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Resilience in keeping the balance between demand and capacity in the COVID-19 pandemic, a case study at a Swedish middle-sized hospital.
University West, Department of Engineering Science, Division of Production Systems. (KAMPT,LOVHH, iAIL, KAMAIL)ORCID iD: 0000-0002-2721-3888
University West, School of Business, Economics and IT, Divison of Informatics. (KAMPT, iAIL, LOVHH, KAMAIL)ORCID iD: 0000-0002-1421-868X
2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 202Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In pandemics, it is critical to find a balance between healthcare demand, and capacity, taking into consideration the demands of the patients affected by the pandemic, as well as other patients (in elective or emergency care). The purpose of this paper is to suggest conceptual models for the capacity requirements at the emergency department, the inpatient care, and intensive care unit as well as a model for building staff capacity in pandemics.

METHODS: This paper is based on a qualitative single case study at a middle-sized hospital in Sweden. The primary data are collected from 27 interviewees and inductively analyzed.

RESULTS: The interviewees described a large difference between the immediate catastrophe scenario described in the emergency plan (which they had trained for), and the reality during the COVID-19 pandemic. The pandemic had a much slower onset and lasted longer compared to, for example, an accident, and the healthcare demand fluctuated with the societal infection. The emergency department and inpatient care could create surge capacity by reducing elective care. Lower inflow of other emergency patients also helped to create surge capacity. The number of intensive care beds increased by 350% at the case hospital. At the same time, the capacity of the employees decreased due to infection, exhaustion, and fear. The study contributes to knowledge of conceptional models and key factors affecting the balance between demand and capacity.

CONCLUSION: The framework suggests conceptual models for balancing surge capacity during a pandemic Health care practitioners need to provide assumptions of the key factors to find the balance between the demand and capacity corresponding to the reality and maintain the delivery of high-quality healthcare services.

Place, publisher, year, edition, pages
2023. Vol. 23, no 1, article id 202
Keywords [en]
Balance, COVID-19, Healthcare, Pandemic, Resilience, Surge capacity
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science; Work Integrated Learning; Production Technology
Identifiers
URN: urn:nbn:se:hv:diva-19812DOI: 10.1186/s12913-023-09182-4ISI: 000940786300003PubMedID: 36855122Scopus ID: 2-s2.0-85149138872OAI: oai:DiVA.org:hv-19812DiVA, id: diva2:1796915
Note

Creative Commons Attribution 4.0 International License

Available from: 2023-09-13 Created: 2023-09-13 Last updated: 2024-05-07Bibliographically approved
In thesis
1. Capacity management in Swedish hospitals during the COVID-19 pandemic
Open this publication in new window or tab >>Capacity management in Swedish hospitals during the COVID-19 pandemic
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Kapacitetsstyrning på svenska sjukhus under COVID-19-pandemin
Abstract [en]

The COVID-19 pandemic emphasized the importance of effective crisis management. This research aims to analyze and comprehend the lessons learnt at Swedish hospitals in implementing surge capacity during the pandemic to enhance preparedness for future pandemics. The study utilizes a mixed-methods approach, combining two qualitative case studies and a quantitative survey. Inductive, explorative, and deductive analysis methods based on framework of learning and dynamic capability have been employed. 

The distinction between a major accident and a pandemic is considerable. A pandemic lasts longer, with changing capacity requirements. Moreover, during a pandemic, information originates within hospitals, upon the admission of patients. The study identified innovative planning strategies, such as stepwise causality planning, for the organization to pursue common goals and material deliveries within an agreed-upon time consumption in an uncertain delivery situation. Internal staff mobility and support for specialized staff are critical for adapting capacity, with a high dependence on equipment, space, and systems. 

Crisis management during a pandemic needs to be distributed and adaptive. Plans must be constantly adjusted aligning to the reality of the crisis. Additionally, the study emphasizes the role of healthcare professionals in decision-making, as well as the importance of continuous learning. Allowing leaders with trust within the organization to lead and create openness within the organization, without power plays and with positive “storytelling,” establishes a secure environment where staff mobility can be enhanced.

