{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T13:01:24Z","timestamp":1780578084758,"version":"3.54.1"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T00:00:00Z","timestamp":1747094400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T00:00:00Z","timestamp":1747094400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005760","name":"University of Gothenburg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005760","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The COVID-19 pandemic exposed critical weaknesses within the healthcare sector in many countries, and intensifying pressure on managers and healthcare workers was immediate. Managers were faced with increased pressure during the pandemic related to difficult prioritizations and severely disrupted daily operations. Therefore, a deeper understanding of managers\u2019 similar and different experiences during pandemics is necessary. Our aim of this study was to explore the experiences of managers\u2019 in leading HCWs at two major Swedish hospitals during the COVID-19 pandemic. Further, to describe their applied managerial approaches and strategies, and comparing the experiences of managers overseeing units caring for COVID-19 patients with those managing units not involved in COVID-19 patient care, to identify both differences and similarities in their crisis management practices.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Method<\/jats:title>\n            <jats:p>A qualitative research design involving thematic analysis was applied during the COVID-19 pandemic. Data used in this study were from the open-ended questions in a web-based survey; 376 managers were included.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Managers\u00b4 experiences in leading HCWs resulted in four themes: (1) centralised crisis management, (2) managing daily operative work, (3) dynamics of managerial support, and (4) new insights into learning and development, accompanied by 13 subthemes. Their experiences in leading HCWs caring for COVID-19 patients or not varied, and managers need to recognize these variations in strategies to provide effective and crucial support to HCWs during challenging times. Managers also appreciated certain hospital operations during the pandemic, while identifying areas for improvement within the organisation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Acknowledging diverse needs among managers is important, especially given the diverse conditions in departments caring for COVID-19 patients versus others. Managers play a critical role in centralised crisis management, ensuring daily operative work, providing managerial support to healthcare workers, and fostering a culture of continuous learning and development. These insights highlight the importance of effective management and the dynamics of managerial support during pandemic crises, which directly impact patient safety. These results contribute to the ongoing improvement of healthcare organisations in addressing unforeseen challenges, such as pandemics and broader existential crises, by emphasizing the managerial perspective on crisis response.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12913-025-12759-w","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T16:13:45Z","timestamp":1747152825000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Managers\u2019 experiences in leading healthcare workers in hospital departments during a pandemic: a qualitative study"],"prefix":"10.1186","volume":"25","author":[{"given":"Linda","family":"Ahlstrom","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanna","family":"Gillberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa","family":"Wikstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helle","family":"Wijk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingibj\u00f6rg H.","family":"Jonsdottir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Degl\u2019Innocenti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara L.","family":"Fallman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,13]]},"reference":[{"key":"12759_CR1","unstructured":"van Ginneken E, Reed S, Siciliani L, Eriksen A, Schlepper L, Tille F, Zapata T. Addressing backlogs and managing waiting lists during and beyond the COVID-19 pandemic. 2022. https:\/\/iris.who.int\/bitstream\/handle\/10665\/358832\/Policy-brief-47-1997-8073-eng.pdf?sequence=1. Accessed 21 Mar 2025."},{"issue":"1","key":"12759_CR2","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1111\/jonm.13488","volume":"30","author":"M V\u00e1zquez-Calatayud","year":"2022","unstructured":"V\u00e1zquez-Calatayud M, Regaira\u2010Mart\u00ednez E, Rumeu\u2010Casares C, Paloma\u2010Mora B, Esain A, Oroviogoicoechea C. Experiences of frontline nurse managers during the COVID\u201019: A qualitative study. J Nurs Adm Manag. 