Understanding for whom, how and why Sydney Local Health District’s Integrated Response was Effective in Addressing COVID-19: A Critical Realist Qualitative Study

Abstract

Introduction: Australia has been comparatively effective in preventing the transmission of COVID-19. The Sydney Local Health District [SLHD] used a "whole of health" integrated approach to respond to the pandemic. The aim of this study was to understand for whom, how and why this response worked, to inform a sustainable system transformation. Methods:A critical realist qualitative study was conducted with 20 purposively selected key informants. Data were collected through in-depth interviews and analysed using thematic analysis guided by abduction and retroduction. The five strategies of the WHO integrated people-centred health services framework was used to guide the overall study.Results: An enabling environment of a strong governance, emergency preparedness, a committed and adaptable workforce, and a strong core infrastructure underpinned SLHD's effective response. With a culture of embracing innovation, the district adapted virtual care to effectively quarantine people through their special health accommodation, and coordinate care across tertiary and community services. The established interagency relationships prior to the pandemic, enabled service directors to quickly integrate their services, which empowered and engaged the community [and staff], working across relevant sectors to provide care "where the people are"; reaching marginalised populations, and reducing community transmission. Discussion and Conclusion:The SLHD's progress towards a 'whole of health' approach, empowered and enabled the district to effectively work within and across sectors to address the pandemic in a people-centred manner. Sustaining the contextual conditions and mechanisms, that facilitated effective integration, will be beneficial beyond the pandemic.

Integration of Mental Health Support Teams in COVID-19 Units within French General Hospitals: A Qualitative Study

“…In line with complex adaptative systems theory applied to health [66][67][68][69], our findings also suggest that, in times of health crisis, self-organizing ability of IC service is an important factor for the success of its implementation. This strengthens previous findings stating that leadership should mainly guarantee environment enabling self-organization, through balance between reliable IC structure and flexibility to adapt to local context [65,70]. At the political level, new reform launched in September 2020 in response to COVID-19 outbreak in France -called "Ségur de la Santé" (referring to location of Ministry of Health in Paris) -laid the stones for the success of such model, with both national financial effort and promotion of territorial projects in mental health, relying on enhanced collaboration between proximity actors [71].…”

Sydney Local Health District’s Integrated Response to the COVID-19 Pandemic: A Descriptive Study

“…During the pandemic, the style of leadership moved from one of participatory leadership toward "Incident Command". We note in accompanying qualitative study [5] that "many informants described how the existing … governance structures facilitated the adaptation to the "incident command" strategy ... [where] the Chief Executive became 'commander, oversight person' who was strongly supported by a network of clinicians and managerial staff". In the SLHD context the "whole of health" and "whole of system" interagency relationships were also important.…”

“…That programme of applied research used critical realist and pragmatic methodologies to evaluate the SLHD integrated response. The first of the critical realist studies [5], sought to understand for whom, how and why this SLHD response worked so as to inform a sustainable system transformation. Critical realist research is particularly focused on understanding how context and underlying mechanisms impact on outcomes.…”

Management of alcohol and other drug issues in Special Health Accommodation during the COVID‐19 Delta variant outbreak in Sydney, 2021

“…In response to community transmission of COVID‐19 Delta Variant in New South Wales (NSW), patients were admitted to Special Health Accommodation (SHA) with often complex psychosocial and medical needs including addiction. SHA functioned as a subacute hospital in repurposed apartment blocks and provided integrated health care to people with COVID‐19 or close contacts, if otherwise unable to isolate [ 1 ]. We reviewed the outcomes of patients who received remote Addiction Medicine consultation, onsite clinical support and provision of alcohol during SHA admission, July–October 2021.…”

“…Emily Nash 1,2 Emily Walker 1 Joshua Watt 1 Alena Sannikova 1 Andrew Dawson 1,2 Teresa Anderson 3 Merryn Sheather 4 Joseph Jewitt 4 Peter Linnegar 4…”