Study demographics.

Globally, healthcare systems continue to recover and manage system demands, including our sustained HHR pressures exacerbated by the COVID-19 pandemic. Health system leaders need to understand how healthcare was adapted during the pandemic, what contributed to these changes, and the impact of these changes to inform future efforts. The overarching research questions included: What changes to models of care were made during COVID-19 and post-recovery? What factors contributed to changes in models of care? What was the impact of these changes? An exploratory interpretative descriptive qualitative study was undertaken to describe what HHR strategies and changes to models of care delivery were employed during the COVID-19 pandemic and post-pandemic recovery. An inductive thematic analysis was conducted where an investigation team of research staff identified, coded, and categorized prominent themes that emerged in the interview data. A total of 118 participants from a variety of healthcare professionals and leadership positions across five healthcare organizations in the greater Toronto area in Ontario and 1 setting from British Columbia were interviewed. The following three themes were identified during the inductive analysis: 1) prioritizing care based on system capacity, patient volume and complexity; 2) adapting care by innovating, clustering, and taking shortcuts; and 3) being impacted by prioritized and adapted care. Adapting and prioritizing care resulted in missed or delayed care and moral distress in healthcare professionals. Study findings call for leaders to develop and deploy anticipatory adaptive strategies at the organizational level to mitigate pressures related to system capacity and patient volume and complexity. In turn, anticipatory adaptive strategies can guide efforts by healthcare professionals to manage and adapt their clinical tasks, workload, and demands, ensuring patient safety and workforce resilience at the clinical microsystem level.

全球范围内，医疗系统仍在持续恢复并应对系统运行需求，其中包括新冠疫情加剧的持续性卫生人力资源（Health Human Resources, HHR）压力。医疗系统管理者亟需了解疫情期间医疗照护模式的调整方式、推动这些调整的因素，以及这些调整带来的影响，以此为未来的相关工作提供参考。本研究的核心研究问题包括：新冠疫情期间及疫情后恢复阶段，医疗照护模式做出了哪些调整？哪些因素推动了医疗照护模式的变化？这些调整产生了何种影响？本研究采用探索性解释描述性定性研究设计，旨在梳理新冠疫情期间及疫情后恢复阶段所采用的卫生人力资源策略与医疗照护服务模式变革。研究采用归纳式主题分析方法，由研究团队成员对访谈数据中浮现的显著主题进行识别、编码与分类。研究共访谈了118名参与者，他们来自安大略省大多伦多地区的五家医疗机构以及不列颠哥伦比亚省的1个医疗场景，涵盖各类医疗专业人员与管理岗位人员。归纳分析阶段共识别出三大主题：1. 基于系统容量、患者量与病情复杂度优先分配照护；2. 通过创新、整合与简化流程调整照护模式；3. 优先化与调整后的照护所带来的影响。研究发现，照护模式的调整与优先化安排导致了医疗照护的遗漏或延误，同时引发了医疗从业者的道德困境。本研究结果呼吁医疗管理者在组织层面制定并部署前瞻性自适应策略，以缓解由系统容量、患者量与病情复杂度带来的运营压力。反之，前瞻性自适应策略可指导医疗从业者管理并调整其临床任务、工作量与工作需求，在临床微系统层面保障患者安全与医护队伍韧性。