2022;30(1):79\u201389.","journal-title":"J Nurs Adm Manag"},{"issue":"1","key":"12759_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-022-08486-1","volume":"22","author":"R Troisi","year":"2022","unstructured":"Troisi R, De Simone S, Vargas M, Franco M. The other side of the crisis: organizational flexibility in balancing Covid-19 and non-Covid-19 health-care services. BMC Health Serv Res. 2022;22(1):1\u20131096.","journal-title":"BMC Health Serv Res"},{"key":"12759_CR4","doi-asserted-by":"publisher","unstructured":"Bj\u00f6rk L, Corin L, Akerstrom M, Jonsdottir IH, Innocenti AD, Wijk H, Ahlstrom L. Under pressure \u2013 The working situation of Swedish healthcare managers during the first wave of COVID-19. Front Psychol. 2023;13:1052382. https:\/\/doi.org\/10.3389\/fpsyg.2022.1052382.","DOI":"10.3389\/fpsyg.2022.1052382"},{"issue":"6","key":"12759_CR5","doi-asserted-by":"publisher","first-page":"1525","DOI":"10.1111\/jonm.13304","volume":"29","author":"JH White","year":"2021","unstructured":"White JH. A phenomenological study of nurse managers\u2019 and assistant nurse managers\u2019 experiences during the COVID-19 pandemic in the united States. J Nurs Adm Manag. 2021;29(6):1525\u201334.","journal-title":"J Nurs Adm Manag"},{"key":"12759_CR6","doi-asserted-by":"publisher","unstructured":"Alexiou E, Wijk H, \u00c5kerstr\u00f6m M, Jonsdottir IH, Degl\u2019 Innocenti A, Ahlstrom L. Worry perception and its association with work conditions among healthcare workers during the first wave of the COVID-19 pandemic: a web-based multimethod survey at a university hospital in Sweden. BMJ Open. 2024;14(2):e080248\u2013080248. https:\/\/doi.org\/10.1136\/bmjopen-2023-080248.","DOI":"10.1136\/bmjopen-2023-080248"},{"issue":"6","key":"12759_CR7","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1016\/j.colegn.2021.10.006","volume":"28","author":"R Middleton","year":"2021","unstructured":"Middleton R, Loveday C, Hobbs C, Almasi E, Moxham L, Green H, et al. The COVID-19 pandemic \u2013 A focus on nurse managers\u2019 mental health, coping behaviours and organisational commitment. Collegian. 2021;28(6):703\u20138.","journal-title":"Collegian"},{"issue":"8","key":"12759_CR8","doi-asserted-by":"publisher","first-page":"2392","DOI":"10.1111\/jonm.13422","volume":"29","author":"J Jackson","year":"2021","unstructured":"Jackson J, Nowell L. The office of disaster management\u2019nurse managers\u2019 experiences during COVID-19: A qualitative interview study using thematic analysis. J Nurs Adm Manag. 2021;29(8):2392\u2013400.","journal-title":"J Nurs Adm Manag"},{"key":"12759_CR9","unstructured":"Swedish National Board of Health and Welfare. Analys om pandemins effekt p\u00e5 v\u00e5rden 2020\u20132021 [Analysis of the impact of the pandemics on healthcare 2020\u20132021. 2022. https:\/\/www.socialstyrelsen.se\/statistik-och-data\/statistik\/alla-statistikamnen\/pandemins-effekter-pa-varden\/analys-uppdamda-vardbehov-efter-pandemin\/. Accessed 21 Mar 2025."},{"issue":"3","key":"12759_CR10","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1111\/nuf.12578","volume":"56","author":"AR Gab Allah","year":"2021","unstructured":"Gab Allah AR. Challenges facing nurse managers during and beyond COVID-19 pandemic in relation to perceived organizational support. Nurs Forum. 2021;56(3):539\u201349. https:\/\/doi.org\/10.1111\/nuf.12578.","journal-title":"Nurs Forum"},{"issue":"1","key":"12759_CR11","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1177\/17449871221124968","volume":"28","author":"ALF Aydogdu","year":"2023","unstructured":"Aydogdu ALF. Challenges faced by nurse managers during the COVID-19 pandemic: an integrative review. J Res Nurs. 2023;28(1):54\u201369.","journal-title":"J Res Nurs"},{"issue":"6","key":"12759_CR12","first-page":"1661","volume":"43","author":"J Bundy","year":"2017","unstructured":"Bundy J, Pfarrer MD, Short CE, Coombs WT. Crises and crisis management: integration, interpretation, and research development. J Manag. 2017;43(6):1661\u201392.","journal-title":"J Manag"},{"issue":"3","key":"12759_CR13","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1057\/palgrave.crr.1550049","volume":"10","author":"WT Coombs","year":"2007","unstructured":"Coombs WT. Protecting organization reputations during a crisis: the development and application of situational crisis communication theory. Corp Reput Rev. 2007;10(3):163\u201376.","journal-title":"Corp Reput Rev"},{"issue":"13","key":"12759_CR14","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1108\/MD-02-2021-0279","volume":"60","author":"CC Donelli","year":"2022","unstructured":"Donelli CC, Fanelli S, Zangrandi A, Elefanti M. Disruptive crisis management: lessons from managing a hospital during the COVID-19 pandemic. Manag Decis. 