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Learning from History or Reacting to Events? Colombia's Navigation of Major System Change in Response to COVID-19

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Organising Care in a Time of Covid-19

Part of the book series: Organizational Behaviour in Healthcare ((OBHC))

Abstract

The concept of “major system change” refers to coordinated changes within health systems, so change involving multiple organisations, and stakeholder interests, rather than more localised forms of change such as improvement work undertaken by an individual hospital. This chapter focusses on the concept of attending to or learning from history, which is a key recommendation from the major system change literature. It explores organisational processes that influenced the planning of responses within Colombia to the health system challenges posed by COVID-19. The findings suggest that the response to COVID-19 involved a combination of learning from previous responses to other infectious diseases and more ad hoc and continuous learning. Although international sources of evidence were used by health system actors, there was recognition that such experiences needed to be tailored to the particular contextual challenges facing Colombia. Health system leadership needs to consider how to encourage rapid adaptations to health services, while ensuring decision-making remains open to emerging evidence and stakeholder consultation.

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References

  • Al‐Dabbagh, Z. S (2020) The role of decision‐maker in crisis management: A qualitative study using grounded theory (COVID‐19 pandemic crisis as a model). Journal of Public Affairs, e2186.

    Google Scholar 

  • Andrus, J. K., Evans-Gilbert, T., Santos, J. I., Guzman, M. G., Rosenthal, P. J., Toscano, C., Valenzuela, M. T., Siqueira, M., Etienne, C., & Breman, J. G. (2020). Perspectives on Battling COVID-19 in Countries of Latin America and the Caribbean. The American Journal of Tropical Medicine and Hygiene, 103(2), 593–596.

    Article  Google Scholar 

  • Appadurai, A. (2013). The future as cultural fact. Essays on the global condition. Verso.

    Google Scholar 

  • Apuzzo, M., & Kirkpatrick, D. (2020). COVID-19 changed How the world does science, together. https://www.nytimes.com/2020/04/01/world/europe/coronavirus-science-research-cooperation.html. Accessed 29 August 2020.

  • Beck, U. (2009). World at risk. Polity.

    Google Scholar 

  • Belser, P. (2020). COVID-19 cruelly highlights inequalities and threatens to deepen them. International Labour Organisation (ILO). http://www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_740101/lang--en/index.htm. Accessed on 28 August 2020.

  • Best, A., Greenhalgh, T., Lewis, S., Saul, J. E., Carroll, S., & Bitz, J. (2012). Large system transformation in health care: A realist review. The Milbank Quarterly, 90(3), 421–456.

    Article  Google Scholar 

  • Burki, T. (2020). COVID-19 in Latin America. The Lancet Infectious Diseases, 20(5), 547–548.

    Article  Google Scholar 

  • Bradley, E. H., Curry, L. A., & Devers, K. J. (2007). Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Services Research, 42(4), 1758–1772.

    Article  Google Scholar 

  • Cárdenas, M., & Martínez, H (2020). COVID-19 in Colombia: Impact and policy responses. CGD Center for Global Development Note. https://www.cgdev.org/publication/COVID-19-colombia-impact-and-policy-responses?fbclid=IwAR2iZ8aJHEITBuGQEN-f95WeQQiljvQ9fj4cz3iH7uJgjM4_DJol6rVA3lc#ftn5. Accessed on 28 August 2020.

  • Congreso de la República. (2010). Ley 1419 de 2010: Por la cual se establecen los lineamientos para el desarrollo de la Telesalud en Colombia. http://www.secretariasenado.gov.co/senado/basedoc/ley_1419_2010.html. Accessed on 28 August 2020.

  • de la Hoz-Restrepo, F., Alvis-Zakzuk, N., de la Hoz-Gomez, J. et. al. (2020). Is Colombia an example of successful containment of the 2020 COVID-19 pandemic? A critical analysis of the epidemiological data, March to July 2020. International Journal of Infection Diseases, 99, 522–529.

    Google Scholar 

  • Djellouli, N., Jones, L., Barratt, H., Ramsay, A. I., Towndrow, S., & Oliver, S. (2019). Involving the public in decision-making about large-scale changes to health services: A scoping review. Health Policy, 123(7), 635–645.

    Article  Google Scholar 

  • Escobar, M. L., Giedion, A. G., & Glassman, A. (2009). Colombia: After a decade of health system reform. In A. Glassman et al. (Eds.), From few to many: Ten years of health insurance expansion in Colombia (pp. 3–13). Inter-American Development Bank.

    Google Scholar 

  • Fraser, A., Baeza, J. I., & Boaz, A. (2017). ‘Holding the line’: A qualitative study of the role of evidence in early phase decision-making in the reconfiguration of stroke services in London. Health Research Policy and Systems, 15(1), 45.

    Article  Google Scholar 

  • Franco-Giraldo, A. (2015). El Rol de los Profesionales de la Salud en la Atención Primaria en Salud (APS). Revista Facultad Nacional De Salud Pública, 33(3), 414–424.

