School of Public Health, University of California Berkeley, Berkeley, California, USA.
Health Serv Res. 2024 Feb;59 Suppl 1(Suppl 1):e14250. doi: 10.1111/1475-6773.14250. Epub 2023 Oct 16.
To examine how a preexisting initiative to align health care, public health, and social services influenced COVID-19 pandemic response.
In-depth interviews with administrators and frontline staff in health care, public health, and social services in Contra Costa County, California from October, 2020, to May, 2021.
Qualitative, semi-structured interviews examined how COVID-19 response used resources developed for system alignment prior to the pandemic.
We interviewed 31 informants including 14 managers in public health, health care, or social services and 17 social needs case managers who coordinated services across these sectors on behalf of patients. An inductive-deductive qualitative coding approach was used to systematically identify recurrent themes.
We identified four distinct components of the county's system alignment capabilities that supported COVID-19 response, including (1) an organizational culture of adaptability fostered through earlier system alignment efforts, which included the ability and willingness to rapidly implement new organizational processes, (2) trusting relationships among organizations based on prior, positive experiences of cross-sector collaboration, (3) capacity to monitor population health of historically marginalized community members, including information infrastructures, data analytics, and population monitoring and outreach, and (4) frontline staff with flexible skills to support health and social care who had built relationships with the highest risk community members.
Prior investments in aligning systems provided unanticipated benefits for organizational and community resilience during the COVID-19 pandemic. Our results illustrate a pathway for investment in system alignment efforts that build capacity within organizations and relationships between organizations to enhance resilience to crisis. Our findings suggest the usefulness of an integrated concept of organizational and community resilience that understands the resilience of systems of care as a vital resource for community resilience during crisis.
考察一项旨在协调医疗保健、公共卫生和社会服务的先行倡议如何影响 COVID-19 大流行的应对。
2020 年 10 月至 2021 年 5 月，对加利福尼亚州康特拉科斯塔县医疗保健、公共卫生和社会服务机构的管理人员和一线工作人员进行深入访谈。
定性、半结构式访谈，考察 COVID-19 应对措施如何利用大流行前为系统协调而开发的资源。
我们采访了 31 名知情人，包括公共卫生、医疗保健或社会服务领域的 14 名管理人员和 17 名代表患者协调这些部门服务的社会需求案件经理。采用归纳演绎定性编码方法系统地识别反复出现的主题。
我们确定了该县系统协调能力的四个不同组成部分，这些能力支持了 COVID-19 的应对，包括（1）通过早期的系统协调努力培养的适应性组织文化，包括快速实施新的组织流程的能力和意愿，（2）基于跨部门合作的先前积极经验的组织之间的信任关系，（3）监测历史上处于边缘地位的社区成员群体健康的能力，包括信息基础设施、数据分析以及人口监测和外联，以及（4）拥有灵活的健康和社会关怀技能的一线工作人员，他们与高危社区成员建立了关系。
在 COVID-19 大流行期间，先前在系统协调方面的投资为组织和社区的弹性提供了意想不到的好处。我们的研究结果说明了对系统协调工作进行投资的途径，该投资可以增强组织内部的能力和组织之间的关系，从而提高应对危机的能力。我们的研究结果表明，综合组织和社区弹性概念的有用性，即理解医疗保健系统的弹性是危机期间社区弹性的重要资源。
