Framing the pandemic: Multiplying "crises" in Dutch healthcare governance during the emerging COVID-19 pandemic

COVID time: Temporal imaginaries and pandemic materialities

Since the advent of the COVID-19 pandemic, several ways of understanding time have emerged: what we may call 'COVID time'. Based on 40 qualitative online interviews in 2022 with Australians living across the continent, this article examines how people situated themselves and COVID-19 in historical time. It further explores how material aspects, place and space (or "pandemic materialities") factored into lived experiences and temporal imaginaries. We focus on how time-related concepts such as synchronisation and the definition of crises and events are interrelated in the participants' understandings of COVID as either over or a continuing crisis. The sociomaterial dimensions that served to alert people to risk and encourage them to engage in preventive action are identified as ways in which COVID time was experienced, remembered, understood and imagined. While some respondents claimed that the present moment was 'post-COVID', for others, the pandemic was far from over in 2022 and indeed stretched into the future. We use a sociomaterial lens to show how respondents portray the 'temporal technologies' and 'objectifications' of the event of COVID-19-the tangible materialisations of its temporal status as either relegated to the past or continuing as a mode of present and future crisis.

Organizational resilience in emergency healthcare: Lessons from the COVID-19 pandemic in five Danish hospitals

The COVID-19 pandemic created significant challenges for healthcare professionals and the provision of hospital care, leading to immense stress and rapidly changing conditions. Hospitals had to constantly adapt their organizational structures and strategies to manage the crisis. This study examines the organizational responses of Danish emergency hospitals during the first COVID-19 surge, focusing on resilience in anticipation, coping, and learning. We conducted a study involving interviews with healthcare professionals and managers from the five emergency hospitals in the Central Denmark Region. The interview guides were based on multi-contingency theory for organizational design, with open-ended discussions to compare key organizational components across hospitals. Topics covered included hospital configuration, task design, resources, information systems, leadership, and coordination during the first surge. Interviews were cross-validated with administrative documents. Results showed that hospitals responded differently to national and regional directives, continuously adjusting their governance structures and strategies to meet the demands for new procedures and information sharing. The ability to introduce, learn from, and adapt organizational changes as the pandemic unfolded was crucial to building resilience. This study provides insights into organizational resilience in healthcare and highlights practical lessons for managing future crises.

Singapore's COVID-19 crisis decision-making through centralization, legitimacy, and agility: an empirical analysis

Background

Decision-making during health crises differs from routine decision-making and is constrained by ambiguity about evolving epidemiological situations, urgency of response, lack of evidence, and fear. Recent analyses of governance and decision-making during COVID-19, focusing on leadership qualities, involvement of specific stakeholders, and effective resource management, do not adequately address a persisting gap in understanding the determinants of decision-making during health crises at the national level.

Methods

We undertook a study to understand the processes and characteristics of decision-making during the COVID-19 pandemic in Singapore. We used a case study approach and collected empirical evidence about public health decision-making, using a combination of key informant interviews and focus group discussions with stakeholders from government, academia and civil society organizations.

Findings

We argue that administrative centralization and political legitimacy played important roles in agile governance and decision-making during the pandemic in Singapore. We demonstrate the role of the Singapore government's centralization in creating a unified and coherent governance model for emergency response and the People's Action Party's (PAP) legitimacy in facilitating people's trust in the government. Health system resilience and financial reserves further facilitated an agile response, yet community participation and prioritization of vulnerable migrant populations were insufficient in the governance processes.

Interpretation

Our analysis contributes to the theory and practice of crisis decision-making by highlighting the role of political and administrative determinants in agile crisis decision-making.

Funding

This study is funded by the U.S. Centers for Disease Control and Prevention through a Cooperative Research Agreement (NU2HGH2020000037).

Are we heroes or couriers? A phenomenological study on reappropriation of professional subjectivity and agency among health professionals during COVID-19 contact tracing in Türkiye

