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Shi W, Chen R, Wang K, Wang Y, Gui L. Exploring hospital resilience protective or risk factors: lessons for future disaster response efforts. Front Public Health 2024; 12:1378257. [PMID: 38601510 PMCID: PMC11004231 DOI: 10.3389/fpubh.2024.1378257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024] Open
Abstract
Background Hospital resilience is essential in responding to disasters, but current research focuses mainly on frameworks and models rather than the protection of resilience and analysis of risk factors during public health emergencies. This study aims to examine the development of resilience in Chinese frontline hospitals during the initial COVID-19 outbreak in 2020, providing insights for future disaster response efforts. Objectives We conducted interviews with 26 hospital staff members who were involved in the initial response to the COVID-19 outbreak in China. We used a semi-structured interview approach and employed purposive sampling and snowball sampling techniques. The interview outline was guided by the 'Action Framework' proposed by the World Health Organization (WHO) for responding to infectious disease emergencies. This framework includes dimensions such as command, surveillance, risk communication, medical response, and public health response. We analyzed the collected data using Colaizzi's seven-step data analysis method and the template analysis method. Results WHO's 'action framework' effectively highlights the factors that contribute to hospital resilience. While medical response, including the availability of materials and facilities, the use of information technology, and the capacity for infectious disease diagnosis and treatment, remains crucial, other important aspects include awareness and beliefs about infections, treatment experience, interdisciplinary collaboration, and more. Additionally, it is essential to establish an intelligent command system, foster trusting partnerships between teams, improve monitoring capabilities for infectious disease agents, enhance risk communication through information synchronization and transparency, strengthen infection control planning, and improve environmental disinfection capabilities for effective public health emergency response. These contradictions significantly impact the enhancement of hospital resilience in dealing with major infectious disease outbreaks. Conclusion In responding to sudden major infectious diseases, hospitals play a vital role within the healthcare system. Enhancing hospital resilience involves more than just improving treatment capabilities. It also requires effective command coordination at the hospital level, infection control planning, and the deployment of intelligent equipment. Additionally, planning for effective communication and coordination between hospitals, communities, and the national healthcare system can further enhance hospital resilience.
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Affiliation(s)
- Wenwen Shi
- Department of Emergency Nursing, School of Nursing, Navy Military Medical University, Shanghai, China
| | - Rujie Chen
- Department of Emergency Nursing, School of Nursing, Navy Military Medical University, Shanghai, China
- 905th Hospital of the PLA Navy, Shanghai, China
| | - Kuan Wang
- Department of Emergency Nursing, School of Nursing, Navy Military Medical University, Shanghai, China
| | - Yixin Wang
- Department of Emergency Nursing, School of Nursing, Navy Military Medical University, Shanghai, China
| | - Li Gui
- School of Nursing, Navy Military Medical University, Shanghai, China
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Portela MC, Martins M, Lima SML, de Andrade CLT, de Aguiar Pereira CC. COVID-19 inpatient mortality in Brazil from 2020 to 2022: a cross-sectional overview study based on secondary data. Int J Equity Health 2023; 22:238. [PMID: 37978531 PMCID: PMC10655483 DOI: 10.1186/s12939-023-02037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND In Brazil, the COVID-19 pandemic found the universal and public Unified Health System (SUS) with problems accumulated over time, due, among other reasons, to low investments, and disparities in resource distribution. The preparedness and response of the healthcare system, involving the SUS and a private sector, was affected by large socioeconomic and healthcare access inequities. This work was aimed at offering an overview of COVID-19 inpatient mortality during the pandemic in Brazil, exploring factors associated with its variations and, specifically, differences across public, private (for-profit) and philanthropic (private non-profit) inpatient healthcare units, providers, and non-providers of services to the SUS. METHODS This cross-sectional study used public secondary data. The main data source was the SIVEP-Gripe, which comprises data on severe acute respiratory illness records prospectively collected. We also employed the National Record of Health Establishments, the SUS' Hospitalization Information System and municipalities' data from IBGE. We considered adult COVID-19 hospitalizations registered in SIVEP-Gripe from February 2020 to December 2022 in inpatient healthcare units with a minimum of 100 cases in the period. Data analyses explored the occurrence of inpatient mortality, employing general linear mixed models to identify the effects of patients', health care processes', healthcare units' and municipalities' characteristics on it. RESULTS About 70% of the COVID-19 hospitalizations in Brazil were covered by the SUS, which attended the more vulnerable population groups and had worse inpatient mortality. In general, non-SUS private and philanthropic hospitals, mostly reimbursed by healthcare insurance plans accessible for more privileged socioeconomic classes, presented the best outcomes. Southern Brazil had the best performance among the macro-regions. Black and indigenous individuals, residents of lower HDI municipalities, and those hospitalized out of their residence city presented higher odds of inpatient mortality. Moreover, adjusted inpatient mortality rates were higher in the pandemic peak moments and were significantly reduced after COVID-19 vaccination reaching a reasonable coverage, from July 2021. CONCLUSIONS COVID-19 exposed socioeconomic and healthcare inequalities and the importance and weaknesses of SUS in Brazil. This work indicates the need to revert the disinvestment in the universal public system, a fundamental policy for reduction of inequities in the country.
