Understanding Hospitals’ Resilience and Reponse to the COVID-19 Pandemic

The COVID-19 pandemic pushed healthcare organizations and hospital systems to their limits

The COVID-19 pandemic exposed vulnerabilities across the U.S. healthcare and public health systems. It tested hospitals’ resilience. The healthcare system had to adapt almost overnight, facing prevention, preparation, and response challenges. Hospitals persevered, using available data and guidance—without the benefit of full evidence-based research—to implement containment strategies, to ensure they had enough testing supplies and personal protective equipment, and to anticipate surge events, while securing sufficient staffing and space.

A robust medical response, akin to disaster situations, requires hospitals to engage in rapid evidence-based decision making about resource allocation and patient care. Unfortunately, while digital healthcare technology has the potential to enhance the emergency pandemic response, real-time data are not always available or optimally presented.

Studying hospital resilience to prepare for future pandemics

New York City was an early epicenter of the COVID-19 pandemic and suffered greatly. Drs. David Kaufman and Yalini Senathirajah wanted to understand how hospitals adapted to the pandemic, the kinds of data that hospital decision makers needed, and what the critical barriers were to provide effective responses for future pandemics. The research team is evaluating and contrasting the resilience, decision-making approaches, and human-factors engineering related to clinical workflows between two hospitals to understand a range of known and emerging information needs that can support an effective emergency response. The team is studying data from two hospitals: the University Hospital of Brooklyn (UHB), a safety net hospital with fewer resources, highly affected by COVID-19, and Columbia University Irving Medical Center (CUIMC), which serves the predominantly Latino Northern Manhattan communities of Heights/ Inwood.

“We wanted to understand how the surge in patients with COVID-19 impacted workflow, how resources were allocated and if they were adequate, how we could leverage existing information technology, and how we can be better prepared. How we could make it easier to access patient information to get a snapshot of the hospital, how many patients we had, how many beds were filled, how many beds were available, and how many people were on respirators.”
- Dr. David Kaufman

Improving technology to support pandemic response

As a first step in evaluating and making workflow improvements, the team is interviewing and observing members of the UHB and CUIMC emergency response teams and interviewing key decision makers, including directors of clinical departments. They will then employ cognitive engineering frameworks such as the Systems Engineering Initiative for Patient Safety and other sociotechnical approaches to technology-mediated work practices to design and prototype novel digital healthcare solutions, with the goal of augmenting hospital resilience in pandemics. Then, the research team will investigate how its proposed methods and tools support the UHB emergency management response team’s information and workflow needs. A set of prototypes, including dashboards, visualizations, and data integration tools, will be developed. The research team hopes that introducing novel and more efficient approaches to improve decision making and emergency responses during a pandemic will enhance the quality of patient care, safety, and well-being.