How to not revert to type: Complexity-informed learnings from the pandemic response for health system reform and universal access to integrated care

Abstract

This article is part of the Research Topic ‘Health Systems Recovery in the Context of COVID-19 and Protracted Conflict’.BackgroundCOVID-19 has highlighted existing health inequalities and health system deficiencies both in Ireland and internationally; however, understanding of the critical opportunities for health system change that have arisen during the pandemic is still emerging and largely descriptive. This research is situated in the Irish health reform context of Sláintecare, the reform programme which aims to deliver universal healthcare by strengthening public health, primary and community healthcare functions as well as tackling system and societal health inequities.Aims and objectivesThis study set out to advance understanding of how and to what extent COVID-19 has highlighted opportunities for change that enabled better access to universal, integrated care in Ireland, with a view to informing universal health system reform and implementation.MethodsThe study, which is qualitative, was underpinned by a co-production approach with Irish health system leadership. Semi-structured interviews were conducted with sixteen health system professionals (including managers and frontline workers) from a range of responses to explore their experiences and interpretations of social processes of change that enabled (or hindered) better access to universal integrated care during the pandemic. A complexity-informed approach was mobilized to theorize the processes that impacted on access to universal, integrated care in Ireland in the COVID-19 context.FindingsA range of circumstances, strategies and mechanisms that created favorable system conditions in which new integrated care trajectories emerged during the crisis. Three key learnings from the pandemic response are presented: (1) nurturing whole-system thinking through a clear, common goal and shared information base; (2) harnessing, sharing and supporting innovation; and (3) prioritizing trust and relationship-building in a social, human-centered health system. Policy and practice implications for health reform are discussed.

Governing Integrated Health and Social Care: An Analysis of Experiences in Three European Countries

“…Conversely, while the COVID-19 pandemic has placed major pressure on the health and social care systems in all countries, the pandemic was not considered as a catalyst for enduring novel ways of working. We found that the pandemic highlighted and exacerbated existing weaknesses within and across the health and social care systems in all three countries, confirming observations reported elsewhere [24]. Perhaps surprisingly, given that we sampled three countries with different approaches to driving integration, we did not identify particular integrated system governance models that showed themselves to be more (or less) resilient to recovering from the pandemic.…”

Experiences of health service access: A qualitative interview study of people living with Parkinson's disease in Ireland

“…While the 2017 ‘Sláintecare’ health policy outlined a 10‐year structural health service reform plan for Ireland, towards universal healthcare 19 and had cross‐party political support, the commitment to full and timely implementation is still unclear. Parker et al 20 highlight how the COVID‐19 pandemic led to system‐wide, rapid pivots in care organisation and provision, and that we should use the key learnings from this to inform the shift towards universal healthcare.…”

Examining universal access to acute hospital care in Ireland during the first three months of COVID-19: Lessons from the policy process

“…This study forms one of the workstreams within the Health Research Board (HRB)-funded Foundations' research project that aims to harness key learnings from Ireland's health system response to COVID-19 with a view to informing the implementation of Ireland's ten-year health reform plan, Sláintecare 17,29,38,[64][65][66] .…”

“…This intersection gains heightened relevance within the Irish context, where the interplay between universalist COVID-19 policies and a substantial private sector holds particular significance. The emergence of UHC principles played a central role in responding to the COVID-19 crisis 17,18,28,29 . Although additional capacity from the private sector was deemed necessary, the primary emphasis remained on upholding an equitable public sector-driven pandemic response 30 .…”