This study highlights an effective crisis handling through dynamic action and openness to learning during the pandemic. However, it identifies shortcomings, including malfunctioning contingency plans, insufficient staff mobility, and undynamic crisis management, especially at the regional crisis management level.

Abstract [sv]

COVID-19-pandemin har belyst nödvändigheten av effektiv krishantering under pandemier. Denna studie syftar till att förstå och analysera de lärdomar kring produktionsstyrning som uppstått under pandemin, då kapaciteten dagligen behövde styras och balanseras mot de olika vårdbehoven. Studien omfattar både kvalitativ forskning med två fallstudier och kvantitativ forskning genom en enkät. Induktiva, explorativa och deduktiva analysmetoder har använts, där den sistabaserades på ramverk kring lärande respektive dynamiska och statiska kapaciteter.

Skillnaden mellan en stor olycka och en pandemi är betydande. Pandemin varar längre och vårdbehovet förändras i vågor, till skillnad från en olycka som oftast är kort och plötslig. Vidare skiljer sig informationsflödet, där det i en pandemi uppstår på sjukhusen genom vårdgivarnas nätverk och när patienter anländer, medan det vid en olycka går direkt från räddningsledare till regionens krisledning. 

Studien har identifierat innovativa planeringsstrategier speciellt för pandemier, såsom en så kallad stegvis kausalitetsplanering som ger organisationen möjlighet att sträva efter samma mål, samt material leveranser mot en överenskommen timkonsumtion i en osäker leveranssituation. Den mest kritiska faktorn för att klara sjukhusvården under pandemin identifierades som intern personalrörlighet. Denna var avgörande för att förstärka avdelningar med utökat behov och därmed stödja uthålligheten för den specialiserade personalen som tjänstgjorde där. Vidare var personalförsörjningen och uthålligheten beroende av tillgänglighetenav skyddsutrustning, utrymme och funktionen i systemet.

En krisledning under en pandemi behöver vara både delegerande och adaptiv. Planer måste ständigt anpassas efter krisens realitet. Dessutom betonar studiens resultat betydelsen av vårdprofessionens medverkan i beslutsfattande, samt betydelsen av kontinuerligt lärande. Genom att låta ledare med uppbyggt förtroende i organisationen leda och skapa öppenhet, genom att undvika maktspel och främja positiv “storytelling”, skapas en trygg miljö som förbättrar personalens välmående och rörlighet.

Studien beskriver att krisen hanterades väl genom att organisationerna agerade dynamiskt och var öppen för lärande. Dock identifierades brister, såsom otillräckliga beredskapsplaner, bristande personalrörlighet och en odynamisk krisledning, särskilt på regionnivå. Resultatet från forskningen kan användas för att bygga bättre beredskap för pandemier i framtiden.

Place, publisher, year, edition, pages
Trollhättan: University West, 2024. p. 127
Series
PhD Thesis: University West ; 62
Keywords
Production and Operations Management; Healthcare; COVID-19; Pandemic; Crisis management; Surge capacity, Operativ styrning; Kris; ledarskap; Kapacitetsökning; Sjukvård; COVID-19; Pandemi; Personalrörlighet
National Category
Manufacturing, Surface and Joining Technology Work Sciences Business Administration
Research subject
Production Technology
Identifiers
urn:nbn:se:hv:diva-21474 (URN)9789189325685 (ISBN)9789189325678 (ISBN)
Public defence
2024-06-13, J106, Gustava Melins gata, Trollhättan, 13:00 (English)
Opponent
Supervisors
Note

Paper 3 (accepted) and 5 (submitted) are not included in this digital thesis.

Available from: 2024-05-22 Created: 2024-05-07 Last updated: 2024-05-23

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Rosenbäck, Ritva GiselaSvensson, Ann

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