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Affiliation(s)
- Margareth Crisóstomo Portela
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
| | - Mônica Martins
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Sheyla Maria Lemos Lima
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Carla Lourenço Tavares de Andrade
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Claudia Cristina de Aguiar Pereira
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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Göras C, Lohela-Karlsson M, Castegren M, Condén Mellgren E, Ekstedt M, Bjurling-Sjöberg P. From Threatening Chaos to Temporary Order through a Complex Process of Adaptation: A Grounded Theory Study of the Escalation of Intensive Care during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7019. [PMID: 37947575 PMCID: PMC10649734 DOI: 10.3390/ijerph20217019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
To ensure high-quality care, operationalize resilience and fill the knowledge gap regarding how to improve the prerequisites for resilient performance, it is necessary to understand how adaptive capacity unfolds in practice. The main aim of this research was to explain the escalation process of intensive care during the first wave of the pandemic from a microlevel perspective, including expressions of resilient performance, intervening conditions at the micro-meso-macrolevels and short- and long-term consequences. A secondary aim was to provide recommendations regarding how to optimize the prerequisites for resilient performance in intensive care. A grounded theory methodology was used. First-person stories from different healthcare professionals (n70) in two Swedish regions were analyzed using the constant comparative method. This resulted in a novel conceptual model (including 6 main categories and 24 subcategories), and 41 recommendations. The conclusion of these findings is that the escalation of intensive care can be conceptualized as a transition from threatening chaos to temporary order through a complex process of adaptation. To prepare for the future, the components of space, stuff, staff, system and science, with associated continuity plans, must be implemented, anchored and communicated to actors at all levels of the system.
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Affiliation(s)
- Camilla Göras
- Department of Caring Sciences, Faculty of Health and Occupational Sciences, University of Gävle, SE-801 76 Gävle, Sweden;
- Department of Anesthesia and Intensive Care, Falu Hospital, SE-791 31 Falun, Sweden
| | - Malin Lohela-Karlsson
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, SE-752 37 Uppsala, Sweden;
- Centre for Clinical Research Västmanland, Uppsala University, SE-721 89 Västerås, Sweden;
| | - Markus Castegren
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE-171 77 Stockholm, Sweden;
- Centre for Clinical Research Sörmland, Uppsala University, SE-631 88 Eskilstuna, Sweden
| | - Emelie Condén Mellgren
- Centre for Clinical Research Västmanland, Uppsala University, SE-721 89 Västerås, Sweden;
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University Kalmar/Växjö, SE-392 31 Kalmar, Sweden;
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Petronella Bjurling-Sjöberg
- Centre for Clinical Research Sörmland, Uppsala University, SE-631 88 Eskilstuna, Sweden
- Department of Public Health and Caring Sciences, Caring Science, Uppsala University, SE-752 37 Uppsala, Sweden
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Neill R, Peters MA, Bello S, Dairo MD, Azais V, Samuel Jegede A, Adebowale AS, Nzelu C, Azodo N, Adoghe A, Wang W, Bartlein R, Liu A, Ogunlayi M, Yaradua SU, Shapira G, Hansen PM, Fawole OI, Ahmed T. What made primary health care resilient against COVID-19? A mixed-methods positive deviance study in Nigeria. BMJ Glob Health 2023; 8:e012700. [PMID: 37984895 PMCID: PMC10660915 DOI: 10.1136/bmjgh-2023-012700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/01/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION The SARS-CoV-2 (COVID-19) pandemic overwhelmed some primary health care (PHC) systems, while others adapted and recovered. In Nigeria, large, within-state variations existed in the ability to maintain PHC service volumes. Identifying characteristics of high-performing local government areas (LGAs) can improve understanding of subnational health systems resilience. METHODS Employing a sequential explanatory mixed-methods design, we quantitatively identified 'positive deviant' LGAs based on their speed of recovery of outpatient and antenatal care services to prepandemic levels using service volume data from Nigeria's health management information system and matched them to comparators with similar baseline characteristics and slower recoveries. 