factors
of disasters, including through reduced exposure to hazards, lessened vulnerability of people and property, wise
management of land and the environment, and improved
preparedness for adverse events’’. This definition of DRR
leads to divisive debate as the concept of disaster has
been widely controversial and the phenomenon has not
been adopted in the same way by researchers. In other
word, the definition has technically used the same term
‘disaster’ to define disaster’. However, empirical studies
propose that DRR focus on scrutinizing and managing hazards to lessen vulnerability to disasters including measures
that reinforce readiness, prevention and mitigation. Moreover, Saudi Arabia is aware about the real contribution of
DRR in sustainable development at make it as a priority.
Various empirical research have confirmed that DRR may
lessen disaster threats such as pandemic hazards, decrease
operational vulnerability, increase the abilities to manage
disasters, and ameliorate actions to acclimatize to disaster
risks [17—20].
To fight disasters the government of Saudi Arabia have
implemented a cross-ministerial structure for disaster risk
reduction and disaster management [15]. This multidisciplinary structure outlines a framework that seeks to increase
risk perception among all Saudi’s government ministries and
agencies, and helps to regularly recognize the full spectrum
of risks. Moreover, in order to protect public health during and after the disaster, all governments must act through
4
Ethics, Medicine and Public Health 18 (2021) 100705
Figure 1. Key elements of disaster risk management reduction.
Source: authors’ elaboration based on International Federation of Surveyors (FIG) (2006).
multi-sectoral collaboration [21]. Additionally, the framework of the DRRSS defines cross-department structure that
may have dropped due to program discrepancies. This Saudi
DRR framework comprises Ministry of Health (MOH) especially National Crisis and Disasters Control Centre (NCDCC),
Ministry of Interior (MI), General Directorate of Civil Defence
(GDCD), Ministry of Defence (MD), Ministry of Municipal
and Rural Affairs (MMRA) and public-private emergency preparedness partnerships. Saudi Arabia’s DRR policy system
works in times of stability and crisis. It refers to an integrated approach where all related ministries and agencies
work together in a fixed structure, with smooth collaboration and risk management coordination [5,15,22].
the lowest fatalities are registered respectively in Djibouti
(61), Qatar (235) and Bahrain (337) (Table 2).
The geographic analysis of the most COVID-19 infected
regions in the kingdom show characteristics of these spatial units. GeoDa software. The 13 Saudi regions included
in our analysis are shown in Fig. 1 in form of quantile and
natural breaks maps, which are elaborated on the basis of
the Jenks Natural Breaks algorithm (De Smith et al., 2009).
Fig. 2 shows the outbreak of COVID-19 pandemic in all Saudi
regions at the end of September 2020. Based on the quantile map, the most Covid-19 infected regions are eastern
(alsharqiya) and Mecca Regions where positive cases range
from 63,532 to 73,849. While the less infected regions are
Al-Jawf and Northern Borders (Alhudud Alshamalia) with a
number of infected people between 791 and 1695. However,
the distribution of deaths shows that the regions of Riyadh
and Mecca have the intensive number of COVID-19 victims
between 300 and 1304 deaths. In a second level, the Eastern
region (alsharqiya) reported between 117 and 300 deaths.
On the contrary, the low level of deaths is associated with
regions of Al-Jawf, Northern Borders (Alhudud Alshamalia),
Ha’il, Najran and Al-Bahah with total fatalities between 4
and 26 people.
Fig. 2 illustrates also natural breaks maps related to the
distribution of total confirmed cases and deaths caused by
COVID-19 pandemic in different Saudi regions. The natural
breaks maps provide a more adequate insight into the region
affected by the pandemic compared to the quantile maps.
The quantile maps hides the truth of many ‘‘dark’’ regions.
That is to say, many regions seemed to be among the most
Statistical considerations of COVID-19
outbreak in Saudi Arabia
In March 2020, the Coronavirus pandemic erupted Saudi Arabia. Late in 2nd of March on her return from Iran via Bahrain,
the first Saudi national to acquire COVID-19 was hospitalized. Yet, what started as a few isolated cases quickly
became a national public health emergency within a few
short weeks reaching 1563 positive cases at the end of
March.
The COVID-19 pandemic has reached and expanded in
all countries of the Middle East and North Africa (MENA)
region [8]. In late October 2020, the highest total deaths
in MENA region was reported respectively in Iran (13,421),
Iraq (11,795), Egypt (6481) and Saudi Arabia (5710), while
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R. Jaziri and M.S. Miralam
Table 2
COVID-19 statistics in the MENA region (October 18th 2020).
Country
Total cases
Total deaths
Total recovered
Iran
Egypt
Saudi Arabia
Algeria
Iraq
Kuwait
UAE
Morocco
Oman
Qatar
Tunisia
Bahrain
Djibouti
Lebanon
Jordan
Palestine
801,894
111,284
354,208
70,629
526,852
138,337
154,101
306,995
121,129
136,441
81,726
85,008
5656
110,037
163,926
66,186
13,421
6481
5710
2206
11,795
857
542
5013
1360
235
2445
337
61
852
1969
589
546,500
101,288
341,515
46,326
455,176
129,839
145,537
253,351
112,014
133,473
56,748
82,900
5548
62,528
94,896
56,843
MENA: Middle East and North Africa. Source: authors’ analysis of data from WTO https://www.worldometers.info/coronavirus/.
COVID-19 infected regions such as ‘Asir. In natural breaks
maps, the distribution of regions indicates that the number of most infected regions is 3, while there are only 2 in
quantile map.
Based on Table 3, we remark that the low intensity of
COVID-19 regional infection rate (RIR) is reported in Northeast regions such as: Al-Jawf (0.32%), Tabuk (1.35%) and
Al-Baha (1.2%). While the largest RIR is registered respectively in Mecca (24.52%) and Riyadh (20.47%).
Concerning the average regional death rate at national
level (ARDR), while the largest is reported respectively in
Mecca (38.59%) and Riyadh (21.83%), the lowest one is registered in Al-Baha (0.01%). Nevertheless, the highest regional
death rate (RDR) is reported in Al-Jawf (4.05%) and the
lowest one is in Medina (0.5%). However, with regard to
the regional recovery rate (RRR), we see that all Saudi
regions have recovery rate more than 90%. However, the
average regional recovery rate at the national level (ARRR)
is recorded in the Eastern Region-alsharqiya (24.72%). This
positive trend can be attributed to the efforts of the kingdom government to fight the COVID-19 pandemic in all
regions.
the Saudi government to control the pandemic. Thirdly, we
explain the government Steps to regulate public health.
