Background Although slack is an asset to resilient hospitals, it is usually explicitly discussed only in terms of the quantity and quality of beds and staff. This paper expands this view by addressing slack in four infrastructures of intensive care units (ICUs) (physical space, electricity supply, oxygen supply, and air treatment) during the COVID pandemic. Methods The study occurred in a leading private hospital in Brazil, aiming at the identification of slack in four units originally designed as ICUs and two units adapted as ICUs. Data collection was based on 12 interviews with healthcare professionals, documents, and comparison between infrastructures and regulatory requirements. Results Twenty-seven instantiations of slack were identified, with several indications that the adapted ICUs did not provide infrastructure conditions as good as the designed ones. Findings gave rise to five propositions addressing: relationships intra and inter infrastructures; the need for adapted ICUs that match as closely as possible the designed ICUs; the consideration of both clinical and engineering perspectives in design; and the need for the revision of some requirements of the Brazilian regulations. Conclusions Results are relevant to both the designers of the infrastructures and to the designers of clinical activities as these must take place in fit-for-purpose workspaces. Top management might also benefit as they are the ultimate responsible for decision-making on whether or not to invest in slack. The pandemic dramatically demonstrated the value of investing in slack resources, creating momentum for this discussion in health services.
The COVID-19 pandemic has posed unprecedented challenges for healthcare services, which have been forced to upscale their capacity to cope with successive surges in demand. The adjustments to match capacity to demand and deal with a new disease have involved creativity and solutions that were not part of the pre-pandemic standardized operating procedures. Those changes are considered manifestations of resilience. This paper focuses on the role played by the built environment of healthcare services during the pandemic, in terms of how it is integral to resilient performance. As such, we investigated the experience of a leading private hospital in Brazil, documenting the main changes related to the built environment and how they influenced resilience. Data collection involved eight interviews with hospital staff. A content analysis allowed the development of a generic functional model of the patient journey and the identification of ten resilience practices. Based on this, six lessons learnt were devised. These lessons are expected to be useful for the design and use of the built environment, supporting the resilience of services.
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