70 semistructured interviews were conducted with LGA officials, facility officers and community leaders in sampled LGAs to analyse comparisons based on Kruk's resilience framework. RESULTS A total of 57 LGAs were identified as positive deviants out of 490 eligible LGAs that experienced a temporary decrease in PHC-level outpatient and antenatal care service volumes. Positive deviants had an average of 8.6% higher outpatient service volume than expected, and comparators had 27.1% lower outpatient volume than expected after the initial disruption to services. Informants in 12 positive deviants described health systems that were more integrated, aware and self-regulating than comparator LGAs. Positive deviants were more likely to employ demand-side adaptations, whereas comparators primarily focused on supply-side adaptations. Barriers included long-standing financing and PHC workforce gaps. CONCLUSION Sufficient flexible financing, adequate PHC staffing and local leadership enabled health systems to recover service volumes during COVID-19. Resilient PHC requires simultaneous attention to bottom-up and top-down capabilities connected by strong leadership.
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Affiliation(s)
- Rachel Neill
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Michael A Peters
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Segun Bello
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Magbagbeola David Dairo
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Viviane Azais
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Ayodele Samuel Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Ayo Stephen Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Ngozi Azodo
- Nigeria Federal Ministry of Health, Abuja, Nigeria
| | | | - William Wang
- Exemplars in Global Health, Gates Ventures LLC, Kirkland, Washington, USA
| | - Rebecca Bartlein
- Exemplars in Global Health, Gates Ventures LLC, Kirkland, Washington, USA
| | - Anne Liu
- Exemplars in Global Health, Gates Ventures LLC, Kirkland, Washington, USA
| | - Munirat Ogunlayi
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Saudatu Umma Yaradua
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Gil Shapira
- Development Research Group, World Bank, Washington, District of Columbia, USA
| | - Peter M Hansen
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
| | - Olufunmilayo I Fawole
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tashrik Ahmed
- The Global Financing Facility for Women, Children, and Adolescents, Washington, District of Columbia, USA
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Raina N, Khanna R, Gupta S, Jayathilaka CA, Mehta R, Behera S. Progress in achieving SDG targets for mortality reduction among mothers, newborns, and children in the WHO South-East Asia Region. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 18:100307. [PMID: 38028159 PMCID: PMC10667297 DOI: 10.1016/j.lansea.2023.100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023]
Abstract
As we reach midway towards the 2030 Sustainable Developmental Goals (SDG), this paper reviews the progress made by the WHO South-East Asia Region (SEAR) and member countries towards achieving the SDG targets for maternal, newborn and child mortality under the regional flagship initiative. Indicators for mortality and service coverage were obtained for all countries and progress assessed in comparison to other regions and between countries. Equity analysis was conducted to focus on the impact on marginalized populations. The article also informs about the priority actions taken by the WHO SEAR office and countries in accelerating reductions in maternal, newborn and child mortality. Moving forward, the region and countries must strategize to sustain the gains made so far and also address challenges of inequities, sub-optimal quality of care, newer priorities like stillbirths, birth defects, early childhood development, and public health emergencies and adverse effects of climate change on human health.