Many scholars acknowledge the urgency of taking urgent
short-term action to intensify global efforts to combat the
COVID-19 crisis [23,24]. In a strongly globalized world, the
effects of the disease beyond fatality and morbidity has been
developed since the outbreak. Since the decelerating of the
world economy with disruptions of production, the operations of worldwide supply chains has been disturbed [25]. In
this section we will elucidated the initiatives taken by the
Saudi government to tackle COVID-19 pandemic.
Initiatives of the kingdom to tackle COVID-19
pandemic
The Saudi government has taken many initiatives in response
to the impact of the repercussions of the novel Coronavirus
pandemic. In addition, to emphasize the support of the
medical sector as well as stimulating the private sector as
an essential partner in the growth of the Saudi economy.
Besides, the government helps the stability of the Saudi
citizen, contributes to adding value to local market consumption and allocate additional amounts to the healthcare
sector as needed. The government support to the healthcare
sector reached an additional 47 billion riyals, with the aim
of raising the sector’s readiness, securing medicines, operating additional beds and providing the necessary medical
supplies (Table 4).
COVID-19’s impact and measures taken by
Saudi government in combatting COVID-19
pandemic
To illustrate the Saudi government’s approach to disaster
management, we use a qualitative case study methodology;
data were collected through observations and documents.
We try to demonstrate the learning policy and lessondrawing for a public policy in a particular context and
timeline. There are three parts of the case study. Firstly, we
outline the economic, cultural, healthcare, and psychosocial consequences of COVID-19 pandemic on Saudi Arabia.
Secondly, we elucidate the risk mitigation steps pursued by
COVID-19’s impact on the healthcare system
and its psychosocial consequences
COVID-19 reduced service and treatment rates in Saudi Arabia’s healthcare system as the government mobilized its
medical services to tackle the COVID-19 outbreak. The flood
of positive cases into hospitals and clinics overcrowded even
other patients with less urgent care medical conditions.
6
Ethics, Medicine and Public Health 18 (2021) 100705
Figure 2. Quantile and natural breaks maps of COVID-19 infected cases and deaths in Saudi regions (end of September 2020).
Source: authors’ elaboration using data from https://covid19.moh.gov.sa/ (ArcGis and GeoDa software outputs).
Nevertheless, the Saudi Ministry of Health has ordered citizens who feels having COVID-19 symptoms to go immediately
to the nearest private clinics to be treated for free.
COVID-19 also seriously impacted the healthcare workers
in Saudi Arabia. There was a shortage of medical and nursing
practitioners at the peak of COVID-19 from June 2020 to July
2020. There was a shortage of medical and nursing practitioners as there was a significant rise in demand for COVID-19
patients. Moreover, there was a reduction in healthcare
workers, as some were also affected by the outbreak. Hospitals and other public health facilities have experienced
a high rate of worker absenteeism and found difficulties in
sustaining regular operations. This contributed to a further
decrease in service efficiency [26].
The limited medical understanding of the novel coronavirus have exacerbated COVID-19’s psychosocial effect
on citizens. In response to the threat of transmission of
disease, the government of Saudi Arabia has implemented
several stringent public policies, such as social distancing, quarantine and isolation, as risk mitigation steps. All
those regulation mechanisms created for the general population an instinctive detachment from society. This lead
to a public behaviour in avoiding human contact with
crowds in public places. Saudi Ministry of education had
closed all educational institutions especially primary, secondary and higher schools and they shift to e-learning
mode.
Community activities have been postponed to prevent
direct interaction among crowds. All citizens and residents
were told to respect the lockdown and stay home for a
period of time to prevent the pandemic outbreak. Harsh
punishments were levied on those who violated quarantine
orders, such as large fines of more than 10,000 riyals. Kelman and Harris [27] argued that the use lockdown in UK
7
R. Jaziri and M.S. Miralam
Table 3
COVID-19 statistics by Saudi regions.
Saudi
regions
Riadh
Mecca
Medina
Qasim
Eastern
region
(alsharqiya)
‘Asir
Tabuk
Northern
Border
Jizen
Najran
Al-Baha
Ha’il
Al-Jawf
Total cases
Recovered
Deaths
352,160 (1)
339,114 (2)
5605 (3)
Total (4)
Regional
infection
rate
% = (4)/(1)
Total (6)
Average
regional
recovery
rate
(%) = (6)/(2)
Total (7)
Regional
recovery
rate
(%) = (6)/(4)
Regional
Average
death
regional
rate = (7)/(4)
death
rate = (7)/(3)
72,112
86,369
28,317
13,380
86,736
20.47
24.52
8.04
3.79
24.62
69,772
83,357
27,302
12,735
83,856
20.57
24.58
8.05
3.75
24.72
96.75
96.51
96.41
95.17
96.67
1224
2163
143
177
725
21.83
38.59
2.55
3.15
12.93
1.69
2.5
0.5
0.13
0.83
27,400
4780
2353
7.78
1.35
0.68
26,783
4630
1980
7.89
1.36
0.58
97.74
96.86
84.14
350
78
80
6.24
1.39
1.42
1.27
1.63
3.39
12,022
6269
4256
7007
1159
3.41
1.78
1.2
1.98
0.32
10,835
6066
4032
6684
1082
3.19
1.78
1.18
1.97
0.31
90.12
96.76
94.73
95.39
93.35
397
59
56
106
47
7.08
1.05
0.01
1.89
0.83
3.30
0.94
1.31
1.5
4.05
In bold: key results. Source: authors’ calculation using data from https://covid19.moh.gov.sa/.
contributed to reducing the limited accessibility of healthcare system since COVID-19 cases peaked.
The effect of social distancing remains uncertain, but
these preventive measures have been suggested by the WHO
depending on the severity of the disease, the risk groups
affected and transmission epidemiology [28]. Saudi MOH
supported social distance activity during COVID-19 outbreak.
The main purpose of social distancing was to restrict physical interactions and to have a psychological effect on close
contact in specific public areas. The practice of social distancing has led to a social reaction in industries that have
suffered from economic losses. COVID-19 has longer lasting psychological effects. The most serious and devastating
consequences were the loss of loved ones.
structure of Saudi Arabia, the legal framework for combating COVID-19, as well as the risk mitigation initiatives within
cultural, healthcare and psychosocial perspectives.
