Navigating Complexity: Lessons from COVID-19 for Sustainable Health System Resilience
Author: Dr. Jana Šimenc, Slovenija-transplant
The world, including Europe, is facing an increasing number of (ongoing) crises that are becoming more and more complex: The ageing of the population is leading to a demographic crisis, climate change is leading to a climate crisis, the emergence of conflict zones and wars is leading to a humanitarian and a refugee crisis, healthcare systems are struggling to adapt to structural social, financial and organisational changes. Beside external crisis, there are specific critical moments in healthcare systems: we are dealing with a crisis in working conditions, workforce and healthcare facilities, and so on and so forth. The number of crises we are living in today is enormous. It is increasingly recognized, crisis became a norm, not an exception. The resilience has become the Zeitgeist of today.[1]
Recently, the world was challenged with Covid19 pandemics, that was an extraordinary crisis in many ways. Anthropologist Trnka opens the understanding of crisis, that can also be understood as a phenomenological state, as there exist moments during which we collectively experience being plunged into a radically different time-space that is perhaps best conceptualised as a ‘collective critical event’. Such ‘extraordinary’ times have been denoted as events beyond the scope of narration (Briggs 2003); ‘failure[s] of the grammar of the ordinary’ (Das 2007); or moments of incredulity that surpass our capacities of narration1.
In many ways, Covid19 shocked the people and the systems, leaving them speechless or with conflicting interpretations. History shows that pandemics and other crises can be catalysts to rebuild systems and society in a new way. What have we learnt from Covid19? How can be build more resilient, robust, yet flexible, trans-national connected organ donation and transplantation systems in time of on-going internal, external and structural crisis? What path leads to a development of better medical and organisational resilience of the donation and transplant systems?
Communication with the public
Huge crises can be catalysts to rebuild society in new ways, but that this requires vision and interconnectivity between policymakers at local, regional and national levels.[2] Dominic Abrams, a researcher who led the analysis of societal impact of Covid19 stressed, one of the lessons that emerged was that the lack of a well-integrated information structure – extending from the national government down to the very local, even hyperlocal level – is a problem. Any disconnect between these levels means a potential loss of trust. This reduces trust in the information they receive and the people who give it to them.
Another problematic aspect during covid19 was, when people needed more information, it was often contradictory information coming from different sources. Even from medical authorities, information was very diverse. They were receiving information they were not convinced of, which enhances the general fear, more insecurity and public confusion in understanding the crisis. Not only did this lead to them behaving less safely, but it also contributed to more anxiety, affected mental health and impacted whether children would go to school, whether people would continue to work and so on.
As to successfully overcome it. I think much more attention is now being paid to this question – the question of the basic structure, the basic network of resources, connections and people that are necessary to effectively manage such crisis.
Additional important aspect and lesson learnt in the need for interdisciplinary cooperation. What happened during covid19 was, most governments relied heavily on the natural sciences and medicine in particular. As Abrams observed,[3] they were trying to find solutions to the things that were happening. However, soon it became evident, many of the effects would not only be medical, but also social, educational and even environmental.
In order to successfully deal with the far-reaching societal and medical consequences of the pandemic, expertise form different scientific disciplines that are brought together is needed. Diverse opinions and different evidence and perspectives make the process of coming to the best possible solution more successful.
What is more, in times of crisis, inequalities are more commonly exaggerated than ameliorated – meaning both that vulnerable populations are often forced to make do with what resources are at hand and that many of those who barely manage in ‘normal’ times are pushed beyond capability and opportunity thresholds. Indeed, new case definitions of vulnerability that emerge in a crisis may push previously unrecognized groups (e.g. service employees, ‘care’ facility residents) into extreme vulnerability, as borderline coping quickly becomes calamity coping.[4]
A health crisis such as Covid19 has shown that beside others, healthcare workers have become one of the unrecognised vulnerable groups. Exposed to possible viral infections and daily risks, working in extreme conditions, caring heavy protective equipment, and having to make major adjustments in their private lives (avoiding contact with family members such as children and the elderly), they have been one of the most vulnerable and under-supported professional groups.
Some of the big lessons learnt from Covid19 are:
Investing in the infrastructure that supports relationships and frequent communication between national and international professionals is extremely important.
More attention must be paid to the basic network structure, connections and people that are necessary to effectively manage potential crisis.
Access to and sharing of the data between professionals must be assured. Aligned and strategic crisis management needs would assure more safety and resilient transplant systems.
People are much more willing to listen to those who know them, who are on the ground and share their situation and context.
Assuring access to information is essential.
Decisions made during crises are not only urgent, but have long-lasting consequences. To address the growing complexity of crises, Interdisciplinary cooperation is a key to a more sustainable and best possible decisions.
Investing in motivated and well-supported health workforce is of crucial importance.
[1] Relations as Immunity: Building Community Resilience. (2024). Medicine Anthropology Theory, 11(1), 1-13. https://doi.org/10.17157/mat.11.1.7266
[2] The Covid decade: understanding the long term societal impact of Covid 19 (policy report). The British Academy, 2021. Available at: https://www.thebritishacademy.ac.uk/publications/covid-decade-understanding-the-long-term-societal-impacts-of-covid-19/
[3] https://www.rtvslo.si/zdravje/pet-let-pozneje/dominic-abrams-tezko-bi-rekli-da-je-pandemija-spremenila-druzbene-norme/741162
[4] Napier, A.D. (2020), Rethinking vulnerability through Covid-19. Anthropology Today, 36: 1-2. https://doi.org/10.1111/1467-8322.12571
