Hospital Resilience in Three COVID-19 Referral Hospitals in Brazil.

Health crises, such as the COVID-19 pandemic, challenge health systems in demonstrating resilience-the ability to cope with change, manage challenges, and adapt in order to retain their effectiveness. Understanding how such challenges affect and produce reactions in those involved in this response is extremely important. This study evaluated resilience in three referral hospitals in the city of Recife, Pernambuco, Brazil-one public, one private, and one philanthropic hospital-by examining the coping activities adopted by the nursing staff working on the COVID-19 frontline. A multiple case study was carried out, using a qualitative approach, triangulating data from direct observations, document analysis, and interviews with 21 nursing professionals working in management and care provision. Data were collected from April to October 2020. The interviews were transcribed and analyzed based on the resilience categories defined by Blanchet (2017): absorption capacity, adaptive capacity, and transformative capacity. Four themes were considered relevant to the objectives of this study: institutional support, access to personal protective equipment (PPE), work relationships, and fear and mental health. Adaptive capacity was demonstrated concerning the four themes analyzed, absorption capacity was demonstrated in two themes, and no transformative capacity was identified. The study highlighted that the health crisis was challenging for all the hospitals studied, regardless of their legal-administrative status. No differences were observed among them in terms of resilience.

Hospital Governance During the COVID-19 Pandemic: A Multiple-Country Case Study.

In response to the disruptions caused by COVID-19, hospitals around the world proactively or reactively developed and/or re-organized their governance structures to manage the COVID-19 response. Hospitals' governance played a crucial role in their ability to reorganize and respond to the pressing needs of their staff. We discuss and compare six hospital cases from four countries on different continents: Brazil, Canada, France, and Japan. Our study examined how governance strategies (e.g., special task forces, communications management tools, etc.) were perceived by hospital staff. Key findings from a total of 177 qualitative interviews with diverse hospital stakeholders were analyzed using three categories drawn from the European Observatory on Health Systems and Policies framework on health systems resilience during the COVID-19 pandemic: 1) delivering a clear and timely COVID-19 response strategy; 2) coordinating effectively within (horizontally) and across (vertically) levels of decision-making; and 3) communicating clearly and transparently with the hospital's diverse stakeholders. Our study gleaned rich accounts for these three categories, highlighting significant variations across settings. These variations were primarily determined by the hospitals' environment prior to the COVID-19 crisis, namely whether there already existed a culture of managerial openness (including spaces for social interactions among hospital staff) and whether preparedness planning and training had been routinely integrated into their activities.

Indicadores de desempenho do Sistema Único de Saúde: uma análise de tendência / Unified Health System performance indicators: a trend analysis / Indicadores de desempeño del Sistema Único de Salud: un análisis de tendencia

Objetivo: Analisar a tendência temporal dos indicadores de desempenho dos serviços de saúde. Métodos: Estudo ecológico de séries temporais e quantitativo. Analisaram-se indicadores de desempenho dos serviços de saúde das regiões pertencentes à III Macrorregião do estado de Pernambuco: Arcoverde (VI), Afogados da Ingazeira (X) e Serra Talhada (XI), no período de 2008 a 2017. Realizou-se regressão linear simples no software estatístico R, versão 3.5.0. Os indicadores avaliados representam as dimensões de efetividade, acesso, adequação e aceitabilidade do modelo de avaliação de desempenho do sistema de saúde brasileiro. Resultados: Observou-se tendência crescente no percentual de usuários diabéticos que realizaram amputação de membros inferiores na X e XI regiões, incidência de tuberculose na VI região, casos novos de sífilis congênita, cobertura da Estratégia Saúde da Família, percentual de pacientes com acidente vascular encefálico que realizaram tomografia computadorizada, de nascidos vivos com mais de 6 consultas de pré-natal, e de partos cesáreos na VI, X e XI regiões de saúde (p<0,05). Decresceram as internações por asma e por gastroenterite nas três regiões e as internações por condições sensíveis à atenção primária e por insuficiência cardíaca na X e XI regiões (p<0,05). Conclusão: A análise dos indicadores de desempenho demonstrou tendências heterogêneas. Destaca-se o decréscimo nas internações por condições evitáveis e o crescimento na incidência de tuberculose na VI região e de sífilis congênita nas três regiões de saúde.

Objective: To analyze the temporal trend of health services performance indicators. Methods: This is a quantitative ecological study of time series. We analyzed health services performance indicators in the regions belonging to the III Macro-region of the state of Pernambuco, namely Arcoverde (VI), Afogados da Ingazeira (X) and Serra Talhada (XI), in the period from 2008 to 2017. Simple linear regression was performed in the R software version 3.5.0. The indicators analyzed represent the dimensions of effectiveness, access, adequacy and acceptability of the model for assessment of the performance of the Brazilian health system. Results: An increasing trend was observed in the percentage of diabetic users who underwent lower limb amputation in the X and XI region, incidence of tuberculosis in the VI region, new cases of congenital syphilis, coverage of the Family Health Strategy, percentage of patients with stroke who underwent computed tomography, live births with more than 6 prenatal consultations, and cesarean deliveries in the VI, X and XI health regions (p<0.05). There was a decrease in hospitalizations for asthma and gastroenteritis in the three regions and in hospitalizations for conditions sensitive to primary care and for heart failure in the X and XI regions (p<0.05). Conclusion: The analysis of the performance indicators showed heterogeneous trends. The decrease in hospitalizations due to preventable conditions and the increase in the incidence of tuberculosis in the VI region and congenital syphilis in the three health regions should be highlighted.

Objetivo: Analizar la tendencia temporal de los indicadores de desempeño de los servicios de salud. Métodos: Estudio cuantitativo y ecológico de series temporales. Se analizaron indicadores de desempeño de los servicios de salud de las regiones de la III Macro región del estado de Pernambuco: Arcoverde (VI), Ahogados de la Ingazeira (X) y Sierra Tallada (XI) en el periodo entre 2008 y 2017. Se realizó la regresión linear simple en el software estadístico R versión 3.5.0. Los indicadores evaluados representan las dimensiones de la efectividad, el acceso, la adecuación y la aceptabilidad del modelo de evaluación de desempeño del sistema de salud brasileño. Resultados: Se observó una tendencia creciente en el porcentual de usuarios con diabetes que realizaron la amputación de miembros inferiores en las X y XI regiones, la incidencia de tuberculosis en la VI región, los casos nuevos de sífilis congénita, la cobertura de la Estrategia Salud de la Familia, el porcentual de pacientes con accidente cerebrovascular que realizaron la tomografía computadorizada, de nacidos vivos con más de 6 consultas prenatal y de partos cesáreos en las VI, X y XI regiones de salud (p<0,05). Los ingresos por la asma y por la gastroenteritis en las tres regiones y los ingresos debido las condiciones sensibles de la atención primaria y por la insuficiencia cardiaca en las X y XI regiones (p<0,05) disminuyeron. Conclusión: El análisis de los indicadores de desempeño ha demostrado tendencias heterogéneas. Se destaca la disminución de los ingresos por condiciones evitables y el aumento de la incidencia de tuberculosis en la VI región y de la sífilis congénita en las tres regiones de salud.