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The lockdown strategy used to prevent the spread of COVID-19 (coronavirus disease 2019) has disrupted the global economy. Some countries have started reopening their economies under the threat of a second wave because studies show that only 4% of the population is infected so far and more waves will be needed to achieve herd immunity. Lockdowns have been used with a primary purpose of regulating the demand for healthcare while ignoring the economic consequences. Contrary to the lockdown strategy, some countries such as Brazil have given priority to their economy leading to very high infection and mortality rates. After a first wave of the pandemic, we now know something critically important-those who are likely to become seriously ill and potentially die if SARS-CoV-2 infection is not prevented. That information cannot be ignored in our strategy and is used to control the pandemic. The paper proposes to focus on managing the risk of the virus being transmitted to the vulnerable rather than focusing on controlling all who can potentially transmit it. It argues that only 4% of the global population is at high risk of severe COVID-19 and would require hospital admission if infected. We propose to target this 4% of the population for preventive efforts. Protecting the vulnerable via lockdowns and other measures will be more effective and efficient than locking down the entire population and destroying their economies that are equally critical to life. We hypothesize that such "targeted prevention" strategies are more likely to help achieve our goals: 1) reduce mortality by preventing the infection reaching its potential victims, 2) spend the resources efficiently by knowing the "target" of our preventive efforts, and 3) achieve effective and efficient control of the pandemic without causing disruption to the socioeconomic activities until an effective vaccine is available.

Background: The functional role of Comprehensive Unit-based Safety Program (CUSP) teams was extended to empower them and make them a part of the organizational management. Purpose: These improvements in the functional roles of CUSP were made with the objective of solving two structural issues, namely, departmentalization and compartmentalization present in health care organizations. Methods: The following were three improved functional roles: 1) instead of just being a reactive mechanism to implement improvements based on real safety issues, they also carried out risk analysis and implemented preventive actions proactively; 2) instead of focusing only on safety, they controlled all results such as safety, quality, treatment effectiveness and timeliness of their respective process units, using a series of Key Performance Indicators; and 3) instead of being a supplementary multidisciplinary team parallel to the organization´s departmentalized management structure, they were made to participate in the decision-making structure, representing their respective process units. These teams represented different process units and were named as Comprehensive Unit-based Process (CUP) teams. Results: The CUP structural design changed the dynamics of the organization: 1) it integrated members of different disciplines, especially physicians and nurses, and integrated them into a team with a shared goal, making internal communication and teamwork a “systemic” requirement; 2) it disabled the middle-level managers to represent the interests of specific knowledge-based groups such as physician departments or nursing areas while making decisions; and 3) it reassigned middle-level managers the task of representing different CUPs, making each manager responsible for a process unit, thus ensuring control over the results of multidisciplinary activities. Conclusion: The new organizational structure put burden on the system, not on its people, as it made multidisciplinary communication and teamwork to be the rule of the game, allowing patient-centered health care.

Stress and burnout are common among healthcare workers, with negative implications for their personal and organizational objectives. They have higher rates of suicides, traffic accidents, psychosomatic illness, consumption of tobacco, alcohol, and other drugs. Healthcare organizations also face the consequences of decreased motivation, increased absenteeism and high turnover of their employees. To carry out their task of providing a safe, effective, fast and efficient service to their customers, employees need to be motivated. In this article, five preventive mechanisms to increase employee motivation are proposed: 1) eliminating systemic conflict and friction among employees by improving the definitions of roles, responsibilities, and authorities; 2) improving resource distribution criteria among different patient-centered organizational processes so that the expected results are correctly correlated to resource availability; 3) ensuring that the organization detects potential deficiencies in the knowledge/competence of its personnel in a pro-active manner and providing them with the necessary training to perform their assigned tasks; 4) defining and using internal communication channels to communicate the objectives of the organization and the results obtained, facilitating employee participation and recognizing their contributions; 5) creating a feedback loop between employees and the management to measure, analyze, and continuously improve their motivational levels.