During novel Coronavirus, the kingdom government institutional structure involved in fighting COVID-19 pandemic
encompassed three main levels especially: strategic, operational and tactic. The strategic level of the disaster risk
reduction strategy system (DRRSS) headed by the Council of
Ministers. The top crisis management level demonstrates the
Strategic Planning Division and runs audit and monitoring of
overall decentralized units of crisis management especially
bodies of state administration in operational and tactical
levels (Fig. 1).
The strategic level of DRRSS is deemed as the frontline of crisis management system in Saudi Arabia. It is
responsible for planning and controlling all kinds of disasters affecting the kingdom. There are various governmental
bodies involved in crisis management with different roles.
There are different crisis managers at the operational level
who supervise the implementation and management of
resources. The government of Saudi Arabia keeps related
ministries responsible according to the extent and severity
of the disaster.
The Saudi Council of Ministers is the major player in risk
mitigation at the strategic level and the civilian emergency
management is almost embodied in government risk management policy. The Saudi Civil Defence Authority (SCDA)
is the leading operating force in the kingdom for public
incidents protection. The ministry of Health (MOH) operates at the operational level in fighting COVID-19 pandemic,
The role of Saudi risk reduction management
framework
One of the most important lessons learnt from the COVID19 outbreak by the Saudi Arabia government was the vital
role that the bureaucracy has played in disaster management. The institutional system then in place was seriously
inadequate for coping with a situation that was both complex and unprecedented. The battle against COVID-19 also
needed more than a medical solution, as resources had to
be drawn from governmental bodies other than MOH. In
response to COVID-19, a three-tiered national control structure was established and defined by the Council of Ministers
(CM). Within this section, we outline the crisis management
8
Ethics, Medicine and Public Health 18 (2021) 100705
Table 4
The initiatives of the Kingdom to tackle the COVID-19.
Governmental body
Initiatives and measures
Council of Ministers
Rapid activation of Cabinet Resolution No. 649 to compel companies in which
the state owns more than 51% of its capital, by taking into account the general
principles and rules for offering business and purchases and giving preference to
local content and small and medium enterprises
A program worth 50 billion riyals aimed at supporting the private sector and
enabling it to play a role in promoting economic growth
Providing free treatment for coronavirus for all citizens, residents, and violates
of residency regulations in Saudi Arabia
Postponing the collection of municipal services fees due on the private sector
for a period of 3 months for more than 1400 economic activities
Postponing the payment of fees for commercial records for more than 116
thousand commercial records for records ending in the period 18/3/2020 to
16/6/2020 for a period of 90 days from the date of expiry
Lifting the suspension of wages work during the current period & lifting the
suspension temporarily from the private sector establishments to correct the
activity and lifting the suspension due to not paying the fines collected &
calculating the employment of Saudis in ranges immediately for all
establishments
30% discount on the value of the electricity bill. In the commercial, industrial
and agricultural sectors for a period of two months (April—May), with the
possibility of extension if necessary
Optional allowance for subscribers in the industrial and commercial sector to
pay 50% of the value of the monthly electricity bill for the months’ bills
(April—May—June) provided that the remaining dues will be collected in divided
installments for a period of 6 months starting from January 2021 AD with the
possibility of postponing the payment period if the need arises
Allocating 5.3 billion riyals to support private sector establishments to employ
and train Saudis as part of the government support initiative to enable the
facilities and develop their performance
A subsidy of 12 billion riyals to support citizens, families and small and
emerging enterprises to face the effects of the Corona virus and the economy
Supporting individuals working directly who are not under the umbrella of any
company and registered with the General Authority of Transport in the activities
of passenger transport and were stopped due to the precautionary measures of
the Corona virus, by paying an amount of the minimum amount of salaries to
them
Allow personal and SMEs loan payments to be postponed for a year, starting
from 3/17/2020
Saudi Arabian Monetary
Agency
Ministry of Health
Ministry of Municipal
and Rural Affairs
Ministry of Commerce
Ministry of Human
Resources and Social
Development
Ministry of Energy,
Industry and Mineral
Resources
Human Resources
Development Fund
(Hadaf)
Social Development
Bank
General Authority of
Transport
The General Authority
for Small and Medium
Enterprises
‘‘Monshaat’’
with the association of Saudi Arabian Monetary Authority
(SAMA) and the governorates. In fact, the MOH is responsible for overseeing and organizing the hygienic and sanitary
protocols of risk management during the pandemic life
cycle. While the principle mission of SAMA is to ensure the
monetary equilibrium using suitable financial policies, the
governorates operates as a catalyst for tactic protagonists.
Nevertheless, in case of COVID-19 pandemic, the SAMA has
quickly activate a budgetary processes and funding lines and
ensure that those lines are properly resourced with sufficient
financial capacity.
The Ministry of Interior (MI) and specially the SCDA is
given the authority to coordinate all response emergencies
forces. However, the Saudi Data and Artificial Intelligence
Authority (SDAIA) launched the ‘‘Tawakkalna’’ application to manage electronic permits during the period of
‘‘curfew’’. On June 14, 2020, SDAIA, in cooperation with the
Ministry of Health, launched ‘‘Tabaud’’ application to notify
users that they had contact with a person infected with the
emerging coronavirus COVID-19, and ‘‘Sehaty’’ application
to register for vaccine where Available [29]. The Ministry of
Hajj and Umrah has launched the application ‘‘Eatmarna’’
to enable pilgrims to book an appointment to perform Umrah
or to visit the Two Holy Mosques. Disaster Health Management (DHM) was been a systemic landmark for Saudi Arabia’s
approach in fighting the COVID-19 outbreak to reducing risk
and managing disasters [1].
The COVID-19 outbreak has questioned the traditional
system of crisis and disaster management, as the pandemic
transcended the control of disaster health management. The
policy makers in the kingdom realized that a robust system
for disaster management was required to fight the COVID-19
9
R. Jaziri and M.S. Miralam
Figure 3.
Saudi Government RRM Framework in fighting COVID-19 pandemic.
pandemic. As a result, a clear framework of multi-sectoral
governance was deemed necessary to deal with COVID-19
pandemic (Fig. 3).