    Article  Google Scholar 

  • Fulop, N. J., Ramsay, A. I., Perry, C., Boaden, R. J., McKevitt, C., Rudd, A. G., Turner, S. J., Tyrrell, P. J., Wolfe, C. D., & Morris, S. (2016). Explaining outcomes in major system change: A qualitative study of implementing centralised acute stroke services in two large metropolitan regions in England. Implementation Science, 11(1), 1–13.

    Article  Google Scholar 

  • Guillermoprieto, A. (2020). Fear, anger, desperation: How Bogotá’s residents are coping with COVID-19. https://www.nationalgeographic.com/history/2020/05/fear-anger-desperation-how-bogota-residents-are-coping-covid-19/. Accessed 29 August 2020.

  • Guerrero, R., Gallego, A. I., Becerril-Montekio, V., & Vásquez, J. (2011). Sistema de Salud de Colombia. Salud Pública De México, 53, s144–s155.

    Google Scholar 

  • Hodgson, A., & Midgley, G. (2014). Bringing foresight into systems thinking: A three horizon approach. 58th Annual Meeting of the International Society for the Systems Sciences, ISSS.

    Google Scholar 

  • Jones, L., Fraser, A., & Stewart, E. (2019). Exploring the neglected and hidden dimensions of large-scale healthcare change. Sociology of Health & Illness, 41(7), 1221–1235.

    Article  Google Scholar 

  • Koselleck, R. (2002). Some questions regarding the conceptual history of “crisis”. In The practice of conceptual history: Timing history, spacing concepts. Stanford University Press.

    Google Scholar 

  • Langley, A. N. N., Smallman, C., Tsoukas, H., & Van de Ven, A. H. (2013). Process studies of change in organization and management: Unveiling temporality, activity, and flow. Academy of Management Journal, 56(1), 1–13.

    Article  Google Scholar 

  • Legido-Quigley, H., Asgari, N., Teo, Y. Y., Leung, G. M., Oshitani, H., Fukuda, K., et al. (2020). Are high-performing health systems resilient against the COVID-19 epidemic? Lancet, 395(10227), 848–850.

    Google Scholar 

  • Lidskog, R., Elander, I., & Standring, A. (2020). COVID-19, the climate, and transformative change: Comparing the social anatomies of crises and their regulatory responses. Sustainability, 12(16), 6337.

    Article  Google Scholar 

  • Lukas, C., Holmes, S., Cohen, A., Restuccia, J., Cramer, I., Shwartz, M., & Charns, M. (2007). Transformational change in health care systems: An organizational model. Health Care Management Review., 32(4), 309–320.

    Article  Google Scholar 

  • McKevitt, C., Ramsay, A. I., Perry, C., Turner, S. J., Boaden, R., Wolfe, C. D., & Fulop, N. J. (2018). Patient, career and public involvement in major system change in acute stroke services: The construction of value. Health Expectations, 21(3), 685–692.

    Article  Google Scholar 

  • Ministerio de Salud y Protección Social. Estadísticas de Covertura. https://www.minsalud.gov.co/proteccionsocial/Paginas/cifras-aseguramiento-salud.aspx

  • OECD. (2020). COVID-19 in Latin America and the Caribbean: An overview of governmental responses to the crises. https://www.oecd.org/coronavirus/policy-responses/COVID-19-in-latin-america-and-the-caribbean-an-overview-of-government-responses-to-the-crisis-0a2dee41/. Accessed on 28 August 2020.

  • Orjuela, A., González, L., Pardo, H., & Angulo E. (2014) La tutela y los derechos a la salud y a la seguridad social, 2014. Defensoría del Pueblo (Colombia). https://www.defensoria.gov.co/public/pdf/LatutelaylosderechosalaSalud.pdf. Accessed 28 August 2020.

  • Pablos-Méndez, A., Vega, J., Aranguren, F., Tabish, H., & Raviglione, M. (2020) COVID-19 in Latin America. British Medical Journal, 370:m2939

    Google Scholar 

  • Prada, C., & Chaves, S. (2019). Health system structure and transformations in Colombia between 1990 and 2013: A socio-historical study. Critical Public Health, 29(3), 314–324.

    Article  Google Scholar 

  • Ramsay, A. I., Morris, S., Hoffman, A., Hunter, R. M., Boaden, R., McKevitt, C., Perry, C., Pursani, N., Rudd, A. G., Turner, S., & Tyrrell, P. J. (2015). Effects of centralizing acute stroke services on stroke care provision in two large metropolitan areas in England. Stroke, 46(8), 2244–2251.

    Google Scholar 

  • Rojas-García, A., Turner, S., Pizzo, E., Hudson, E., Thomas, J., & Raine, R. (2018). Impact and experiences of delayed discharge: A mixed-studies systematic review. Health Expectations, 21(1), 41–56.

    Article  Google Scholar 

  • República de Colombia. (2020). Decreto 444 de 2020 Por el cual se crea el Fondo de Mitigación de Emergencias -FOME y se dictan disposiciones en materia de recursos, dentro del Estado de Emergencia Económica, Social y Ecológica. https://dapre.presidencia.gov.co/normativa/normativa/DECRETO%20444%20DEL%2021%20DE%20MARZO%20DE%202020.pdf. Accessed 10 August 2020.

