Dancing with a virus

Since the start of the pandemic in March 2020, we were able to watch over the shoulders of administrators, managers and professionals involved in the healthcare crisis organisation in the Netherlands. Our ethnographic research started during the first wave of the pandemic in the Rotterdam region, but the more the pandemic progressed, and with pressure on healthcare remaining high in the second wave, our focus shifted to the regional level, and then specifically to the Regional Coalitions of Acute Care (ROAZ) in its national and local context.

By hanging around (480 hours of observation), chatting (164 focused interviews), reading and reflecting with our participants, we tried not to offer a clear-cut evaluation of the healthcare crisis organisation, but rather to clarify what exactly happened and reflect together with our participants on what a ‘good’ pandemic response might look like. How can healthcare administrators adapt and respond flexibly in times of a pandemic? In relation to this our ongoing research we organised a hybrid symposium on 30 September 2021. During this even we shared our initial research results with the speakers and audience. We were explicitly not looking for simple solutions or answers, but wanted, in the words of Kim Putters, to let the ‘multi-faceted crisis’ that is COVID speak for itself.

Timestamps:

• 11:46 - Welcome by Roland Bal (EUR)
• 24:51 - Presentation Ernst Kuipers (Erasmus MC, LNAZ)
• 42:11 - Presentation Bert de Graaff (EUR)
• 1:01:14 - Video-column Miriam Struyk (PAX)
• 1:07:58 - Presentation Jet Bussemaker (RV&S, LUMC)
• 1:32:57 - Presentation Hester van de Bovenkamp (EUR)
• 2:04:34 - Presentation Diederik Gommers (Erasmus MC)
• 2:22:27 - Presentation Iris Wallenburg (EUR)
• 2:37:15 - Video-column Kim Putters (EUR, SCP)
• 2:44:28 - Panel discussion (Saskia Baas (Philadelphia Zorg), Karin Kalthoff (Zorgbelang Inclusief), Diederik Gommers)
• 3:15:36 - Closure by Roland Bal

The event started with two presentations aimed at the administrative level of the crisis organisation. Ernst Kuipers (Erasmus MC, LNAZ) emphasised the importance of the established healthcare crisis organisation, including the distribution of patients between regions. Bert de Graaff (EUR) then talked about how adapting acute care in and by the crisis organisation was in conflict with the current healthcare system. Miriam Struyk (PAX) shared a moving video column of her experiences as a long-COVID patient, in which she asked for long-term focus, information and support for patients suffering long-term COVID-related impairments. This column served as a bridge to the second theme: that of societal engagement. Jet Bussemaker (RV&S, LUMC) discussed the work of the Dutch Council for Public Health & Society in contributing to policy early on in the pandemic, and identifying ways of achieving a resilient society that focuses on quality of life rather than survival. Hester van de Bovenkamp (EUR) showed how difficult it was for client representatives to join the discussion during this crisis, partly as a consequence of all the existing bottlenecks and the attitude of client councils regarding the crisis organisation. At the same time, she referred to some examples in which client councils contributed actively to the provision of more humane healthcare, for example with respect to visitor regulations.

The third theme, dubbed ‘professionals at the helm’, followed after the break. Diederik Gommers (Erasmus MC, NVIC) shared his experiences during the pandemic. For him, important moments included the creation of the so-called ‘Code Black’ roadmap. Iris Wallenburg (EUR) took the perspective of nurses. She highlighted the fight for recognition that seemed to have been won during the pandemic, but is now crumbling. According to Iris, it is vital that we work on new forms of recognition and appreciation for nursing, preferably with nurses themselves. Kim Putters (EUR, SCP) then gave insight into the broader societal aspects of the ‘multi-faceted’ crisis in his video column and the importance of effectively organising the role of knowledge in decision-making and policy. A panel including Saskia Baas (Philadelphia Zorg, formerly DPG GGD Rotterdam Rijnmond), Diederik Gommers and Karin Kalthoff (Zorgbelang Inclusief) then commented on the many questions and themes that were suggested by the speakers, together with the audience. That meant we ended our symposium with more questions than answers, but possibly the most important lesson of the afternoon is that the pandemic itself, just like the established crisis organisation, reinforced existing fundamental issues about our healthcare system (such as the planning and sharing of healthcare in contrast to competition and rivalry) as well as raising new ones (such as learning to handle delayed healthcare, or how resilient we are during pandemics).

Currently the pandemic seems to have slowed down, but the societal discussion and the effects on healthcare will remain with us for a long time to come. Our research will continue to monitor the organisation of healthcare in relation to COVID in the coming year. Our sincere thanks for the support we received from research participants, speakers and audience during the symposium and from our funders ZonMw and NWO who made this research possible.