Potential Strengths and Weaknesses in Hospital Resilience in the Context of the COVID-19 Pandemic in Brazil: A Case Study.

The analysis of hospital resilience is essential in understanding how health services prepared for and responded to sudden shocks and unexpected challenges in the COVID-19 health crisis. This study aimed to analyze the resilience of a referral hospital in the state of Pernambuco, Brazil, in the context of the COVID-19 pandemic. The main theoretical approach based on resilience is the system's capacity to maintain essential functions and to absorb, adapt, and transform in the face of unprecedented or unexpected changes. A single case study approach was used to identify the strengths and weaknesses of this response capacity. Data triangulation was employed. Data were collected from April (beginning of case discharges) to October 2020 (decrease in the moving average of cases in 2020). A content analysis was then conducted. Data were analyzed in relation to context, effects, strategies, and impacts in facing the disruptions caused by the pandemic. The results indicated the occurrence of four configurations mostly favorable to hospital resilience during the study period. Among the main strengths were: injection of financial resources; implementation of new hospital protocols; formation of a support network; equipping and continuing education of professionals; and proactive leadership. Weaknesses found in the analysis included: initial insufficiency of personal protective equipment and confirmatory tests; difficulties in restructuring work schedules; increasing illness among professionals; stress generated by constant changes and work overload; sense of discrimination for being a health professional; lack of knowledge about the clinical management of the disease; and the reduction of non-COVID assistance services.

Adaptation and Response of a Major Parisian Referral Hospital to the COVID-19 Surge: A Qualitative Study.

Since the beginning of the COVID-19 pandemic, few studies have focused on crisis management of multiple services within one hospital over several waves of the pandemic. The purpose of this study was to provide an overview of the COVID-19 crisis response of a Parisian referral hospital which managed the first three COVID cases in France and to analyze its resilience capacities. Between March 2020 and June 2021, we conducted observations, semi-structured interviews, focus groups, and lessons learned workshops. Data analysis was supported by an original framework on health system resilience. Three configurations emerged from the empirical data: 1) reorganization of services and spaces; 2) management of professionals' and patients' contamination risk; and 3) mobilization of human resources and work adaptation. The hospital and its staff mitigated the effects of the pandemic by implementing multiple and varied strategies, which the staff perceived as having positive and/or negative consequences. We observed an unprecedented mobilization of the hospital and its staff to absorb the crisis. Often the mobilization fell on the shoulders of the professionals, adding to their exhaustion. Our study demonstrates the capacity of the hospital and its staff to absorb the COVID-19 shock by putting in place mechanisms for continuous adaptation. More time and insight will be needed to observe whether these strategies and adaptations will be sustainable over the coming months and years and to assess the overall transformative capacities of the hospital.

Evaluation and Obstacle Analysis of Emergency Response Capability in China.

Emergency response capability evaluation is an essential means to strengthen emergency response capacity-building and improve the level of government administration. Based on the whole life cycle of emergency management, the emergency capability evaluation index system is constructed from four aspects: prevention and emergency preparedness, monitoring and early warning, emergency response and rescue, and recovery and reconstruction. Firstly, the entropy method is applied to measure the emergency response capability level of 31 Chinese provinces from 2011 to 2020. Second, the Theil index and ESDA (Exploratory Spatial Data Analysis) are applied in exploring the regional differences and spatial-temporal distribution characteristics of China's emergency response capacity. Finally, the obstacle degree model is used to explore the obstacle factors and obstacle degrees that affect the emergency response capability. The results show that: (1) The average value of China's emergency response capacity is 0.277, with a steady growth trend and a gradient distribution of "high in the east, low in the west, and average in center and northeast" in the four major regions. (2) From the perspective of spatial distribution characteristics, the unbalanced regional development leads to the obvious aggregation effect of "high-efficiency aggregation and low-efficiency aggregation", and the interaction of the "centripetal effect" and "centrifugal effect" finally forms the spatial clustering result of emergency response capability level in China. (3) Examining the source of regional differences, inter-regional differences are the decisive factor affecting the overall differences in emergency response capability, and the inter-regional differences show a reciprocating fluctuation of narrowing-widening-narrowing from 2011 to 2020. (4) Main obstacles restricting the improvement of China's emergency response capabilities are "the business volume of postal and telecommunication services per capita", "the daily disposal capacity of city sewage" and "the general public budget revenue by region". The extent of the obstacles' impacts in 2020 are 12.19%, 7.48%, and 7.08%, respectively. Based on the evaluation results, the following countermeasures are proposed: to realize the balance of each stage of emergency management during the holistic process; to strengthen emergency coordination and balanced regional development; and to implement precise measures to make up for the shortcomings of emergency response capabilities.

The Public Servants' Response When Facing Pandemic: The Role of Public Service Motivation, Accountability Pressure, and Emergency Response Capacity.

(1) Background: Public servants are regarded as guardians of the public interest, and their pandemic response played a vital role in controlling the spread of the epidemic. However, there is limited knowledge of the factors that influence public servants' response (PSR) when facing pandemic prevention and control tasks. (2) Methods: Based on the theory of planned behavior (TPB), models were constructed and a regression method was employed with Chinese civil servant data to investigate how PSR is influenced by public service motivation (PSM), accountability pressure (AP), and emergency response capacity (ERC). (3) Results and discussion: PSM, AP, and ERC all have a positive effect on PSR, with AP having the greatest influence, followed by PSM and ERC. The effects of PSM, AP, and ERC on PSR have group heterogeneity, which had little effect on civil servants with very low levels of PSR and the greatest impact on civil servants with medium-level PSR. Job categories of civil servants also are a factor related to PSR; PSM and AP have the strongest effects on civil servants in professional technology, and ERC has the greatest influence on administrative law enforcement. Moreover, gender, administrative level, and leadership positions also have an impact on PSR. (4) Conclusions: Based on the factors of PSR, we found at least three important aspects that governments need to consider in encouraging PSR when facing a pandemic.