Weishaar Heide, Evans Megan, Chemali Souaad, Maray Eloisa Montt, Böttcher Rike, Umlauf René, Abunijela Susan, Muller Nadine, Buchberger Barbara, Geurts Brogan, Fischer Hanna-Tina, El Bcheraoui Charbel
Evidence-based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany.
Preparedness and Operations Support Unit, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany.
PLoS One. 2025 Jan 14;20(1):e0317231. doi: 10.1371/journal.pone.0317231. eCollection 2025.
Health system resilience is defined as the ability of a system to prepare, manage, and learn from shocks. This study investigates the resilience of the German health system by analysing the system-related factors that supported health care workers, a key building block of the system, during the COVID-19 pandemic. We thematically analysed data from 18 semi-structured interviews with key informants from management, policy and academia, 17 in-depth interviews with health care workers, and 10 focus group discussions with health care workers. We identified six categories of factors which supported health care workers during the pandemic: (1) appreciation and encouragement; (2) team support and communication; (3) collaboration across professions and institutions; (4) informational, material and technical support; (5) leadership and participation; and (6) creativity and innovation. The analysis highlights the importance of systemic and organisational factors for maintaining health system resilience. The need to improvise and develop pragmatic solutions to deal with COVID-related challenges offered ample opportunities for participation, self-determination, innovation, and alternative work processes. Learning from adaptations made during the pandemic and implementing sustainable organisational and systemic changes to increase participation, conducive organisational cultures, and non-hierarchical working styles hold promising potential for health system transformation and health system strengthening.
卫生系统韧性被定义为一个系统准备、管理并从冲击中学习的能力。本研究通过分析在新冠疫情期间支持作为该系统关键组成部分的医护人员的系统相关因素，来调查德国卫生系统的韧性。我们对来自管理、政策和学术界的关键信息提供者进行的18次半结构化访谈、对医护人员进行的17次深度访谈以及与医护人员进行的10次焦点小组讨论的数据进行了主题分析。我们确定了在疫情期间支持医护人员的六类因素：（1）赞赏与鼓励；（2）团队支持与沟通；（3）跨专业和机构的协作；（4）信息、物资和技术支持；（5）领导与参与；（6）创造力与创新。该分析突出了系统和组织因素对维持卫生系统韧性的重要性。为应对与新冠相关的挑战而即兴发挥并制定务实解决方案的需求，为参与、自主、创新和替代性工作流程提供了充足机会。从疫情期间的调整中学习，并实施可持续的组织和系统变革，以增加参与度、营造有利的组织文化和非等级制工作方式，对卫生系统转型和加强卫生系统具有广阔的潜力。
