Department of Population Health Sciences, University of Leicester, Leicester, UK.
Leicester NIHR Biomedical Research Centre - Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK.
BMC Health Serv Res. 2023 Jul 3;23(1):720. doi: 10.1186/s12913-023-09645-8.
COVID-19 caused disruption to healthcare services globally, resulting in high numbers of hospital admissions and with those discharged often requiring ongoing support. Within the UK, post-discharge services typically developed organically and were shaped over time by local need, funding, and government guidance. Drawing on the Moments of Resilience framework, we explore the development of follow-up services for hospitalised patients by considering the links between resilience at different system levels over time. This study contributes to the resilient healthcare literature by providing empirical evidence of how diverse stakeholders developed and adapted services for patients following hospitalisation with COVID-19 and how action taken at one system level influenced another.
Qualitative research comprising comparative case studies based on interviews. Across three purposively selected case studies (two in England, one in Wales) a total of 33 semi-structured interviews were conducted with clinical staff, managers and commissioners who had been involved in developing and/or implementing post-hospitalisation follow-up services. The interviews were audio-recorded and professionally transcribed. Analysis was conducted with the aid of NVivo 12.
Case studies demonstrated three distinct examples of how healthcare organisations developed and adapted their post-discharge care provision for patients, post-hospitalisation with COVID-19. Initially, the moral distress of witnessing the impact of COVID-19 on patients who were being discharged coupled with local demand gave clinical staff the impetus to take action. Clinical staff and managers worked closely to plan and deliver organisations' responses. Funding availability and other contextual factors influenced situated and immediate responses and structural adaptations to the post-hospitalisation services. As the pandemic evolved, NHS England and the Welsh government provided funding and guidance for systemic adaptations to post-COVID assessment clinics. Over time, adaptations made at the situated, structural, and systemic levels influenced the resilience and sustainability of services.
This paper addresses understudied, yet inherently important, aspects of resilience in healthcare by exploring when and where resilience occurs across the healthcare system and how action taken at one system level influenced another. Comparison across the case studies showed that organisations responded in similar and different ways and on varying timescales to a disruption and national level strategies.
COVID-19 扰乱了全球医疗保健服务，导致大量患者住院治疗，出院后往往需要持续支持。在英国，出院后服务通常是自然发展的，并随着时间的推移受到当地需求、资金和政府指导的影响。本研究利用韧性时刻框架，通过考虑随着时间的推移不同系统层面的韧性之间的联系，探讨了为住院患者提供后续服务的发展。本研究通过提供实证证据，说明不同利益相关者如何为 COVID-19 住院患者开发和调整服务，以及一个系统层面的行动如何影响另一个系统层面，为有韧性的医疗保健文献做出了贡献。
包括基于访谈的比较案例研究的定性研究。在三个有目的选择的案例研究（英格兰两个，威尔士一个）中，共对参与开发和/或实施出院后随访服务的临床工作人员、管理人员和负责人进行了 33 次半结构化访谈。访谈进行了录音，并由专业人员进行了转录。在 NVivo 12 的帮助下进行了分析。
案例研究展示了医疗保健组织如何为 COVID-19 出院后患者开发和调整其出院后护理的三个不同示例。最初，目睹 COVID-19 对即将出院的患者的影响以及当地的需求，使临床工作人员有动力采取行动。临床工作人员和管理人员密切合作，规划和实施组织的应对措施。资金可用性和其他背景因素影响了临时和即时反应以及对出院后服务的结构性调整。随着大流行的发展，NHS 英格兰和威尔士政府为 COVID 后评估诊所的系统调整提供了资金和指导。随着时间的推移，在特定、结构和系统层面进行的调整影响了服务的韧性和可持续性。
本文通过探讨韧性在医疗保健系统中的发生时间和地点，以及一个系统层面的行动如何影响另一个系统层面，解决了医疗保健中研究不足但至关重要的方面。通过对案例研究的比较，我们发现组织对干扰和国家层面战略的反应方式相似和不同，时间也不同。