During the COVID-19 pandemic, Türkiye implemented a distinctive contact tracing approach involving in-person home visits by medical professionals to individuals who tested positive for the virus. This study examines the experiences of health professionals involved in contact tracing, exploring how they reappropriated their professional subjectivity and agency during their deployment in this role. It is an interpretive phenomenological qualitative study. We conducted 21 semi-structured in-depth interviews, subsequently carried out two separate focus group interviews with an additional 31 participants from various districts in Istanbul. Participants were selected from different medical professions (i.e. doctors, nurses, midwives), career stages, gender and age groups, and hierarchical levels (i.e. officers and directors). Data analysis was conducted collaboratively by the research team from sociology and public health disciplines. Our main finding is that for the majority of health professionals, contact tracing was a novel experience with challenges and ambivalances. Yet, regardless of their perceptions (positive, negative, or mixed), the experience promoted a reaffirmation of professional identity and reappropriation of professional subjectivity and agency, which discloses that professional subjectivity is not firm but dynamic, carrying stability as well as flexibility and adjustment. Four main themes are identified in their reappropriation of professional subjectivity and agency: uncovering professional fulfillment, feeling restrained in professional dissatisfaction, assessing the job, and engaging in professional and bureaucratic negotiations.The profound exploration into the dynamics of contact tracing amidst the pandemic illuminates a multidimensional narrative that transcends the conventional discourse on physical and psychological stress experienced by medical professionals. Contact tracing experience had a transformative impact on meaning and purpose of professional identity. Our findings highlight a need for a balanced approach between centralized decision-making, mobilization of professionals, quantitative evaluation, and professional autonomy and discretion, qualitative assessments, and meaningful engagement.

The patient representation struggle during the COVID-19 pandemic: Missed opportunities for resilient healthcare systems

BACKGROUND

The role of patient participation and representation during crises, such as the COVID-19 pandemic, has been under-researched. Existing studies paint a pessimistic picture of patient representation during the pandemic. However, there are indications that patient representatives have adapted to the new situation and can contribute to the resilience of healthcare systems. This paper aims to further explore the potential contribution of patient representatives for healthcare system resilience during the COVID-19 pandemic.

METHODS

The study used a qualitative approach. We conducted a thematic analysis on the following data: interviews with client council members (n = 32) and representatives from patient organizations (n = 6) and focus groups (n = 2) to investigate patient representation on both the national policy level and organizational level in the Netherlands.

RESULTS

We identified the crisis discourse, the dependent position, the diversity of patient perspectives and the layered decision-making structure as themes that help to understand what made patient representation in pandemic times a struggle for national and local patient representatives. The analysis of the subjects these representatives put forward during decision-making shows that their input can play an important role in broadening discussions, challenging decisions, and suggesting alternatives during a crisis. We identified several strategies (e.g., collaborating with other actors, proactively putting subjects on the policy agenda, finding new ways of contacting their 'constituency') used by the patient representatives studied to exert influence despite the difficulties encountered.

CONCLUSIONS

The struggle for patient representation during pandemic decision-making is a missed opportunity for resilient healthcare systems as these representatives can play a role in opening up discussions and putting different perspectives to the fore. Moreover, the adaptive strategies used by representatives to influence decision-making offer lessons for future representation activities. However, adaptations to the crisis decision-making structure are also needed to enable patient representatives to play their role.

PATIENT CONTRIBUTION

We conducted interviews with patient representatives and discussed our preliminary findings with patient representatives during the focus groups. Zorgbelang, a patient organization supporting client councils and enabling and organizing patient participation for organizations and municipalities, was partner in this research and contributed to the interview guide, conducting interviews and focus groups. Additionally, the analysis made by the first author was discussed and refined multiple times with the partners of Zorgbelang and one of them co-authored this paper.

Perspectives on Assessing the Flexibility of Hospitals for Crisis Mode Operations: Lessons From the COVID-19 Pandemic in the Netherlands

BACKGROUND

The COVID-19 pandemic placed healthcare design at the heart of the crisis. Hospitals faced challenges such as rapidly increasing their intensive care unit capacity, enabling physical distancing measures, quickly converting to telehealth and telework practices, and above all, keeping patients and staff safe. Improving flexibility in hospital facility design and adaptability of hospital operations to function in "crisis mode" can be seen as ways of future-proofing for pandemics. In a design brief, flexibility is typically mentioned as an important target. Meanwhile, robustness of technical infrastructure is called for, and standardization at unit level with single-occupancy inpatient accommodation may be considered a way to enhance flexibility and adaptability in dealing with a surge in infectious patients.

AIM

To future-proof facility design with pandemic preparedness and resilience in mind, this study evaluated what kinds of interventions were taken in Dutch hospital facilities and what perspectives need to be considered when hospitals operate in crisis mode.

METHODS

We have collected data from facility and estate professionals from 30 Dutch hospitals. Using a practice-based approach, in-depth interviewing helped uncover and compare successful operational strategies and design elements that provided the flexibility needed in the early stages of the recent crisis.

RESULTS

As we looked at existing facilities and alterations made to allow hospitals to operate during the COVID-19 pandemic, we discovered that staff availability and adaptability were deemed crucial.

CONCLUSION

We add the perspective of staff as an essential factor to be considered when future-proofing hospital facility desigr crisis mode operation.