Many countries have developed their own DRRS to
fight devastating accidents and disasters such as China
[30], Philippines [31], Oman [32], Singapore [2] and Czech
Republic [33]. For instance, since the crisis of severe
acute respiratory syndrome (SARS), China has modernized
its national emergency management system (NEMS) which
revealed its efficacy in fighting COVID-19 pandemic. The
Chinese NEMS was been organized by vertical administratorsector lines’ [34]. However, after 2003 SARS crisis, China
rebuilt a new NEMS based on ‘‘one plan and three subsystems’’ [35]. The Saudi institutional framework of DRRS in
comparison with other international systems, shows that is
very similar to that of Singapore that is structured in a multilevel governance and which shows its success in fighting SARS
pandemic [2].
As the COVID-19 pandemic outspread at the beginning
of March 2020, causing an enormous impact on healthcare services and on socioeconomic level in the kingdom.
As a result, the Saudi government has applied severer
measures to combat the spread of the virus. Fig. 4 Elucidate some of the stricter measures taken by the Saudi
government.
Based on the efforts made by the Saudi Risk Reduction
Management Framework between September 2020 and January 2021, Fig. 5 in form of dot density maps shows the
outbreak of COVID-19 pandemic in all Saudi regions before
(September 2020) and after (January 2021) the strict measures taken by Saudi government.
Government steps to regulate public
health
Monitoring and monitoring is crucial in the battle against
COVID-19 pandemics as it helps to provide early notice and
also to predict potential outbreaks. The monitoring method
includes searching for potential variations of virulent strains
and diseases both within the boundaries of a country and at
major border crossings [1,8,37—39].
The existence of the virus was largely unknown when
COVID-19 first appeared. As a result, health and healthcare
professionals across the globe were increasingly unable to
identify and track suspicious cases. Yet, Saudi Arabia managed to develop identification and reporting protocols in a
timely manner with the assistance of WHO technical advisors. In addition, the MOH has extended the concepts of the
WHO for reported COVID-19 cases (including any healthcare
staff with fever and/or respiratory symptoms) to broaden
the surveillance network [40].
Although these monitoring measures were laudable,
COVID-19 also revealed the shortcomings of the fragmented
epidemiological surveillance and reporting processes in
Saudi Arabia [26]. A number of new surveillance initiatives
were implemented as a major part of the lesson-drawing
in the post-COVID-19 pandemic period to incorporate
10
Ethics, Medicine and Public Health 18 (2021) 100705
Figure 4. Some stricter measures taken by the Saudi government.
Source: adopted from [36] and modified by authors.
Figure 5. Dot density map of COVID-19 before and after Saudi government measures.
Source: authors’ elaboration using data from https://covid19.moh.gov.sa/ (ArcGis and GeoDa software outputs).
epidemiological data and classify Current virulent strain
evolving more rapidly. One of the most prominent was the
development of a clinical database and infectious disease
warning system to incorporate essential clinical, laboratory
and contact tracing information. The monitoring program
currently has three major operational elements, including
group surveillance, laboratory surveillance, and external
surveillance.
11
R. Jaziri and M.S. Miralam
Infection prevention at hospitals
To limit the risk of transmission in healthcare institutions once the COVID-19 epidemic broke out, the MOH
implemented a series of stringent infection-control measures to which all healthcare professionals and hospital
visitors had to adhere. It has made the use of personal
protective equipment compulsory. Visitors to public hospitals in those areas were barred healthcare professionals
activities in public hospitals have also been heavily prohibited. Sadly, these essential steps were not enforced in all
healthcare sectors until the end of March 2020, and this failure resulted in a number of intra-hospital infections [26].
Moreover, the approach of limiting healthcare professionals and visitors’ movements to hospitals has been taken
further. Patient movement between hospitals, meanwhile,
was strictly restricted to medical transfers. The number of
visitors to hospitals was also limited and their particulars
recorded during each visit.
It is also important to note that strong public support
and cooperation were needed for these rather stringent
control measures. Indeed, if these two elements had
been missing their implementation would not have been
successful.
Public contact and education
Public education and communication are two key components of handling health emergencies [41,42]. Communication difficulties are likely to complicate the challenge,
particularly when there is no existing, high-status entity
that can serve as a centre for gathering and disseminating information. Hence, critical information needs to be
disseminated transparently to the targeted population. The
Saudi MOH maintained a high degree of openness during the
COVID-19 outbreak, when it shared details with the public.
Nonetheless, the MOH’s simple and distinct communications
have greatly contributed to raising the possibility of public panic. The MOH has worked closely with the media to
provide daily, timely reports and advisories on health. In
addition to the media (e.g., television and radio), knowledge pamphlets were distributed to every household, and
the Saudi MOH website provided the population with regular
alerts and health advisories.
Notably, a government information portal was established (https://covid19awareness.sa/en/home-page) when
the WHO released a global warning, dedicated to providing timely updates. A series of dedicated awareness-raising
television spots to protect against COVID-19 was launched.
A common message received during the COVID-19 outbreak
has been the importance of social responsibility and personal hygiene, in order to treat new COVID-19 positive cases,
such as public hospitals and local clinics. Children at the
school were told to wash their hands daily and check their
body temperature. They told the public to wear masks and
to postpone non-essential travel to other countries. Saudi
education policies corroborate with the study performed in
Japan by [43], which analyzed the COVID-19 response in the
education sector using the Sendai Framework for disaster
risk reduction.
Social distancing and measures of psychosocial
affairs
During COVID-19 outbreak the Saudi MOH promoted the practice of social distancing. Of course, the sole purpose of social
distancing was to restrict physical encounters and near
communication in public places, thus slowing the COVID-19
transmission rate. As a result, from 9 March 2020 all preparatory, primary and secondary schools and universities were
closed. In the meantime, Saudi MOH also urged businesses
to take social distancing steps, such as encouraging workers to work from home and use peer production platforms.
Those most at higher risk of contracting complications were
transferred if infected and removed from frontline work to
other locations where they were less likely to contract the
virus. As mentioned earlier, the practice of social distancing also drew strong criticisms from those businesses that
suffered economic losses as a result. Apart from providing
economic compensation, measures to mitigate psychosocial
impacts are also important.
As mentioned above, the government’s public health control measures drew strong criticism from businesses and
the public during the COVID-19 outbreak because of the
invasive nature of those actions. Besides these, total jobs
and personal income have been affected by economic slowdown. In response to public concerns, King Salman agreed to
exempt borrowers from the Social Development Bank, who
are most in need especially people with disabilities and the
elderly. He offered economic assistance to those individuals
and businesses that had been affected by home quarantine
orders.
