Resilience in keeping the balance between demand and capacity in the COVID-19 pandemic, a case study at a Swedish middle-sized hospital

Abstract

Background In pandemics, it is critical to find a balance between healthcare demand, and capacity, taking into consideration the demands of the patients affected by the pandemic, as well as other patients (in elective or emergency care). The purpose of this paper is to suggest conceptual models for the capacity requirements at the emergency department, the inpatient care, and intensive care unit as well as a model for building staff capacity in pandemics. Methods This paper is based on a qualitative single case study at a middle-sized hospital in Sweden. The primary data are collected from 27 interviewees and inductively analyzed. Results The interviewees described a large difference between the immediate catastrophe scenario described in the emergency plan (which they had trained for), and the reality during the COVID-19 pandemic. The pandemic had a much slower onset and lasted longer compared to, for example, an accident, and the healthcare demand fluctuated with the societal infection. The emergency department and inpatient care could create surge capacity by reducing elective care. Lower inflow of other emergency patients also helped to create surge capacity. The number of intensive care beds increased by 350% at the case hospital. At the same time, the capacity of the employees decreased due to infection, exhaustion, and fear. The study contributes to knowledge of conceptional models and key factors affecting the balance between demand and capacity. Conclusion The framework suggests conceptual models for balancing surge capacity during a pandemic Health care practitioners need to provide assumptions of the key factors to find the balance between the demand and capacity corresponding to the reality and maintain the delivery of high-quality healthcare services.

COVID-19 healthcare success or failure? Crisis management explained by dynamic capabilities

“…The interviews were semi-structured, which means the interviewees were allowed to talk freely, and the interviewer avoided affecting the interviewees [ 37 ]. The same researcher moderated all interviews and used a semi structured interview guide as been described in earlier research [ 6 ], with topics of the feeling of the size of the disaster, the contingency plan, how they built capacity for the COVID-19 patients, management during the pandemic and the information flow, as support. Another researcher actively observed the interviews and used the interview guide to follow the completeness of the collection of information and sometimes added a few questions for completion.…”

“…Usually the flow of information comes from a rescue leader through the regional management that prioritizes and distributes the patients to the hospitals [ 5 ]. The hospital management needs to use the in-house knowledge and improve the mobility at the hospital [ 6 ]. Thus, the management’s need in a pandemic is less hierarchical and more learning and innovative [ 4 , 7 , 8 ].…”