Covid-19: An International Hospital perspective
em 2020-05-20 Ano: 2020
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Eric de Roodenbeke, PhD


International Hospital Federation (IHF)

Sitting at the headquarter of the International Hospital Federation, I can only provide views from reported Covid experiences and share an opinion on how future can possibly unfold.  This is an unprecedent situation with a pandemic hurting the hospitals in an era of advanced technologies. The previous global alert was on H1N1 that finally had very limited consequences and potentially has contributed to slowness of response in Europe that was also quite preserved from MERS and SARS.

All hospitals have in common experimenting an extraordinary mobilization of the health workers that all put their energy, knowledge, and intelligence to provide a response to a situation for which, in most countries, they were not prepared. In some countries this mobilization started early because some hospitals had faced previous epidemic crisis (mostly in Asia) but in Europe it started with first patients arriving in the hospitals. This mobilization can be summarized by the extraordinary goodwill and the strong collaboration of all health professionals: Everyone was concerned and willing to be part of the response. The big question is whether this will be a game changer after the crisis or just a momentum before going back to previous habits. For hospitals this can be a critical turn if there is a capacity to harness this collaborative experience to transform hospital from mostly silo into multi-disciplinary organization. There is an important responsibility of the leadership to push for this change and convince policy makers to enable it.  

Although in most countries health authorities have provided guidelines to support hospitals for responding to Covid crisis, the agility and local capacity to adapt and find most appropriate solutions have also demonstrated that health service providers cannot be just considered as a bureaucracy. In many countries public hospitals do not have the level of autonomy that allows them to best adapt to the community health needs and to the best possible mobilization of available resources. This does not mean that hospitals should operate in unregulated environment but that the regulation should be more focused on objectives to achieve than on processes and protocols expecting that result will just come from these processes. Covid crisis should give an opportunity to review existing governance. More decision-making power at level of hospitals should be combined with more accountability on results that should cover both health outcomes and fiduciary performance. Such a move is very articulated with the development of an interprofessional collaborative model driven by objectives.

Most of time health leaders consider that health service delivery is a national issue because of the health system and people attitudes that are specific to the country. Covid crisis has demonstrated that although differences exist, health providers are facing common threats. In such situations, there is a lot to learn from each other and many possibilities to leapfrog and accelerate transformation of hospital organizations. While clinicians have an international culture, this is not the case of health managers often tied up with short term local constrains requiring on the site solutions. The Covid crisis should unleash the reservation regarding international collaboration and exposure. If language barrier can be an obstacle, it should not be a reason for not participating to international platforms and collaboration on transformation of leadership and management. 

The Covid crisis is creating a lot of fear and uncertainty, not only on the health side (how to overcome or live with Covid) but also from the expected major recession resulted from countries lockdown. Although it may be tempting for hospitals to use a favorable political momentum to get more resources and improve health workers compensation, this should not derive them from the need to transform health services to increase the value for the population including systematic involvement of people at individual and collective levels. There is a need for a new social contract giving more room for local arrangements between all health providers both at primary care and referral levels but also public and private for and not for profit. Health must be recognized more than ever as a merit good that requires regulation for the common good and mechanisms allowing the providers to provide the best from themselves.

A crisis is often changing the focus with immediate priorities occupying the mindset and putting aside what was considered as a core priority. The need to improve patient safety and innovate for providing best possible quality of care in an efficient way remains a major driver of hospitals in all setting. The major challenge will be for hospitals to absorb the shock and to adapt to new parameters while keeping the direction. Yesterday the uncertainty was mostly about promises of innovation and how technology adoption will set the pace of transformation, today this uncertainty is still present with an additional one on the consequence of a pandemic not yet mastered. 

There will be though times, but we can also hope for a creative transformation if social casualties can be limited by more effective social buffers and there is no doubt that like for HIV-Aids we will find over time solutions to mitigate this additional health risk factor.

Geneve, 18th May 2020