At the same time, the MOH worked with various government ministers to provide essential social services to
those affected by the lockdown order. For example, housing was offered to stranger residents those who lives in
crowded houses. During their lockdown, the Saudi Arabia
Civil Defence Force openly offered emergency services to
those undergoing quarantine at home to see their physicians.
Not only were all of these risk management steps effective
in combating the outbreak, but they were also relevant for
applications in managing disaster risks.
Research implications
This section outlines the lesson learning from the experience
of Saudi Arabia in combating the COVID-19 outbreak, and discuss the implications of disaster risk management for future
research. The implications are explained in three aspects:
staying vigilant at the level of the community, remaining
flexible in a national management structure and collaborative local governance.
Stay alert at community level
It remains unclear that the strict health protection measures taken by Saudi government might not be acceptable
or replicable in other countries. The evidence suggests that
punitive government policies such as the set out of new fines
for COVID-19 breaches, the lockdown and travel bans are
12
Ethics, Medicine and Public Health 18 (2021) 100705
less effective than voluntary interventions for instance good
personal hygiene and the voluntary wearing of face masks
[26,44]. Recalling the public to maintain a high degree of
vigilance and promoting individual social responsibility may
be a technique of coercion by the government authority
to control and exert pressure. Nevertheless, not to complicate the policy with individuals or groups [45,46]. Promoting
social responsibility is therefore crucial in terms of slowing
the pace of COVID-19 infection in all settings through good
personal hygiene and wearing respiratory masks.
To accomplish this goal, two essential components of
health crisis management (HCM) are public awareness and
risk communication [41,42]. The community needs to be
aware of the nature and extent of the disasters. They need
to be informed about the value of emergency preparedness
and engagement in drills, training and physical preparations.
Institutions and capacities are established and strengthened
at community level, which in effect contribute systematically to the vigilance against potential risks. This is best
demonstrated in the good communication policy of the government of Saudi Arabia for avoiding public fear and panic
during COVID-19 outbreak [47]. Throughout the epidemic,
the Saudi government has steadfastly raised the level of personal hygiene and awareness of social responsibility. It has to
depend in large part on public awareness and coordination
of threats. Political leaders were seen as doing and initiating
a series of countermeasures to reassure the public, in order
to effectively disseminate the idea of vigilance across the
public.
By showing the people that government leaders practiced
what they were preaching, the examples served to naturalize and legitimize the social responsibility public discourse
for all Saudi citizens and residents. Through showing the
people that policy officials were practicing what they were
teaching, the examples helped to naturalize and legitimize
the popular debate on social responsibility for all citizens
and residents. The evolving circumstance is adapting flexibly, and even more quickly than in the case of disease
transmission.
Staying flexible within a national coherent
strategy
All local emergency response bodies will operate under the
authority of a single National Management system to organize multi-institutional cooperation in emergency response
and disaster management. In addition to promoting strong
inter-institutional cooperation, the power of this robust
framework lies in its ability to ensure a rapid response to
such disease outbreak through the more effective and efficient execution of risk reduction steps.
Structural versatility includes the rapid deployment of
forces to mitigate the accident at the tactical level and the
provision of professional guidance at the operational level
to reduce life and property harm. The endogenous versatility of this management structure facilitates lead to the
building of trust between the government and people. This
in effect ensures timely acceptance by the population of
policy initiatives.
As shown in this article, the Saudi MOH has been
entrusted by the government and designated as the
public health emergency incident manager. Where a sudden
incident involves public health or a large-scale loss of life,
the MOH is responsible for the planning, coordination and
implementation of a range of disease control programs and
activities.
During the COVID-19 outbreak a national management
and control system was created by the Saudi government.
This national framework was able to respond to rapidly
changing circumstances emerging from the outbreak. As
more cases of COVID-19 were identified and better epidemiological knowledge became available, the Saudi Council
of Ministries quickly formed an Inter-institutional cooperation to ensure planning and implementing all risk reduction
steps. Although this overarching system of governance is
more or less ordinary worldwide [48].
From the experiences of Saudi Arabia in fighting COVID-19
pandemic, we learned that a national management structure’s strength lies in its flexibility to connect relevant
ministries on the same framework. These linkages guarantee a timely, coordinated response and delivery of services.
Being flexible in structure was not the only reason behind
COVID-19’s successful defeat. In the case of Saudi Arabia, we
also note the effectiveness of having to depend on expansion
capacity to withstand an unexpected, high-impact catastrophe.
The need for expansion capacity and
collaborative regional governance
In the context of this paper, the capacity for surge refers to
the ability to mobilize resources (health professionals, facilities, medical devices, vaccines, etc.) to combat a pandemic
outbreak. The strategic responsiveness of Saudi Arabia to
COVID-19 illustrates the importance of rapidly increasing
the capacity to deal with an outbreak of infectious disease.
This problem continues to hinder the ability of many countries to counter infectious diseases. It is a matter of fact
for many public health organizations that they are unable
to cope with pandemics because the means for doing so are
clearly lacking [49,50].
In the meantime, there is evidence suggesting that
expanding capacity alone is not the full answer. For instance, abundant resources during the COVID-19 outbreak
contribute to a significant but not all-encompassing factor in
the fight against this pandemic. When it turned out, as different stakeholders brought their specific skill sets and tools
to the task-at-hand, they simply complicated the battle
because of their lack of synergy. Indeed, abundant resources
without collaboration could potentially undermine collaborative efforts. Therefore, the ability to connect various
stakeholders needs to be complemented by some form of
synergy between them. These abilities can be improved by
close cooperation. This takes us to the third concept for
disaster management: national collective governance.
The transboundary complexity of disasters needs a prepared and organized strategy for successful rescue and relief
operations to disaster response [49]. Combating epidemics
includes close coordination between various states and government bodies [1,51,52].
It is also clear that various stakeholders’ collaborative ability is essential to the battle against transboundary
13
R. Jaziri and M.S. Miralam
Table 5
Disaster risk reduction framework.
