Publication Details

Title :

Perceptions of postoutbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study


BMJ Open

Impact Factor:



Al Knawy BA1, Al-Kadri HMF2, Elbarbary M3, Arabi Y1, Balkhy HH4, Clark A5.


1 Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

2 College of Medicine, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

3 College of Public Health, King Abdulla International Research Center and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

4 Department of Pediatrics, King Abdullah International Medical Research Centre and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

5 Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.

Year of Publication:





This study examines perceptions of the operational and organisational management of a major outbreak of Middle East Respiratory Syndrome (MERS) caused by a novel coronavirus (MERS-CoV) in the Kingdom of Saudi Arabia (KSA). Perspectives were sought from key decision-makers and clinical staff about the factors perceived to promote and inhibit effective and rapid control of the outbreak.

A large teaching tertiary healthcare centre in KSA; the outbreak lasted 6 weeks from June 2015.

Data were collected via individual and focus group interviews with 28 key informant participants (9 management decision-makers and 19 frontline healthcare workers).

We used qualitative methods of process evaluation to examine perceptions of the outbreak and the factors contributing to, or detracting from successful management. Data were analysed using qualitative thematic content analysis.

Five themes and 15 subthemes were found. The themes were related to: (1) the high stress of the outbreak, (2) factors perceived to contribute to outbreak occurrence, (3) factors perceived to contribute to success of outbreak control, (4) factors inhibiting outbreak control and (5) long-term institutional gains in response to the outbreak management.

Management of the MERS-CoV outbreak at King Abdulaziz Medical City-Riyadh was widely recognised by staff as a serious outbreak of local and national significance. While the outbreak was controlled successfully in 6 weeks, progress in management was inhibited by a lack of institutional readiness to implement infection control (IC) measures and reduce patient flow, low staff morale and high anxiety. Effective management was promoted by greater involvement of all staff in sharing learning and knowledge of the outbreak, developing trust and teamwork and harnessing collective leadership. Future major IC crises could be improved via measures to strengthen these areas, better coordination of media management and proactive staff counselling and support.