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Table 3 Representative verbatim quotations (please note: these are examples; the content of some quotations covers more than one category and thus may have appeared in multiple subthemes in our analysis)

From: Coordination and resource-related difficulties encountered by Quebec's public health specialists and infectious diseases/medical microbiologists in the management of A (H1N1) - a mixed-method, exploratory survey

Themes and Subthemes




a) Communication

"There was too much information, and too many sources"

"There needs to be better coordination between the two specialties"

"Difficult to communicate changing recommendations to different services"

"Use the current network rather than creating a parallel network"

b) Clinical Practice Guidelines

"The waiting times to get CPG was long, and like already mentioned, documents were coming from everywhere"

"Changing and contradicting CPG complicated the situation when it came time to disseminate to other health professionals and sometimes rendered the infection control guidelines less credible since they were constantly changing"

"CPGs were not adjusted based on clinical reality"

c) Decision-Making

"Very little flexibility... Again, the decisions were unclear and not very well explained"

"Lack of latitude at the regional level"

"Too many stakeholders and too many messages"

"Give more autonomy to the regional-local levels due to differences between different areas"

"It is clear that an interdisciplinary expert committee should work together on the management of pandemics and other infectious disease emergencies"

d) Roles and Responsibilities

"It is frustrating to not be remunerated for the overwhelming number of calls answered and for infection control management"

"There needs to be a better distinction between hierarchical roles and expert roles"

"Avoid having too many meetings and instead have a better, more transparent structure that avoids daily (and multiple) changes"

"Clarify roles and responsibilities quickly at the start of crises to the different parties involved"

e) Epidemiologic Investigation

"There was a big problem in accessing data (local cases: clinical presentation, severity, etc.)"

"Lack of information in the beginning, late access to pertinent Quebec epidemiological data"

f) Public Health Expert Advisory Committees

"More openness from experts and less closure of government leaders, professional associations, etc."

"Very little information given about the experts on advisory committees and from the different levels of government and public health"

"Difficulty with decisions and conclusions of the committees and treatment recommendations"


"Delay in the transmission of clinical practice guidelines from the Committee of...*"

Clinical Resources


a) Laboratory Resources

"Long delays in obtaining results"

"Regional labs should have access to proper diagnostic technologies"

"The number of lab technologists available is insufficient"

"Allow diagnostic PCR analysis at the local level, which will allow faster results and thus better management of patient beds"

b) Patient Management

"Lack of individual rooms"

"Difficulties encountered in transferring patients to intensive care"

"Patients were referred directly to our hospital's emergency department without prior evaluation"

c) Vaccination Process

"Peculiar recommendations for different risk groups"

"Too late to have the most impact"

"Late vaccination of the general population"

"Late access to vaccines; only supplied by one company; lack of non-adjuvanted vaccine for target groups"

  1. * We did not want to name the actual committee