Key recommendations
1. Mitigation/readiness
At the strategic level, government needs to opt for strict quarantine measures for people coming from other red
zones
There is a necessity to establish village committees to furnish basic healthcare and hygiene information using
door to-door communication
At operational level, there is a need to convince the population about the need to take vaccine and to fight
against disinformation and fake news
Community volunteers, at tactical level, can be trained to make quick COVID-19 tests that deliver quick results or
the government, at operational level, can make recruitment of healthcare professionals to achieve this
There is a need to give subventions to private labs to rise the number of COVID-19 tests by decreasing the costs
for the population
2. Preparedness
At a strategic level, there is a need to build a pandemic insurance solution for the community to cover significant
economic losses
Healthcare facilities need to provide free vaccine to more than two-third of inhabitants
Government bodies, at operational and tactical levels, have to oblige individuals to respect social distancing
It is interesting to prioritize the funding of the most affected ventures by the pandemic
3. Response/implementation
Healthcare professionals have to be well rewarded by the government, at the operational level, for their brave
efforts during the pandemic
The government can use information and communication technology, in public places, to recognize individuals
who are not wearing masks and who have fever
The government, at a strategic level, can continue to support small and medium enterprises (SMEs) to survive
during COVID-19 crisis
Saudi banks have no liquidity shortage and can permit companies in economic difficulty to postpone loan payment
At tactical level, securities officials can be given more authority to force individuals to respect social distancing
4. Recovery/post-COVID-19
After the COVID-19 pandemic, it is necessary to think about human capital development especially in the
strategic fields of education, healthcare facilities and agriculture
In the future, there is a need to develop bilateral cooperation agreements with other developed countries to
manage scientific research project, share knowledge and technology
At the strategic level, Saudi government, need to review its monetary policy by reducing taxes and expenditures
It is important to help many SMEs affected by the pandemic by providing them reasonable loans to support their
resilience and to boost economic growth
communicable diseases [49,53]. Although advanced economic development member states usually lead these
efforts, it is important and ultimately unavoidable to include
other developing countries and organizations. Indeed, with
the assistance of regional cooperation, significant countermeasures such as border protection and surveillance are also
made possible such as the Gulf Cooperation Council (GCC),
which adopts an anticipatory mechanism in order to enhance
and implement a disaster risk reduction system (DRRS).
Discussion, conclusions and policy
recommendations
The COVID-19 is not only a health crisis but also socioeconomic and political crisis that will have serious repercussions
in societies and people. Loss of jobs and incomes are main
challenges facing governments. The immediate lesson from
Saudi experience in fighting the pandemic is about the
need to reiterate the operational responsiveness of the Risk
Reduction Management system in dealing with crisis. Villarin and Basilio [54] argued that local government and
political-administrative structure are on the front line for
COVID-19 preparedness. Bogati and Gautam [55] show that
rapid recovery after COVID-19 crisis requires the capability
of governments and local communities to mobilize diverse
stakeholders and managing available financial and human
resources.
Today the world is much more interconnected than ever
before, owing to globalization, international trade and
cross-border migration. No nation is spared being directly or
indirectly affected by catastrophes. Saudi Arabia is vulnerable to both natural and man-made disasters alongside its
remarkable economic growth. In response, the Saudi Arabia
government adopts an approach of integrated risk management, a concerted, coordinated effort based on a universal
national response.
We observed the disaster risk reduction system (DRRS)
of Saudi Arabia in this case study, with clear references
to the COVID-19 outbreak. In its combat against COVID19 pandemic, The Saudi health authority was sufficiently
responsive to take action when it realized that the flexible
inter-institutional was suitable to facilitate close cooperation between various key government bodies to tackle the
14
Ethics, Medicine and Public Health 18 (2021) 100705
on-going health crisis. So, a crisis management structure
was established quickly. The nature of a versatile management system, the way and extent it was used determines
how effectively an outbreak was managed. Flexibility has
actually improved the potential of organizations by making
organizations more productive under some circumstances.
Epidemic prevention strategies such as surveillance, social
distancing and lockdown need broad public support for their
efficacy. Saudi Arabia’s COVID-19 experience strongly indicates that risk reduction strategies can only be successful
when a number of partners and stakeholders are involved
such as ministries, civil society (associations) participate
appropriately. This is also important for controlling risk of a
disaster. Whether all these aspects can be transferred elsewhere in future research needs to be assessed.
Today, this particular approach has definitely helped
Saudi Arabia periodically recover from public health crisis.
Saudi Arabia’s response to the COVID-19 outbreak provides
useful insights into the kinds of strategies required to battle
future pandemics. Furthermore, [56] confirm that, the use
of a framework for Disaster Risk Reduction, needs the use
of wide-ranging strategies that protect vulnerable peoples
during the four stages of Mitigation (readiness), preparedness, response (implementation) and recovery (post-COVID)
(Table 5).
Human and animal rights
The authors declare that the work described has been carried out in accordance with the Declaration of Helsinki of
the World Medical Association revised in 2013 for experiments involving humans as well as in accordance with the
EU Directive 2010/63/EU for animal experiments.
Informed consent and patient details
The authors declare that this report does not contain any
personal information that could lead to the identification of
the patient(s) and/or volunteers.
Funding
This work did not receive any grant from funding agencies
in the public, commercial, or not-for-profit sectors.
Author contributions
All authors attest that they meet the current International
Committee of Medical Journal Editors (ICMJE) criteria for
Authorship.
Disclosure of interest
The authors declare that they have no competing interest.
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17
Webology (ISSN: 1735-188X)
Volume 19, Number 2, 2022
Impact Of Transformational Leadership Style, Organizational
Innovation On Company Performance In Saudi Arabia
Basil Mahmod Ali Defalla1 , Yap Voon Choong2
1,2
Faculty of Management, Multimedia University, Malaysia.
Abstract
This study Investigates the impact of transformational leadership style, organizational innovation
on company performance in Saudi Arabia. The leadership theory is employed in proposing the
transformational leadership style, organizational innovation and company performance.
Transformational leadership has a great importance in terms of motivation and encouragement
and an impression on the followers. A leader who has a strong and influential personality leaves
a strong impact. Moreover, transformational leadership also supports organizational innovation,
which improves the performance of employees, thus, the performance of the companies.
Accordingly, the company’s performance develops and improves its growth and competitiveness
in the market, and enhances its ability to improve performance for the better. The importance of
this study is to understand how transformational leadership provides wise to the managers and
guidance to make sure that the companies succeed and continues in the business environment in
the long-term. Therefore, to understand how innovation organization has ability to impact the
performance of the companies. Based on the quantitative research approach, the questionnaires
were randomly distributed to 300 different business sectors companies in Saudi Arabia. A total
of 220 companies returned the completed questionnaires and these were used in the final analysis.
