ABSTRACT
BACKGROUND: While health systems researchers have advanced conceptual thinking about the meaning of “resilience”, specific suggestions regarding how systems can become more resilient remain scarce. Moreover, additional work is needed on strategies for developing a resilience-oriented workforce responsive to public healthcare needs during crisis. This study seeks to fill this evidence gap through consideration of a new program recently launched at the Veterans Health Administration (VA) called Clinical Resource Hubs (CRHs). CRHs provide contingency staffing for primary care and mental health services, using predominantly telehealth modalities in 18 regional networks. Drawing upon insights from organizational theory, we describe how CRH resources (e.g., additional primary care providers with telehealth expertise) were leveraged during the early days of COVID-19 to deliver patient care and workforce training and support, and key factors that facilitated these responses. We hypothesize that having flexible contingency providers and staff who specialize in telehealth modalities may increase a health system's resilience (e.g., ability to absorb shocks), while also providing needed contingency care during non-crisis times. METHODS: We conducted semi-structured interviews with CRH directors and national program leaders (n=26) and used a rapid analysis approach to identify actions taken by CRHs to support the resiliency of the VA healthcare system during the pandemic. RESULTS: Respondents reported that almost all CRHs assisted with VA's COVID-19 response by maintaining patient access to care during the pandemic. This was accomplished by providing virtual and in-person contingency staffing for outpatient and inpatient care and triage support in VA clinical settings and the private sector. For example, respondents described how CRHs provided virtual outpatient staffing coverage for primary care providers and nurses reassigned to hospitals during the surge;virtual coverage for inpatient units in social work and pharmacy;and virtual triage for nurse advice lines. In addition, respondents reported that CRHs provided workforce support through training, coaching, and care delivery. Finally, respondents discussed key factors that facilitated CRHs' ability to quickly respond to the pandemic which included hub staff expertise in telehealth and increased acceptability of virtual care among key stakeholders. CONCLUSIONS: We found that the CRH program was flexible and nimble enough to respond to the demands of COVID-19. Having contingent staffing adept at virtual modes of care enabled VA health system resiliency during a public health crisis. As a multi-function program, CRHs may be a model for other similarly resourced healthcare organizations for supporting day-to-day operations through virtual staffing solutions, which can be redirected to meet human resource needs during shocks.
ABSTRACT
Purpose: The COVID-19 pandemic forced cancer centres worldwide to consider shortened radiotherapy regimens to minimize the risk of infectious exposure of patients and staff members. The process of obtaining consensus and implementation of new treatment approaches can be more challenging in larger institutions with multiple treatment centres. We describe the implementation of single fraction (SF) lung stereotactic ablative radiotherapy (SABR) in a multi-centre provincial cancer program. Materials and Methods: In a Canadian province with a provincial cancer program, radiotherapy services are distributed across six regional centres. In March 2020, provincial mitigation strategies were developed in the event of severe limitations on radiotherapy access during the COVID-19 pandemic. The provincial lung radiation oncology group identified SF lung SABR as a mitigation measure supported by high quality randomized evidence that could provide comparable outcomes and toxicity to existing fractionated SABR protocols. A working group of radiation oncologists and medical physicists performed a literature review and drafted provincial consensus guidelines and procedures. The guidelines were reviewed by a group of centre representatives as a component of provincial lung radiotherapy mitigation strategic planning. Individual centres were encouraged to implement SF lung SABR as their resources and staffing would allow. Centres were then surveyed about barriers to implementation. Results: On March 24, 2020, a working group was created and consensus guidelines for SF lung SABR were drafted. The final version was approved and distributed by the working group on March 26, 2020. The provincial lung radiotherapy mitigation strategy group adopted the guidelines for implementation on April 1, 2020. Implementation was completed at the first centre on April 27, 2020. Barriers to implementation were identified at the remaining five centres. Two centres located in regions with disproportionately high numbers of positive COVID-19 cases described inadequate staffing as an impediment to implementation. One centre experienced delays due to prescheduled commissioning of new treatment techniques. Three centres cited competing priorities as reasons for delay. As of February 2021, two centres had active SF lung SABR programs in place, three centres were in the process of implementation, and one centre had no immediate plans for implementation due to ongoing resource issues. Conclusions: SF lung SABR was introduced in a multi-centre provincial cancer program within weeks of conception through rapid communication during the development of pandemic mitigation strategies for radiotherapy. Although consensus guidelines were adopted quickly, the actual implementation by individual centres was variable due to differences in resource allocation and staffing among the centres. Strong organizational structures and early identification of potential barriers may improve the efficiency of adopting new treatment initiatives in large distributed radiotherapy programs.
ABSTRACT
This article examines how ideas about music and music listening are articulated and what listening practices are constructed when symphony orchestras provide concert performances through streaming services. This is achieved by paying attention to how listening situations connected to symphony orchestras’ digital performances are characterized, how the audience is positioned in relation to the performances and the involved musicians, and furthermore to how the music is represented in text, images and verbal statements. The empirical data comprises the streaming service platforms, and supporting materials, of two concert institutions, London Symphony Orchestra (LSO) and Gothenburg Symphony Orchestra (GSO), and was gathered during spring 2020, i.e. when concert halls were closed in response to the Covid-19 pandemic. The article demonstrates how online listening practices are characterized as disconnected from constraints of time and space, and free for anyone to use, anytime and for almost any reason, yet also as strongly connected to temporal and spatial dimensions. Furthermore, it demonstrates how the listening practices connected to online symphonic performances are constructed in line with discourses on music as a health resource or as a mood enhancer and emotional regulator, but also in line with romantic aesthetic ideals. Even if the romantic aspects are less explicit, and thus could be perceived to be challenged, such ideals seem to remain uncontested as long as they are combined with more recent discourses on music. © 2021. The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.