The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic.
The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic.
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DOI：
10.34172/ijhpm.2021.130
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发表时间：
2022-10-19
影响因子：
3.5
通讯作者：
Lingam R
中科院分区：
文献类型：
--
作者：
Hodgins M;van Leeuwen D;Braithwaite J;Hanefeld J;Wolfe I;Lau C;Dickins E;McSweeney J;McCaskill M;Lingam R
背景：2019冠状病毒病（COVID-19）已导致全球超过200万人死亡。澳大利亚的经验提供了一个研究对COVID-19卫生系统冲击的对比反应的机会。我们采用Hanefeld等人的卫生系统冲击框架，创建了COVID-19系统冲击框架（CSSF）。这一框架使我们能够评估悉尼儿童医院网络（SCHN）通过COVID-19带来的创新和变化，SCHN是南半球最大的儿童健康服务提供商。 方法：我们在CSSF的指导下，使用民族志方法来绘制大流行期间在SCHN实施的创新和举措。一名嵌入式实地研究员跟踪紧急行动中心（EOC）的成员长达9个月。我们还审查了与SCHN应对COVID-19相关的诊所和政策文件，并与利益相关者进行了访谈和焦点小组，包括临床主任，项目经理，一线临床医生以及参与在SCHN实施创新的其他人员。 结果：CSSF捕捉到了SCHN对大流行的复杂反应。应对措施包括COVID-19评估诊所、住院和传染病管理服务、重新部署和管理在家工作的员工队伍、有凝聚力的沟通举措以及远程护理服务，所有这些都是通过专门的COVID-19基金实现的。塑造SCHN应对大流行的卫生系统价值观包括医疗服务提供的公平原则、全面和综合的护理模式，支持劳动力福利。SCHN的弹性是通过非等级化的治理结构和对新出现的挑战的响应与单一愿景的平衡来实现的。 结论：使用CSSF，我们发现SCHN的创新能力是确保其在大流行期间恢复能力的关键。
Background: Coronavirus disease 2019 (COVID-19) has resulted in over 2 million deaths globally. The experience in Australia presents an opportunity to study contrasting responses to the COVID-19 health system shock. We adapted the Hanefeld et al framework for health systems shocks to create the COVID-19 System Shock Framework (CSSF). This framework enabled us to assess innovations and changes created through COVID-19 at the Sydney Children’s Hospitals Network (SCHN), the largest provider of children’s health services in the Southern hemisphere. Methods: We used ethnographic methods, guided by the CSSF, to map innovations and initiatives implemented across SCHN during the pandemic. An embedded field researcher shadowed members of the emergency operations centre (EOC) for nine months. We also reviewed clinic and policy documents pertinent to SCHN’s response to COVID-19 and conducted interviews and focus groups with stakeholders, including clinical directors, project managers, frontline clinicians, and other personnel involved in implementing innovations across SCHN. Results: The CSSF captured SCHN’s complex response to the pandemic. Responses included a COVID-19 assessment clinic, inpatient and infectious disease management services, redeploying and managing a workforce working from home, cohesive communication initiatives, and remote delivery of care, all enabled by a dedicated COVID-19 fund. The health system values that shaped SCHN’s response to the pandemic included principles of equity of healthcare delivery, holistic and integrated models of care, and supporting workforce wellbeing. SCHN’s resilience was enabled by innovation fostered through a non-hierarchical governance structure and responsiveness to emerging challenges balanced with a singular vision. Conclusion: Using the CSSF, we found that SCHN’s ability to innovate was key to ensuring its resilience during the pandemic.
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作者：
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