Table 1
Logic model of SLHD integrated response to summarise our findings.
| CONTEXTUAL PROBLEMS | INTERVENTION/RESPONSE [INPUT]. DESCRIPTION OF SLHD INTEGRATED RESPONSE WHICH ADDRESS THE CONTEXTUAL PROBLEMS, ACROSS THE PHASES OF ABSORB, ADAPT, AND TRANSFORM FOR HEALTH SYSTEM RESILIENCE | ACTIVATION OF THE THEORISED WHO 5 STRATEGIES AS MECHANISMS WITHIN LOCAL CONTEXTUAL SYDNEY LOCAL HEALTH DISTRICT STRUCTURES TO RESULT IN PROXIMAL OUTCOMES | AUSTRALIAN GOVERNMENT HEALTH POLICY OUTCOMES FOR THE COVID- 19 RESPONSE |
|---|---|---|---|
| Global pandemic timelines that required a rapid response to address the uncertainties, and to prevent overwhelming of the health system, and address staff and communities fears. | Integrated response to ABSORB: Rapid public health response needed such as the flying squad, guidelines for infection control, care of positive patients, preparing the system, quarantine measures to be put in place | The context of strong leadership, established infrastructure, and epidemic preparedness, activated mechanisms of accountability and governance [4], to result in swift responses and early detection of COVID-19. The context of underlying partnerships and a culture of innovation, activated mechanisms of coordination [2] within and across agencies, to result in efficient and streamlined care. | “Minimise the number of people [including staff] who become infected or sick with COVID19; Minimise how sick these people become & how many people die; Reduce the burden on our health systems, to continue to provide the regular health care ; Help Australians to reduce their own risk and the risk to their families and communities; Delivery of Vaccine” |
| Overseas experience [e.g., UK], highlighted how hospitals were overwhelmed, and the need to address the needs of the community and reach the vulnerable populations | Integrated response to ADAPT: Models of care to expand the reach into the community, facilitated by the telehealth/virtual hospital that was being piloted, community well-being clinics, drive through clinics set up, aged care outreach teams empowered. Engaging other sectors to address the marginalised populations. | The context of SLHD’s vision to keep all community and staff safe activated the mechanisms of empowering and engaging diverse communities [1], resulted in reduced community transmission and anxiety. The context of inter-sectoral partnerships and virtual care brought services to ‘where the people are’ activated mechanisms of reorientating the model of care [3], resulted in more equitable access to screening and testing. | |
| In face of the uncertainties of subsequent waves, there is a need for sustainability of the integration of the model of care, workforce deployment. | Integrated response to TRANSFORM: strong infrastructure built quickly, and measures to sustain this while providing usual care in a more efficient manner. | The context of SLHD underlying ‘whole of health’ approach, and accountability structures activated mechanisms of an enabling environment [5] for the pandemic response that resulted in transformational change. |
Table 2
Illustrative quotes across the themes.
| THEME | ILLUSTRATIVE QUOTES |
|---|---|
| The context of strong leadership, established infrastructure, and epidemic preparedness, activated mechanisms of accountability and governance, to result in swift responses and early detection of COVID-19. | “We have a strong Chief Executive who took a strong lead very early and worked very strictly with the three C’s, Command, Control and Communication. So, there was no doubt in which way we were moving forward, there were Action Plans developed, meetings held, …” [Participant 14] |
| The context of underlying partnerships and a culture of innovation, activated mechanisms of coordination within and across agencies, to result in efficient and streamlined care. | “a Virtual Care model has a role in a pandemic response and can surge very quickly. Has very different infrastructure requirements to a traditional hospital. For example, we have 350 m2 here. We’ve been able to treat 3,500 patients… So, it’s a much more efficient and leaner model” [Participant 9]. “the chief executive is also pretty tech savvy to an extent, you know, she is very …a very innovative thinker, so if we present to her an idea that solves a sticky problem, she’ll have, you know, a couple of questions but then she’ll back you a thousand percent and, you know, give us the money that we need to pull that off” [Participant 11]. |
| The context of SLHD’s vision to keep all community and staff safe activated the mechanisms of empowering and engaging diverse communities, resulted in reduced community transmission and anxiety. | “people have universally, across the district, accepted that life is different and that their roles have changed and that they’re willing – the willingness, I think, has just been unbelievable, for people to shift and pivot and change focus and do extra things, or do different things, or, you know, put their hand in and say, Yep, I’m willing to step up” [Participant 18]. “People were really frightened. A lot of those residents. And so, they were able to meet with social workers and other mental health people to actually address their issues. Many people needed assistance. They needed meals. They needed other things… So, the translation of that amazing amount of work, amazing amount of material, has been a really important – and we’ve worked very closely with local councils to try and get ideas off them and how we can assist with different strategies, with different groups” [Participant 16]. |
| The context of inter-sectoral partnerships and virtual care brought services to ‘where the people are’ activated mechanisms of reorientating the model of care, resulted in more equitable access to screening and testing. | “We set up wellbeing clinics in the community, in locations that were easily walkable for primarily, people sleeping rough and people in boarding houses…. We got a heat map where people from the homelessness count and where boarding houses are. And we mapped where we could reasonably provide these wellbeing clinics….” [Participant 13] “if the [aged care] facilities are virtually enabled, then there’ll be means of enabling video conference, communication with families and others in the event of a problem with lockdown to overcome … or to lessen the … the severe effects of isolation” [Participant 10] |
| The context of SLHD underlying ‘whole of health’ approach, and accountability structures activated mechanisms of an enabling environment for the pandemic response that resulted in transformational change. | “For example, the Waterloo pop-up, you know, where we started to understand about the Public Health issues that were emerging from Melbourne … the Public Housing issues… and we had to learn from that… So that’s happening a lot more than it ever did” [Participant 7]. “Very little has been shifted to the Community sector over the years. And that’s even in terms of building infrastructure. Whenever you hear about infrastructure, it’s always acute hospital infrastructure…. But it certainly has brought everyone a lot closer together, which is a terrific thing across the district, rather than seeing, you know, “theirs” and “ours” or whatever. I think there’s more respect there, for what everybody does” [Participant 16]. |