Government Actions and Their Relation to Resilience in Healthcare During the COVID-19 Pandemic in New South Wales, Australia and Ontario, Canada

Abstract

Background: Resilience, a system's ability to maintain a desired level of performance when circumstances disturb its functioning, is an increasingly important concept in healthcare. However, empirical investigations of resilience in healthcare (RiH) remain uncommon, particularly those that examine how government actions contribute to the capacity for resilient performance in the healthcare setting. We sought to investigate how governmental actions during the coronavirus disease 2019 (COVID-19) pandemic related to the concept of resilience, how these actions contributed to the potential for resilient performance in healthcare, and what opportunities exist for governments to foster resilience within healthcare systems. Methods: We conducted case studies of government actions pertaining to the COVID-19 pandemic in New South Wales, Australia and Ontario, Canada. Using media releases issued by each government between December 2019 and August 2020, we performed qualitative content analysis to identify themes relevant to the resilience potentials (anticipate, monitor, respond, learn) and RiH. Results: Direct references to the term 'resilience' appeared in the media releases of both governments. However, these references focused on the reactive aspects of resilience. While actions that constitute the resilience potentials were evident, the media releases also revealed opportunities to enhance learning (eg, a need to capitalize on opportunities for double-loop learning and identify strategies appropriate for complex systems) and anticipating (eg, incorporating the concept of hedging into frameworks of RiH). Conclusion:Though fostering RiH through government action remains a challenge, this study suggests opportunities to realize this goal. Articulating a proactive vision of resilience and recognizing the complex nature of current systems could enhance governments' ability to coordinate resilient performance in healthcare. Reflection on how anticipation relates to resilience appears necessary at both the practical and conceptual levels to further develop the capacity for RiH.

Reimagining consumer involvement: Resilient system indicators in the COVID‐19 pandemic response in New South Wales, Australia

“…Their capacity to be responsive and make constant adjustments before, during or following both expected and unexpected events are key to resilience in these systems 6 . Indeed, studies show that health systems with components that were agile, adaptive and encouraged flexibility tended to do better in the pandemic, while more rigid systems were forced to change 1,2,7 . In Australia, healthcare organizations made rapid changes for better functioning during the pandemic, including introducing new policy advisory groups, 8 reforms in patient care protocols, 9 reallocation and co‐ordination of roles and resources between public and private hospitals and adoption of telehealth and its inclusion as a Medicare (public funding) billing item.…”

Resilience of Health Systems: Understanding Uncertainty Uses, Intersecting Crises and Cross-level Interactions Comment on "Government Actions and Their Relation to Resilience in Healthcare During the COVID-19 Pandemic in New South Wales, Australia and Ontario, Canada"

“…To advance our understanding and knowledge of such 'contextualized' system resilience through analyses of uncertainty uses, systemic intersections, or cross-level interactions, we need conceptual and analytical clarity. In view of the empirical landscape on health system resilience 4 and the non-exhaustive view of the emerging literature, 5,8,10 we argue that agreement (or at least clarity) is needed whether resilience is studied as outcome, mediator, or determinant of a system's performance. Some studies use these interchangeably: resilience as underlying feature or potential, required to achieve a given outcome, while at the same time the system "was" or "proved" resilient.…”

“…In the study of Smaggus et al, the government communication resembled the mechanistic and probabilistic modes of dealing with uncertainties, while their related responses were characterised by an overemphasise on prescriptive measures and protocols to compensate for the incomplete knowledge and uncertainty caused by the pandemic. 10 This aspect is interlinked not only with the absorptive or adaptive capacity of a system, but especially with its, empirically widely neglected 4 , transformative capacity. Keeping in mind the unpredictability of social behaviour under crises situations, 6 we need to advance our understanding of why, how, and to which end uncertainties are used by decisionmakers to advance or impede change, and how these uses shape the response to existential threats such as the pandemic.…”

Government Actions and Their Relation to Resilience in Healthcare; What We See Is Not Always What We Get Comment on "Government Actions and Their Relation to Resilience in Healthcare During the COVID-19 Pandemic in New South Wales, Australia and Ontario, Canada"

“…Endnote [1] Note to editor: a summary of the webinar can be found at https://www.zwollenu. nl/wp-content/uploads/2020/03/FMS_Webinar_COVID-19_2020-03-18.…”

“…4 As Smaggus wrote in an earlier article, success in complex systems requires front-line workers to adapt to dynamic circumstances and vary their behaviour to match their conditions. 5 To give an example from the country we are most familiar with: at a webinar for medical staff on March 18, 2020, in the first weeks of the COVID-19 pandemic in the Netherlands, the director of the Dutch Health & Youth Care Inspectorate urged doctors to not let guidelines or regulations get in the way of treating their patients [1] . This created space for healthcare professionals to respond and adjust to the situation as it evolved and can be seen as a governmental action to increase RiH.…”