Runtime: May 2024 – May 2025
Funder: Dutch Healthcare Inspectorate
During the COVID-19 pandemic, the organization of healthcare in the Netherlands demonstrated a strong adaptability (de Graaff et al. 2023). This also applies to healthcare supervision. Existing field standards and quality frameworks, such as those around triage in the event of declaring 'Code Black' in the Netherlands, were established ad hoc or were under discussion, and professionals and organizations were given space and trust to tackle the pandemic (Leistikow & Bal 2021). As a result of the pandemic, there is growing attention to pandemic preparedness and resilience of healthcare systems (Wiig & O’Hara 2021). In addition to the pandemic, this also includes other crises and disasters that will increasingly confront society and healthcare with a changing climate, such as the recent floods in Limburg, the growing impact of heat stress, and new risks of infectious diseases from invasive species (such as mosquitoes). However, it is still unclear how supervision can be conducted on the (pandemic) preparedness and resilience of healthcare organization, while this question is already being asked by society and politics. How to organize healthcare supervision in times of, and in preparation for, moments of great uncertainty?
Previous research shows that it requires concrete work from a regulator to arrive at a regulatory object (de Kam 2020). For regulators such as the Dutch Healthcare and Youth Inspectorate (IGJ), this requires translating societal appreciation and political discussion around, in this case, pandemic preparedness into concrete supervision practices. This includes, for example, assessing the risk, formulating relevant field standards (or encouraging their formulation), and engaging relevant stakeholders (Leistikow, Pot, & Bal 2022). In the case of preparedness and resilience, this is not a straightforward task. Existing literature and our own research on the pandemic (de Graaff et al. 2023), for example, show that a static view of preparedness overlooks crucial aspects of healthcare practice. Existing models of pandemic preparedness were poor predictors of how different countries dealt with the COVID-19 pandemic; countries like the United States and England, which scored high on such lists, actually performed relatively poorly during the pandemic. Consequently, there is a movement in the literature that emphasizes a dynamic view of pandemic preparedness and resilience; not (only) as measurable properties of a system but as a complex practice (Paschoalotto et al. 2023). Wiig et al. (2022) define resilience in healthcare as the capacity to adapt to challenges and changes at various system levels to deliver high-quality care. This involves how healthcare adapts (adaptation), anticipates, and learns to deliver consistently good care during, and in preparation for, crises and disasters. Preparedness mostly refers to the phase before the outbreak of a crisis or disaster and refers to the extent to which a system is ready to respond to such an outbreak or event (Paschoalotto et al. 2023). Supervision can be in tension with resilient healthcare practices, for example, if more universally formulated 'top-down' compliance measures impede context-specific adjustments (Øyri, et al. 2024).
Consequently, we are particularly interested in how to conduct effective supervision and provide good care during, and in preparation for, moments of great uncertainty (Greenhalgh & Engebretsen 2022), and want to pay attention to the role of trust and legitimacy of supervision, involving stakeholders, and the importance of spaces for reflection (Wiig, Aase & Bal 2021). Questions that arise include: How, and in what different ways, can a healthcare system consist of resilient and robust practices, and how can supervision be carried out? What role can a regulator play? A potential study on supervision of this aspect of pandemic preparedness should therefore focus on supervision practice. Thus, this research emphasizes the work between policy and execution, between broad policy plans, managers at national, regional, and local levels, and the professional in the consultation room. The IGJ plays a central role in this 'middle' of the Dutch healthcare system. How does the work of the IGJ relate to that of others in this middle, such as field parties and regulators? How, and in what ways, can the IGJ creatively address pandemic preparedness – and what can or should the IGJ leave to other parties? How does supervision of organizational pandemic preparedness in healthcare relate to preparedness at a more systemic level (e.g., the testing landscape) and the field of public health (e.g., infection prevention, oversight of the Municipal Health Services)? How 'issue-agnostic' can supervision of preparedness and resilience be? In this project we aim to these questions in order to develop an approach for the supervision of pandemic preparedness and resilience of healthcare in the Netherlands.
Research Question: How can the IGJ translate the societal and political discussion and appreciation of pandemic preparedness, crises, and resilience of the healthcare system into the practice of supervising healthcare organizations in the Netherlands?
Approach: The research initially has a duration of 1 year, with the expectation that this will be extended by 3 years. The exact content and scope of the research are therefore yet to be determined. We develop an ethnographic approach and formative stance that ESHPM has successfully applied in research with and on healthcare supervision (e.g., de Graaff et al. 2019).
Team
- Dr. Bert de Graaff (ESHPM)
- Bertien Winkel (IGJ)