2022;60(13):66\u201391.","journal-title":"Manag Decis"},{"issue":"6","key":"12759_CR15","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1111\/puar.12558","volume":"76","author":"T Christensen","year":"2016","unstructured":"Christensen T, L\u00e6greid P, Rykkja LH. Organizing for crisis management: Building governance capacity and legitimacy. Public Adm Rev. 2016;76(6):887\u201397.","journal-title":"Public Adm Rev"},{"issue":"2","key":"12759_CR16","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3390\/soc7020012","volume":"7","author":"L Dellve","year":"2017","unstructured":"Dellve L, Eriksson A. Health-Promoting managerial work: A theoretical framework for a leadership program that supports knowledge and capability to craft sustainable work practices in daily practice and during organizational change. Societies. 2017;7(2):12.","journal-title":"Societies"},{"issue":"4","key":"12759_CR17","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1002\/sres.1083","volume":"28","author":"M Kira","year":"2011","unstructured":"Kira M, van Eijnatten FM. Socially sustainable work organizations: conceptual contributions and worldviews. Syst Res Behav Sci. 2011;28(4):418\u201321.","journal-title":"Syst Res Behav Sci"},{"issue":"14","key":"12759_CR18","doi-asserted-by":"publisher","first-page":"5041","DOI":"10.3390\/ijerph17145041","volume":"17","author":"B Worringer","year":"2020","unstructured":"Worringer B, Genrich M, M\u00fcller A, G\u00fcndel H, Angerer P, Contributors Of The Seegen Consortium. Hospital medical and nursing managers\u2019 perspective on the mental stressors of employees. Int J Environ Res Public Health. 2020;17(14):5041.","journal-title":"Int J Environ Res Public Health"},{"key":"12759_CR19","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1111\/sjop.12851","volume":"63","author":"C Gadolin","year":"2020","unstructured":"Gadolin C, Larsman P, Skyvell Nilsson M, Pousette A, T\u00f6rner M. How do healthcare unit managers promote nurses\u2019 perceived organizational support, and which working conditions enable them to do so? A mixed methods approach. Scand J Psychol. 2020;63:648\u201357.","journal-title":"Scand J Psychol"},{"key":"12759_CR20","doi-asserted-by":"publisher","first-page":"1039456","DOI":"10.3389\/fpsyg.2022.1039456","volume":"13","author":"G Abid","year":"2023","unstructured":"Abid G, Contreras F, Rank S, Ilyas S. Sustainable leadership and wellbeing of healthcare personnel: A sequential mediation model of procedural knowledge and compassion. Front Psychol. 2023;13:1039456.","journal-title":"Front Psychol"},{"key":"12759_CR21","doi-asserted-by":"publisher","first-page":"7","DOI":"10.2147\/JHL.S287243","volume":"13","author":"B H\u00f8lge-Hazelton","year":"2021","unstructured":"H\u00f8lge-Hazelton B, Kjerholt M, Rosted E, Hansen ST, Borre LZ, McCormack B. Health professional frontline leaders\u2019 experiences during the covid-19 pandemic: A cross-sectional study. J Healthc Leadersh. 2021;13:7\u201318.","journal-title":"J Healthc Leadersh"},{"key":"12759_CR22","unstructured":"Nemeth C, Wears R, Woods D, Hollnagel E, Cook R. Minding the gaps: creating resilience in health care. In: Henriksen K, Battles J, Keyes M, Grady M, editors. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools). Rockville (MD): Agency for Healthcare Research and Quality (US); 2008."},{"issue":"12","key":"12759_CR23","doi-asserted-by":"publisher","first-page":"4267","DOI":"10.3390\/ijerph17124267","volume":"17","author":"P Rangachari","year":"2020","unstructured":"Rangachari P, Woods JL. Preserving organizational resilience, patient safety, and staff retention during COVID-19 requires a holistic consideration of the psychological safety of healthcare workers. Int J Environ Res Public Health. 2020;17(12):4267.","journal-title":"Int J Environ Res Public Health"},{"key":"12759_CR24","doi-asserted-by":"publisher","unstructured":"Jonsdottir IH, Degl\u2019Innocenti A, Ahlstrom L, Finizia C, Wijk H, Akerstrom M. A pre\/post analysis of the impact of the COVID-19 pandemic on the psychosocial work environment and recovery among healthcare workers in a large university hospital in Sweden. J Public Health Res 2021;10(4). https:\/\/doi.org\/10.4081\/jphr.2021.2329.","DOI":"10.4081\/jphr.2021.2329"},{"issue":"2","key":"12759_CR25","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77\u2013101.","journal-title":"Qual Res Psychol"},{"issue":"9","key":"12759_CR26","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1097\/ACM.0000000000000388","volume":"89","author":"BC O\u2019Brien","year":"2014","unstructured":"O\u2019Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245\u201351.","journal-title":"Acad Med"},{"issue":"20","key":"12759_CR27","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","volume":"310","author":"A World Medical","year":"2013","unstructured":"World Medical A. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191\u20134.","journal-title":"JAMA"},{"issue":"1","key":"12759_CR28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/1609406917733847","volume":"16","author":"LS Nowell","year":"2017","unstructured":"Nowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: striving to Meet the trustworthiness criteria. Int J Qual Methods. 2017;16(1):1\u201313.","journal-title":"Int J Qual Methods"},{"issue":"4","key":"12759_CR29","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1111\/jonm.12741","volume":"27","author":"SL Fallman","year":"2019","unstructured":"Fallman SL, Jutengren G, Dellve L. The impact of restricted decision-making autonomy on health care managers\u2019 health and work performance. J Nurs Adm Manag. 2019;27(4):706\u201314.","journal-title":"J Nurs Adm Manag"},{"issue":"7","key":"12759_CR30","doi-asserted-by":"publisher","first-page":"2609","DOI":"10.1111\/jonm.13817","volume":"30","author":"S Ozmen","year":"2022","unstructured":"Ozmen S, Arslan Yurumezoglu H. Nurse managers\u2019 challenges and opportunities in the COVID-19 pandemic crisis: A qualitative descriptive study. J Nurs Adm Manag. 2022;30(7):2609\u201319.","journal-title":"J Nurs Adm Manag"},{"key":"12759_CR31","doi-asserted-by":"publisher","unstructured":"Gillberg N, Ahlstrom L, Erichsen Andersson A, Fallman SL, Degl\u2019Innocenti A, Jonsdottir IH, et al. Resilience capability and capacity in unexpected crises: experiences and lessons learned in a healthcare organisation during the COVID-19 pandemic. J Nurs Adm Manag. 2023;2023(1):6418267. https:\/\/doi.org\/10.1155\/2023\/6418267.","DOI":"10.1155\/2023\/6418267"},{"issue":"5","key":"12759_CR32","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.1111\/jonm.13249","volume":"29","author":"P Arcadi","year":"2021","unstructured":"Arcadi P, Simonetti V, Ambrosca R, Cicolini G, Simeone S, Pucciarelli G, et al. Nursing during the COVID-19 outbreak: A phenomenological study. J Nurs Adm Manag. 2021;29(5):1111\u20139.","journal-title":"J Nurs Adm Manag"},{"key":"12759_CR33","doi-asserted-by":"publisher","unstructured":"Hick JL, Hanfling D, Wynia MK, Pavia AT. Duty to plan: health care, crisis standards of care, and novel coronavirus SARS-CoV-2. Nam Perspect. 2020. https:\/\/doi.org\/10.31478\/202003b.","DOI":"10.31478\/202003b"},{"key":"12759_CR34","unstructured":"World Health Organization W. Strategy and planning. 2023. https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/strategies-and-plans. Acceced 21 Mar 2025."},{"issue":"12","key":"12759_CR35","doi-asserted-by":"publisher","first-page":"2459","DOI":"10.1111\/apa.15582","volume":"109","author":"JF Ludvigsson","year":"2020","unstructured":"Ludvigsson JF. The first eight months of Sweden\u2019s COVID-19 strategy and the key actions and actors that were involved. Acta Paediatr. 2020;109(12):2459\u201371.","journal-title":"Acta Paediatr"},{"issue":"1","key":"12759_CR36","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1111\/apa.16535","volume":"112","author":"JF Ludvigsson","year":"2023","unstructured":"Ludvigsson JF. How Sweden approached the COVID-19 pandemic: summary and commentary on the National commission inquiry. Acta Paediatr. 2023;112(1):19\u201333.","journal-title":"Acta Paediatr"},{"key":"12759_CR37","doi-asserted-by":"publisher","unstructured":"Rasmussen B, Holton S, Wynter K, Phillips DJ, David JL, Rothmann MJ, Skjoeth MM, Wijk H, Frederiksen K, Ahlstrom L, Anderson JE. We\u2019re on Mute! Exclusion of nurses\u2019 voices in National decisions and responses to COVID-19: an international perspective. J Adv Nurs. 2022;78(7):e87. https:\/\/doi.org\/10.1111\/jan.15236.","DOI":"10.1111\/jan.15236"},{"issue":"3","key":"12759_CR38","first-page":"158","volume":"68","author":"A Ruffin","year":"2023","unstructured":"Ruffin A, Shirey MR, Dick T, Fazeli PL, Patrician PA. Understanding the impact of span of control on nurse managers and hospital outcomes. J Healthc Manag. 2023;68(3):158\u201373.","journal-title":"J Healthc Manag"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-025-12759-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-025-12759-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-025-12759-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T16:13:50Z","timestamp":1747152830000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-025-12759-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,13]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["12759"],"URL":"https:\/\/doi.org\/10.1186\/s12913-025-12759-w","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,13]]},"assertion":[{"value":"20 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 May 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted in compliance with the Declaration of Helsinki [] and approved by the Swedish Ethical Review Authority (Ref. No. 2020\u201304771), and participants provided their informed consent by responding to a specific question in the web-based survey.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"690"}}