Why It Matters
On May 5, 2023, the World Health Organization ended the global health emergency declaration for COVID-19. Both globally and in the United States, the three-year pandemic uncovered major challenges and disparities in the public health and health care system. These disparities have not been limited to availability of resources, but also in the ability of communities or systems to respond and adapt quickly to an ambiguous, evolving situation.
It is not easy to dynamically assess risk and identify and allocate resources to the areas with the highest need in a targeted, efficient matter. You must identify the areas with the highest need, have the capacity to deploy resources, and the ability to change directions quickly. The last three years have made it clear that health care needs and the ability to access services extend beyond the walls of the health system, hospital, or clinic, and requires partnership and trust between local municipalities, various for-profit and non-profit organizations, actors, communities, and individuals.
An article published recently in Learning Health System reflected on the experiences of health care system and public health employees to better understand organizational responses to the challenges presented by the COVID-19 pandemic. These experiences included how organizations collected and used data for decision-making, identified the communities most vulnerable and with the highest risk, and quickly communicated and intervened in those settings. Initially, we were interested in understanding what it would take to reach near-herd immunity in different communities but shifted course due to the ever-changing behavior of the virus, the politically charged nature of the pandemic response, and vaccine uptake. However, as the diverse partners in this learning system reflected on their methods to achieving meaningful situational awareness, we identified a pattern of key themes and experiences that were dependent on both existing infrastructure and aligned intentions.
We conducted 16 qualitative interviews with public health professionals across the United States, as well as three interviews with partner organizations. Our goal was to identify key findings around having accessible data available in near real-time, transparency in data collection and reporting, and the profound impact authentic coalition building can have on an agile, hyper-localized response to COVID-19. Interviewees referenced tensions between communities (that needed near real-time, transparent data to make decisions) and public health departments that were sensitive about collecting hyperlocal data that could potentially be identifiable in reporting. In some cases, there were regulations or laws that prohibited COVID-19 status disclosure, and regional teams had to adapt quickly to design workarounds that both protected confidentiality and provided clarity in reporting. Comprehensive and accessible data dashboards are only as good as the data that populate it. This is where situational awareness and coalition building with the community is foundational.
Individuals that reported strong relationships and trust between major actors in the community and the health care sector also reported a more agile response that built systems for long-term improvement. For example, one interviewee said their organization is experiencing the most comprehensive and regular data collection they have ever had, and using strong, reliable data to build systems beyond the COVID-19 pandemic. The organization is currently using customer relationship management software to support individuals with chronic illness in their community. Conversely, individuals that reported tension, competing political agendas, and a lack of trust consistently described the difficulties of reliable data collection and vaccine uptake in their communities. They were also more likely to report burnout and turnover in their organization and the need for a more coordinated response to public health crises in the future.
Bi-directional approaches to coalition building — where health systems and public health departments view their organization as a part of the community and not outside of it — resulted in responses that were faster and more positive for participating actors. Trust, visibility, and partnership were critical to creating an authentic coalition in a community. Additionally, learnings from the COVID-19 pandemic response are not only applicable to the next global pandemic, but teams are building systems for a variety of future public health crises. In addition to infectious diseases, this could include management of chronic conditions, vaccine availability and uptake, and any situation that requires mass testing or medication distribution.
Health care tragedies — from millions of lives lost, overwhelmed health systems, staff burnout and exhaustion, and sustained health problems for millions of people — have punctuated the last three years. Amid the crisis and catastrophe, there was also tremendous innovation and the start of building a more agile and resilient public health and health care system. We can and should use technologies, partnerships, and strategies designed for the COVID-19 pandemic to support responses to other public health challenges. With the end of the official state of emergency, we are responsible to the public to continually reflect upon the decisions made and lessons learned over the last three years. As the saying goes, “In the midst of every crisis lies great opportunity.” What will history say about the impact of COVID-19 on health care?
Morgen Stanzler, MPH, is an Institute for Healthcare project director.
You may also be interested in:
IHI Innovation Report: Organizational Trustworthiness in Health Care
NEJM Catalyst: The Imperative for Integrating Public Health and Health Care Delivery Systems