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Affiliation(s)
- Neena Raina
- WHO Regional Office for South-East Asia, Delhi, India
| | - Rajesh Khanna
- WHO Regional Office for South-East Asia, Delhi, India
| | | | | | - Rajesh Mehta
- Formerly with WHO Regional Office for South-East Asia, Delhi, India
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van de Bovenkamp H, de Graaff B, Kalthoff K, Bal R. The patient representation struggle during the COVID-19 pandemic: Missed opportunities for resilient healthcare systems. Health Expect 2023; 27:e13877. [PMID: 37814486 PMCID: PMC10768858 DOI: 10.1111/hex.13877] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND The role of patient participation and representation during crises, such as the COVID-19 pandemic, has been under-researched. Existing studies paint a pessimistic picture of patient representation during the pandemic. However, there are indications that patient representatives have adapted to the new situation and can contribute to the resilience of healthcare systems. This paper aims to further explore the potential contribution of patient representatives for healthcare system resilience during the COVID-19 pandemic. METHODS The study used a qualitative approach. We conducted a thematic analysis on the following data: interviews with client council members (n = 32) and representatives from patient organizations (n = 6) and focus groups (n = 2) to investigate patient representation on both the national policy level and organizational level in the Netherlands. RESULTS We identified the crisis discourse, the dependent position, the diversity of patient perspectives and the layered decision-making structure as themes that help to understand what made patient representation in pandemic times a struggle for national and local patient representatives. The analysis of the subjects these representatives put forward during decision-making shows that their input can play an important role in broadening discussions, challenging decisions, and suggesting alternatives during a crisis. We identified several strategies (e.g., collaborating with other actors, proactively putting subjects on the policy agenda, finding new ways of contacting their 'constituency') used by the patient representatives studied to exert influence despite the difficulties encountered. CONCLUSIONS The struggle for patient representation during pandemic decision-making is a missed opportunity for resilient healthcare systems as these representatives can play a role in opening up discussions and putting different perspectives to the fore. Moreover, the adaptive strategies used by representatives to influence decision-making offer lessons for future representation activities. However, adaptations to the crisis decision-making structure are also needed to enable patient representatives to play their role. PATIENT CONTRIBUTION We conducted interviews with patient representatives and discussed our preliminary findings with patient representatives during the focus groups. Zorgbelang, a patient organization supporting client councils and enabling and organizing patient participation for organizations and municipalities, was partner in this research and contributed to the interview guide, conducting interviews and focus groups. Additionally, the analysis made by the first author was discussed and refined multiple times with the partners of Zorgbelang and one of them co-authored this paper.
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Affiliation(s)
| | - Bert de Graaff
- Erasmus School of Health Policy & ManagementErasmus UniversityRotterdamThe Netherlands
| | | | - Roland Bal
- Erasmus School of Health Policy & ManagementErasmus UniversityRotterdamThe Netherlands
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Poroes C, Seematter-Bagnoud L, Wyss K, Peytremann-Bridevaux I. Health System Performance and Resilience in Times of Crisis: An Adapted Conceptual Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6666. [PMID: 37681806 PMCID: PMC10487449 DOI: 10.3390/ijerph20176666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
With the COVID-19 pandemic, the notion of health system (HS) performance has been discussed, and the notion of resilience has become increasingly important. Lacking a recognised framework that measures the performance of HSs throughout a crisis, i.e., one that explicitly includes time as a key aspect, we examined the literature about conceptual frameworks for measuring the performance and the resilience of HSs. This review highlighted a significant diversity among 18 distinct HS performance frameworks and 13 distinct HS resilience frameworks. On this basis, we developed a model that integrates the WHO's widely recognised six building block framework in a novel approach derived from the European Observatory on HSs and Policies. The resulting framework adapts the building blocks to the different stages of a crisis, thereby allowing for a comprehensive assessment of an entire health system's performance throughout the crisis's duration, while also considering the key aspect of resilience. For a more pragmatic use of this framework in the future, indicators will be developed as a next step.