The use of cross-sectional data and key informants are the main limitations of this study. The
results indicate that managers must have knowledge of leadership styles and examine critical
assumptions to question interest in perspectives to obtain different performance results.
Keywords: transformational leadership, organizational innovation, performance, Saudi Arabia.
1. Introduction:
Wise leadership is a guide for the companies to support and motivate employees to enhance their
performance, achieve innovation, stability, and job satisfaction, which achieves the required goals
for the company’s success. Thus, many evidence shows that transformational managers have
significant impact on the company performance (García Morales et al., 2008). and influence the
follower’s performance. Transformational leadership has an effective impact on the innovation
climate that adds an effective value to the performance of the companies (Naguib and Naim,
2018). This was also explained Howell and Avolio, (1993) who found that intellectual stimulation
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and individual consideration of transformational leadership affect the innovation environment, as
employees tend to follow the style of a leader who has the ability to influence others.
Furthermore, Leadership is an important factor in to enhance the transformations in organizations
(Thomas and Dennis, 2014; Zia, 2015). The leaders need to understand the need and motive of
the subordinates. Importantly, the learning abilities such as exploitation and exploration (Alpkan
et al., 2012). A successful leader can breathe life into the company, using existing competencies
and exploiting the revision of the current organizational process, so that it becomes more efficient,
and improve production requirements. Therefore, exploration involves researching, developing,
discovering new possibilities, and achieving uncertain results (González, Jiménez, 2018). Thus,
it becomes necessary not only to exploit existing products or services but to explore new
opportunities to implement new products or services.
Transformational leadership encourages employees to challenge difficulties. Wang and Rod
(2010) found that the innovation climate creates the relationship between transformational
leadership and employee creativity. Thus, the relationship between transformational leadership
and innovation climate may be a mediator between transformational leadership and organizational
innovation (Naguib and Naim, 2018). The transformational leader seeks to bring about change
and development constantly. He also cares about organized teamwork. Leadership styles have an
impact on managers or supervisors and on organizational performance, therefore, help mediate
roles to improve organizational performance (Arif and Akram, 2018). Transformational
leadership focuses on the moral and human values of followers, equality, and the promotion of
these human values in followers. (E. Struchan et al., 2015) Organizational effectiveness and high
financial performance require a leader who could be collaborative, exploiting tension and internal
conflict to achieve an advanced level of awareness (Yukl, 2008; Shahin et al, 2014). Importance
of research presented in this paper comes out of a fact that there is a need of studies on this topic.
Therefore, the basic motive of this paper was to understand and to identify condition of leadership
and its impact on business performance in companies in Saudi Arabia. This research has an
additional importance due to centralization management, existed in public and private companies,
that do business in Saudi Arabia.
2. Literature Review and hypothesis development
2.1 Transformational Leadership and Company Performance
Drawing from the literature, transformational leadership has been clarified as one of the most
used methods for its important role in organizational performance. Bass and Avolio (2012) outline
developments in transformational leadership. He stated that transformational leadership has four
components; The engaging role of modeling, inspirational motivation, individual consideration
and intellectual stimulation. Some factors affect the performance of the company, it could be
internal or external factors (Arif and Akram, 2018). Leadership style is considered as an Internal
factor that affects the performance of the company (Alrowwad, Obeidat, Tarhini and Aqqad,
2017). Leader behavior encourages followers to focus on achieving organizational goals and
motivates followers (Avolio et al., 2004). Employees who work in a supportive climate are more
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Volume 19, Number 2, 2022
effective. Charismatic behaviors of the transformational leaders, provide inspirational motivation,
intellectual stimulation (Dvir, Eden, Avolio and Shamir, 2002).
In the literature, transformational leaders influence employee performance within a company
through the strong bonds they make with employees and their followers (Wang et al., 2008; Wang
et al., 2005). Scholars also provide the support that these leaders as they advocate conceptual
values and engage in conscious incentives that support the performance of the organization
(Shamir et al., 1993). Thus, companies changing from the traditional authoritarian style to the
transformational style as a result of the fact that employees need support and encouragement from
their management rather only financial benefits (Zia, 2015).
By looking at studies of organizational learning and innovation showing an effect on
organizational performance. Hypothesis (H1): Transformational leadership has an impact on
company performance.
2.2 Transformational Leadership Relationship with Organizational Innovation
The researchers concluded in the research of collective innovative behavior that it is positively
related to transformational leadership, as the relationship between collective innovative behavior
and transformational leadership is moderate through radical change. (Feng, Huang and Zhang,
2016). Furthermore, leadership is a dynamic concept that has an impact on the financial and
individual operations of many companies (Zia, 2015).
Thus, transformational leadership has an important impact on innovation, such as increasing goaldirected behavior, promoting organizational change, and helping employees to exceed their
performance expectations. Moreover, the relationship and the effect between both exploitative
and exploratory innovation on organizational performance were clarified. By motivating
employees, the impact of transformational leadership is positive by halting motivational, moral,
or empowering decline with the followers (Dvir, Eden, Avolio and Shamir, 2002)
Studies have also shown that organizational innovation has a positive impact on company
performance. It is also important for managers to pay attention to innovation in companies to
improve performance and increase production (Pejman Ebrahimi, Seyedeh Marzieh Moosavi,
Ebrahim Chirani, 2016; Arif and Akram, 2018). Innovation is the systematic analysis of
opportunities resulting from change, reflection and optimal exploitation of these opportunities,
and transforming them into creative potentials. Hypothesis (H2): Transformational leadership has
an impact on organizational innovation.
2.3 Transformational Leadership, Organizational Innovation and Company Performance
Innovation plays a mediating role in the performance of the organization, as the use of Innovation
Management Techniques (IMTS) affects the innovation performance of companies. According to
Schepers (2013) “Transactional leadership style is characterized by characteristics of charisma,
individual considerations, intellectual stimulation, and inspiring motivation while transactional
leadership is characterized by episodic reward and management by exception”. The charisma of
the leaders should inspire their employees and instill pride and respect for the organizations they
work (Mutahar, et al, 2015). Innovation is to bring renewal in the organization, flexibility in
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performing tasks, and improving working relationships, which requires the experience of
managers, in how to follow methods that contribute to regulating the behavior of the organization
and making it more effective.
