Organizational approaches to implement rapid change in hospitals to respond to public health emergencies

Abstract

The COVID-19 pandemic has intensified the need for crisis preparedness among public health systems worldwide. Securing both human and financial resources to improve standards of health care remains a global priority (1-4). Yet, efforts to improve preparedness lack the necessary frameworks to develop and sustain improvements in health care systems’ processes and outcomes (5,6). The sudden and far-reaching impact of the COVID-19 pandemic has prompted scientists to develop frameworks that aim to adequately prepare hospitals and other health service delivery systems for surges in demand for care. A report on the operational readiness of nations on several indicators of preparedness found that only 57% of 182 countries had the functional capacity to execute crucial emergency-related activities (7). Elements of health care systems that have been implicated in low levels of preparedness have varied, ranging from supply chain failures, workforce shortages, organizational readiness for change, and resource constraints, among others (8,9). The COVID-19 pandemic has certainly impacted these elements. With decades of organizational research on the adoption and implementation of innovative practices, system and organizational scientists are poised to help health care organizations respond to the need for technical, financial, and cultural resources to effectively address public health crises (10-12). In this special issue, we embarked on an exploration of health care systems’ capacity to respond to increasing public health challenges, to meet the global imperative for more efficient and effective crisis preparedness infrastructure. This special issue on “organizational approaches to implement rapid change in hospitals to respond to public health emergencies” presents conceptual and empirical papers on various approaches that hospitals and other health care organizations could implement to counteract current (e.g., the COVID-19 pandemic), ongoing (e.g., HIV, opioid overdose) and emerging epidemics that will impact global health. The purpose of this special issue is to advance Systems, as well as Organizations and Implementation Sciences by developing and testing frameworks that lead to a highly responsive and effective public health system. These interdisciplinary sciences organizational learning in hospitals’ response to crisis management with regard to COVID-19 (15). Focusing on the practice of disaster management and crisis-driven changes, the authors review published case studies that reveal which components of change were most effective in preparing hospitals to respond to patients care challenges during the COVID-19 pandemic. The authors focus on efforts to help professionals and policy makers developed robust responses across different countries in the world. Their findings inform a framework for optimal patient care response, including the use of big data systems. The last paper in the series is written by Drs. Choflet, Packard, and Stashower, who also offer a framework on organizational change that can be used to design organizations with the ability to effectively adapt to different types of change (16). In their article, which focuses on organizational change and the need to rethink existing approaches, especially in Covid-19 era, the authors advance a planned organizational change framework relying on complexity theory. The theory informs their conceptualization of hospitals as complex adaptive systems, and how this framing can better position organizations to respond to COVID-19 and future emergent public health challenges. The authors redesign areas such as constant assessment, ongoing high levels of communication, iterative cycles of experimentation, reflection and learning, and use of leadership behaviors in order to improve decision-making. The paper highlights key practices that can be used to adapt the organizational change needs of healthcare organizations. These four articles provide conceptual frameworks and empirical data that inform best practices for healthcare organizations, and effectively responding to the multiple challenges resulting from the COVID-19 pandemic. Preparing hospitals and other health care delivery organizations to respond to crises more effectively, both current and emerging, will requires additional understanding of the complex relationship between patients’ needs and demands, and resources at multiple levels. This special issue addresses a broad range of topics important to enhancing organizational approaches that promote the rapid and effective implementation of change in health care systems in response to public health emergencies. It centers Innovation and operational flexibility, effective crisis management practices, organizational learning and translation of big data systems, and rethinking