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Affiliation(s)
- Camille Poroes
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, 1010 Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, 1010 Lausanne, Switzerland
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- Faculty of Natural Science, University of Basel, 4001 Basel, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, 1010 Lausanne, Switzerland
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8
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Overton C, Emerson T, A Evans R, Armstrong N. Responsive and resilient healthcare? 'Moments of Resilience' in post-hospitalisation services for COVID-19. BMC Health Serv Res 2023; 23:720. [PMID: 37400780 DOI: 10.1186/s12913-023-09645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/04/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND COVID-19 caused disruption to healthcare services globally, resulting in high numbers of hospital admissions and with those discharged often requiring ongoing support. Within the UK, post-discharge services typically developed organically and were shaped over time by local need, funding, and government guidance. Drawing on the Moments of Resilience framework, we explore the development of follow-up services for hospitalised patients by considering the links between resilience at different system levels over time. This study contributes to the resilient healthcare literature by providing empirical evidence of how diverse stakeholders developed and adapted services for patients following hospitalisation with COVID-19 and how action taken at one system level influenced another. METHODS Qualitative research comprising comparative case studies based on interviews. Across three purposively selected case studies (two in England, one in Wales) a total of 33 semi-structured interviews were conducted with clinical staff, managers and commissioners who had been involved in developing and/or implementing post-hospitalisation follow-up services. The interviews were audio-recorded and professionally transcribed. Analysis was conducted with the aid of NVivo 12. RESULTS Case studies demonstrated three distinct examples of how healthcare organisations developed and adapted their post-discharge care provision for patients, post-hospitalisation with COVID-19. Initially, the moral distress of witnessing the impact of COVID-19 on patients who were being discharged coupled with local demand gave clinical staff the impetus to take action. Clinical staff and managers worked closely to plan and deliver organisations' responses. Funding availability and other contextual factors influenced situated and immediate responses and structural adaptations to the post-hospitalisation services. As the pandemic evolved, NHS England and the Welsh government provided funding and guidance for systemic adaptations to post-COVID assessment clinics. Over time, adaptations made at the situated, structural, and systemic levels influenced the resilience and sustainability of services. CONCLUSIONS This paper addresses understudied, yet inherently important, aspects of resilience in healthcare by exploring when and where resilience occurs across the healthcare system and how action taken at one system level influenced another. Comparison across the case studies showed that organisations responded in similar and different ways and on varying timescales to a disruption and national level strategies.
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Affiliation(s)
- Charlotte Overton
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Tristan Emerson
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Rachael A Evans
- Leicester NIHR Biomedical Research Centre - Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Natalie Armstrong
- Department of Population Health Sciences, University of Leicester, Leicester, UK.
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de Claro V. Reframing health systems resilience: a necessary step towards transformative action. BMJ Glob Health 2023; 8:e013233. [PMID: 37487645 PMCID: PMC10373662 DOI: 10.1136/bmjgh-2023-013233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
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Marchal B, Michielsen J, Simon S, Verdonck K, Accoe K, Tonga C, Polman K, Tawaytibhongs O, Cornu T, Dens S, Sy H, Nieto-Sanchez C, Van Belle S. Making 'resilience' useful again: recognising health system resilience as an effective boundary object. BMJ Glob Health 2023; 8:bmjgh-2023-012064. [PMID: 37247871 DOI: 10.1136/bmjgh-2023-012064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/05/2023] [Indexed: 05/31/2023] Open
Affiliation(s)
- Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Joris Michielsen
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Sara Simon
- Department of Conflict Resolution, University of Massachusetts, Boston, Massachusetts, USA
| | - Kristien Verdonck
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Kirsten Accoe
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Katja Polman
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Tom Cornu
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- Family Medicine and Population Health Department, University of Antwerp, Antwerpen, Belgium
| | - Stefanie Dens
- Research Group for Urban Development, University of Antwerp, Antwerpen, Belgium
- Department of Public Health, Institute of Tropical Medicine Department of Clinical Sciences, Antwerpen, Belgium
| | - Houssynatou Sy
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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Massuda A, Dall'Alba R, Chioro A, Temporão JG, Castro MC. After a far-right government: challenges for Brazil's Unified Health System. Lancet 2023; 401:886-888. [PMID: 36841254 DOI: 10.1016/s0140-6736(23)00352-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Adriano Massuda
- Departamento de Administração Fundação Getúlio Vargas-Escola de Administração do Estado de São Paulo e Centro de Pesquisa e Planejamento em Saúde (FGV-Saúde), São Paulo, Brazil
| | - Rafael Dall'Alba
- Organização Pan-Americana da Saúde Brasil and Department of Collective Health of the Faculty of Health Sciences of the University of Brasília, Campus Universitário Darcy Ribeiro, Brasília Distrito Federal 70.910-900, Brazil.