The relationship between transformational leadership and innovation management also has a
strong influence within the industrial companies (Igartua, and Peiro, 2018). That enhances the
importance of the relationship. According to the results of Tareq Ghaleb Abu Orabi, (2016),
transformational leadership positively affects organizational performance. In terms of direction
and development to increase the performance of organizations business organizations fouces on
the ability of the leaders, improve motivation and create a positive environment (Sohmen, 2013;
Al Shanqaiti and Farea, 2021). Therefore, multinational companies are more interested in
innovation (Arif and Akram, 2018). The effective leader must sense and realize the problems that
are around him in the company and their results, thus, trying to develop solutions to those
problems in a creative way.
Hypothesis (H3): Organizational innovation has an impact on company performance.
Figure 1 demonstrates conceptual framework of the research and the hypothesized relationships
between the construct’s variables.
Transformational
leadership
H1
Company
performance
H2
H3
Organizational
innovation
Figure 1. The proposed conceptual framework
2.4 Hypothesis of research
1. Transformational Leadership has an impact on company performance.
2. Transformational Leadership has an impact on Organizational Innovation.
3. Organizational Innovation has an impact on Company performance.
3. Research methodology
3.1 Research Design:
This study investigates the effect of transformational leadership style on organizational
performance and mediating organizational innovation in Saudi Arabia companies, by means of a
research designs area adopted. The quantitative study applies a survey questionnaire approach as
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a type of research design. The survey method using a structured questionnaire was utilized to
obtain primary data from the participants. The data has been analyzed using Statistical Package
for Social. The 5-point scale was chosen for measuring the acceptance level of the respondents.
1 for strongly disagree, and 5 for strongly agree.
3.2 Research Sample and Data Collection:
A various number of companies in Saudi Arabia have been selected from Riyadh, Jeddah and
Dammam. Without display of the company names for the purpose of confidentiality. The
companies were selected are involved in different business sectors. A random sample consisting
of 300 employees was invited to be the survey, and only 220 were returned to the researcher. This
represents a return rate of 73.33%.
3.3 Objective of research
The study was conducted to obtain the objectives below:
1. To find the effect of transformational leadership on company performance.
2. To examine the effect of transformational leadership on organizational innovation.
3. To examine the effect of organizational innovation on company performance.
In the research summarizes the final results of the hypothesizer were examined in this study:
4. Measures
The first demographic characteristic considered in this study was the gender, with 84.5% (i.e.,
186 respondents) male and 15.5% (i.e., 68 respondents) female. The management field is a maledominated profession in Saudi Arabia as a result the substantial difference in gender is expected.
The respondents within the age group of 41- 50 years made up 44.5% of the sample, followed by
those within 31 – 40 years, corresponding to 35.9%. Moreover, the other two age categories of
30 years and below, and 50 years and above, made up 10.5% and 79.1% of the total respondents
respectively. Regarding educational attainment, 11.4% of the respondents have at least diploma /
equivalent, 57.7% of the respondents have at least a bachelor’s or equivalent degree, with 30.9 %
of these having a graduate degree.
Consistent with sampled respondents. Thus, the sampled respondents were found to have acquired
experience in different management level. Finally, with respect to management level, a majority
of the respondents (i.e., 46.4%) were from middle management, followed by top management
who constituted 35.5%. And the remaining 18.2% occupied low management level. Additionally,
analysis on the data revealed demography, the nationality of the respondents (i.e., 37%) are Saudi
national. (i.e., 63%) are non- Saudi nationality.
5. Research results and Discussion
5.1 Correlation Analysis
Table 5.1: Correlation Analysis
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Transformation
al Leadership Organizational
Variables
style
Innovation
Transformational
Pearson Correlation
1
.508**
Leadership style
Sig. (2-tailed)
.000
N
220
220
Organizational
Pearson Correlation
.508**
1
Innovation
Sig. (2-tailed)
.000
N
220
220
Company performance Pearson Correlation
.226**
.458**
Sig. (2-tailed)
.001
.000
N
220
220
**. Correlation is significant at the 0.01 level (2-tailed).
Company
performance
.226**
.001
220
.458**
.000
220
1
220
5.2 Regression analysis
Table 5.2: Regression analysis
Hypothesis
Transformational Leadership has an impact on
company performance.
Transformational Leadership has an impact on
Organizational Innovation.
Organizational Innovation has an impact on Company
performance
Beta
Coefficient
.508
p-value
.000
Hypothesis
Support
Yes
.458
.000
Yes
.226
.000
Yes
The hypnotized test of transformational leadership carries an impact on company performance.
The dependent variable transformational leadership was regressed on predicting variable
company performance to test hypothesis H1. Which indicate that transformational leadership can
play a significant role in shaping company performance (b = .508, p < 0.001). Therefore, the hypnotized test of transformational leadership carries an impact on organizational innovation. The dependent variable transformational leadership was regressed on predicting variable organizational innovation to test hypothesis H2. Which show that transformational leadership can play a significant role in shaping organizational innovation (b = .458, p < 0.001). Furthermore, the hypnotized test of organizational innovation carries an impact on company performance. The dependent variable organizational innovation was regressed on predicting variable company performance to test hypothesis H3. Which also, indicate that organizational innovation can play a significant role in shaping company performance (b = .226, p < 0.001). 5.3 Model Summary Table 5.3: Model Summary analysis 5334 http://www.webology.org Webology (ISSN: 1735-188X) Volume 19, Number 2, 2022 Change Statistics Std. Error F Mode R Adjusted R of the R Square Chang Sig. F l R Square Square Estimate Change e df1 df2 Change a 1 .458 .210 .203 .68931 .210 28.858 2 217 .000 a. Predictors: (Constant), Organizational Innovation, Transformational Leadership style Moreover, as shown in model summary that F = 28.858, p < .001, R2 = .210 depicts that the model explains 21% of the variance in company performance. 6. Conclusion The results of the study indicate that it is necessary for managers to pay attention to and encourage diversity and individuality in the company, as well as consider the moral and ethical consequences of decisions that help others develop their strengths. The results indicate that managers must have knowledge of leadership styles and examine critical assumptions to question interest in perspectives to obtain different performance results. The results support the assumed hypothesis and indicate that transformational l...

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