Qualitative Analysis of the Coordination of Major System Change Within the Colombian Health System in Response to COVID-19: Study Protocol

Abstract

Background Coronavirus (COVID-19) is posing a major and unprecedented challenge to health service planning and delivery across health systems internationally. This nationally-funded study is analysing the response of the Colombian health system to the COVID-19 pandemic, drawing on qualitative case studies of three local health systems within the country. The approach will be informed by the concept of 'major system change' - or coordinated change among a variety of healthcare organisations and other relevant stakeholders - in order to identify processes that both enable and inhibit adaptation of health services to the challenges presented by COVID-19. The study will collect information on capacity “bottlenecks” as well as successful practices and forms of innovation that have emerged locally, which have the potential for being 'scaled up' across Colombia's health services. Methods/design This qualitative study will be undertaken in two phases. In the first, up to 30 stakeholder interviews will be conducted to ascertain and share immediate challenges and opportunities for improvement in response to COVID-19 that can be shared in a timely way with health service leaders to inform immediate health service planning. The stakeholders will be selected in order to sample a range of planning, provider and intermediary organizations within the health system at the national level. In the second, up to 60 further interviews will be conducted to develop in-depth case studies of three local health systems at the metropolitan area level within Colombia. The interview data will be supplemented with documentary analysis and, where feasible, non-participant observation of meetings directly related to the planning and implementation of actions responding to COVID-19. The study will also establish mechanisms for providing timely, formative feedback to inform health system planning relating to COVID-19 and future pandemics by ascertaining stakeholders' preferences during the interviews and wider scoping discussions. Discussion The study's findings will aid evaluation of the relevance of the concept of major system change in a context of 'crisis' decision-making and contribute to international lessons on improving health systems' capacity to respond to COVID-19 and future pandemics. Study findings will be shared among various stakeholders in the Colombian healthcare system in a formative and timely way in order to inform healthcare planning in response to COVID-19 and future pandemics. Conducting the study at a time of COVID-19 raises a number of practical issues (including physical distancing and pressure on health services) which have been anticipated in the study design and research team's ways of working.

Organisational responses to mitigate the effects of COVID-19 on healthcare workers: a qualitative case study from Bogotá, Colombia

“…Themes were derived from the dataset and developed using both deductive and inductive analysis [20], meaning that our approach was informed by the particular focus and objectives of our study, while being open to novel ideas discovered through the narratives expressed in the empirical data. For example, we were surprised by the significant impact of COVID-19 on the physical and mental health of the workforce which was not a particular theme in our study protocol [15]. Deductively, the objectives of the wider study from which this paper is derived -and an interview topic guide that was developed response to those objectives [15] -informed the types of themes explored in the interviews.…”

“…This paper is derived from an ongoing qualitative study that is analysing how the Colombian health system responded to COVID-19 [15]. The methodology we followed was a case study approach [16] in order to understand the response to the emergency taking into account the narratives of the actors who have been directly involved in system planning to face the pandemic and the implementation of health services for patients with COVID-19.…”

“…were informed by a topic guide that has been published previously as a supplementary file alongside the study protocol [15]; however, the questions were adapted to each interviewee's context [19]. The topic guide was not piloted formally but it was reviewed by the team periodically and aspects of its use were adapted (e.g.…”

Organisational responses to mitigate the effects of COVID-19 on healthcare workers: a qualitative case study from Bogotá, Colombia

“…Interviews lasted 55 minutes on average. The interviews were informed by a topic guide that has been published as a supplementary le alongside the study protocol (14); however, the questions were adapted to each interviewee's context (18). The topic guide was not piloted formally but it was reviewed by the team periodically and aspects of its use were adapted (e.g.…”

“…This paper is derived from an ongoing qualitative study that is analysing how the Colombian health system responded to COVID-19 (14). The methodology we followed was a case study approach (15) in order to understand the response to the emergency taking into account the narratives of the actors who have been directly involved in system planning to face the pandemic and the implementation of health services for patients with COVID-19.…”