| | - Arthur Chioro
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - José Gomes Temporão
- Centro de Estudos Estratégicos, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
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12
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Yu Y, Zhou R, Qian L, Yang X, Dong L, Zhang G. Supply-demand balance and spatial distribution optimization of primary care facilities in highland cities from a resilience perspective: A study of Lhasa, China. Front Public Health 2023; 11:1131895. [PMID: 36969676 PMCID: PMC10032525 DOI: 10.3389/fpubh.2023.1131895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/06/2023] [Indexed: 03/10/2023] Open
Abstract
IntroductionThe development of urban resilience, which is fundamentally a balance between the supply capacity of primary care resources and the demand from urban residents, includes an appropriate architecture of primary care facilities. Resilient city construction in highland areas is hampered by the physical environment and transportation constraints and frequently encounters issues like poor accessibility and unequal distribution of primary care facilities.MethodsTo optimize the supply and demand of primary care resources in highland cities and effectively improve the resilience of urban public health, this paper assesses the distribution of primary care facilities within the built-up area of Lhasa (China) through a spatial network analysis method based on GIS, combined with population distribution data, and employs a location-allocation model to optimize the distribution.ResultsFirstly, the overall supply of primary care exceeds the overall demand, but the facilities' service area can only accommodate 59% of the residences. Secondly, there is a clear spatial variation in the accessibility of primary care facilities, and the time cost of healthcare is too high in some residences. Thirdly, the supply-demand relationship of primary care facilities is unbalanced, with both over-saturated and over-deficient areas.DiscussionAfter distribution optimization, the coverage and accessibility of primary care facilities have increased significantly, and the spatial imbalance of supply and demand has been alleviated. This paper proposes a research method to evaluate and optimize the spatial distribution of primary care facilities from multiple perspectives based on the resilience theory. The results of the study and visualization analysis methods can be used as an invaluable reference for planning the distribution of urban healthcare facilities and urban resilience construction in highland areas and other underdeveloped areas.
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Affiliation(s)
- Yang Yu
- School of Architecture, Southwest Jiaotong University, Chengdu, China
| | - Rui Zhou
- School of Architecture, Southwest Jiaotong University, Chengdu, China
| | - Liyuan Qian
- School of Architecture, Southwest Jiaotong University, Chengdu, China
| | - Xian Yang
- School of Architecture, Southwest Jiaotong University, Chengdu, China
| | - Liuyang Dong
- School of Architecture, Southwest Jiaotong University, Chengdu, China
| | - Guangyuan Zhang
- School of Transportation and Logistics, Southwest Jiaotong University, Chengdu, China
- *Correspondence: Guangyuan Zhang
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Chabrol F, David PM. How resilience affected public health research during COVID-19 and why we should abandon it. Glob Public Health 2023; 18:2212750. [PMID: 37196668 DOI: 10.1080/17441692.2023.2212750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/07/2023] [Indexed: 05/19/2023]
Abstract
Resilience has accompanied the COVID-19 pandemic as a rallying motto, with calls by governments for a resilient society, resilient families and schools, and, of course, resilient healthcare systems in the face of this unprecedented pandemic shock. Resilience had already gained traction as an analytical concept in public health research for approximately a decade. It became a key concept despite the recognition of its lack of conceptual consistency. The COVID-19 pandemic presented itself as a perfect test-case and encouraged a multiplicity of studies on resilience and health care systems. In this commentary, we add to the existing critiques of resilience in the social sciences by reflecting on the effects of resilience when used to frame empirical inquiries and to draw lessons from the crisis. Resilience as a concept is unable to address crucial structural issues that health systems already faced throughout the world, and it remains a non-neutral political notion. We argue that we need to resist a generalised view of resilience and work with alternative imaginaries.
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Affiliation(s)
- Fanny Chabrol
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
- Institute for Humanities in Africa (HUMA), University of Cape Town, Cape Town, South Africa
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