Transforming health care systems towards high-performance organizations: qualitative study based on learning from COVID-19 pandemic in the Basque Country

Abstract

Background: The COVID-19 pandemic is one of the worst health catastrophes of the last century, which caused severe economic, political, and social consequences worldwide. Despite these devastating consequences, a great opportunity has also opened up that can drive the reform of health systems to become high-performing, effective, equitable, accessible and sustainable organisations. This work identifies areas in which changes must be encouraged that will enable health systems to deal effectively with current and future challenges. Methods: A realist design was chosen, based on qualitative data collection techniques, content analysis and triangulation to identify subject matters (areas of intervention) behind the changes implemented to react to the COVID 19 pandemic in the Basque Country. Twenty key informants were used as an expert source of information. Thematic analysis was done using the Framework Method. Results: The analysis of the interviews resulted in the identification of 106 codes, which were reviewed and agreed upon by the researchers. Following the process of methodological analysis, these codes were grouped into 24 sub-themes, and these in turn into 7 themes. Specifically, the themes and sub-themes (in brackets) are: responsiveness (planning, governance, organisational elasticity and staff flexibility), telehealth (telecare, telework and telecoordination), integration (teamwork, collaborative networks, coordination with Public Health and partnerships), knowledge management (intellectual capital, scientific evidence, transmission and training), professional roles (reinforcement and innovation), digitisation (strategy, data analytics, automation and interoperability) and organisational communication (management, content and channels). The detailed description of each theme and subtheme is presented. Conclusions: The findings of this work pretend to guide the transformation of health systems into organisations that can improve the health of their populations and providing high quality care. Such a multidimensional and comprehensive reform encompasses both strategic and operational actions in diverse areas and requires a broad and sustained political, technical, and financial commitment.