  • Riveros-Pérez, E., & Amado-González, L. N. (2012). Modelo de salud en Colombia: ¿Financiamiento basado en seguridad social o en impuestos? Revista Gerencia y Políticas De Salud, 11(23), 111–120.

    Google Scholar 

  • Rodriguez-Morales, A. J., Gallego, V., Escalera-Antezana, J. P., Méndez, C. A., Zambrano, L. I., Franco-Paredes, C., Suárez, J. A., Rodriguez-Enciso, H. D., Balbin-Ramon, G. J., Savio-Larriera, E., Risquez, A., & Cimerman, S. (2020). COVID-19 in Latin America: The implications of the first confirmed case in Brazil. Travel Medicine and Infectious Disease, 35, 101613.

    Google Scholar 

  • Rodríguez-Villamizar, L. A., Ruíz-Rodríguez, M., & Acosta-Ramírez, N. (2016). Evaluación de un modelo de atención primaria en salud en Santander, Colombia. Revista Facultad Nacional De Salud Pública, 34(1), 88–95.

    Google Scholar 

  • Roitman, J. (2012). Crisis. In Political concepts: A critical lexicon. Tel Aviv.

    Google Scholar 

  • Roitman, J. (2013). Anti-crisis. Duke University Press.

    Book  Google Scholar 

  • Ruiz, F., Avila-Burgos, L., & Trujillo, A. J. (2018). How does managed competition affect hospital prices in a social health insurance system? The Colombian case. Health Policy and Planning, 33(9), 1037–1046.

    Google Scholar 

  • ‘t Hart, P, Rosenthal, U, & Kouzmin, A. (1993). Crisis decision making: The centralization thesis revisited. Administration and Society, 25(1), 12–45.

    Google Scholar 

  • The Economist. (2020). Latin America’s health systems brace for a battering. https://www.economist.com/the-americas/2020/04/11/latin-americas-health-systems-brace-for-a-battering. Accessed 11 April 2020.

  • The Lancet. (2020). COVID-19: Learning from experience. The Lancet, 395(10229):1011. https://doi.org/10.1016/S0140-6736(20)30686-3

  • Turner, S., & Niño, N. (2020). Qualitative analysis of the coordination of major system change within the Colombian health system in response to COVID-19: Study protocol (forthcoming). Implementation Science Communications

    Google Scholar 

  • Turner, S., Ramsay, A., Perry, C., Boaden, R., McKevitt, C., Morris, S., Pursani, N., Rudd, A., Tyrrell, P., Wolfe, C., & Fulop, N. (2016a). Lessons for major system change: centralization of stroke services in two metropolitan areas of England. Journal of Health Services Research & Policy, 21(3), 156–165.

    Google Scholar 

  • Turner, S., Goulding, L., Denis, J., et al. (2016b). Major system change: a management and organisational research perspective. In Challenges, solutions and future directions in the evaluation of service innovations in health care and public health Health Services and Delivery Research. NIHR Journals Library.

    Google Scholar 

  • United Nations. (2020). Policy brief: The impact of COVID-19 on Latin America and the Caribbean. https://www.un.org/sites/un2.un.org/files/sg_policy_brief_COVID_lac.pdf. Accessed on 28 August 2020.

  • Vargas, I., Mogollón-Pérez, A. S., de Paepe, P., Ferreira da Silva, R., Unger, J. P., & Vazquez, M. L. (2016). Barriers to healthcare coordination in market based and decentralized public health systems: A qualitative study in healthcare networks of Colombia and Brazil. Health Policy and Planning., 31, 736–748.

    Article  Google Scholar 

  • Vargas-Zea, N., Castro, H., Rodríguez-Páez, F., Téllez, D., & Salazar-Arias, R. (2012) Colombian health system on its way to improve allocation efficiency—transition from a health sector reform to the settlement of an HTA agency. Value in Health Regional Issues, 1(2), 218–222.

    Google Scholar 

  • Vindrola-Padros, C., Ramsay, A. I., Perry, C., Darley, S., Wood, V. J., Clarke, C. S., Hines, J., Levermore, C., Melnychuk, M., Moore, C. M., & Morris, S. (2020). Implementing major system change in specialist cancer surgery: The role of provider networks. Journal of Health Services Research & Policy. https://doi.org/10.1177/1355819620926553

    Article  Google Scholar 

  • Waring, J., Bishop, S., Clarke, J., Exworthy, M., Fulop, N. J., Hartley, J., & Ramsay, A. I. (2018). Healthcare leadership with political astuteness (HeLPA): A qualitative study of how service leaders understand and mediate the informal ‘power and politics’ of major health system change. BMC Health Services Research, 18(1), 918.

    Article  Google Scholar 

  • Werner, A. (2020). Outlook for Latin America and the Caribbean: An intensifying pandemic. IMFBlog. https://blogs.imf.org/2020/06/26/outlook-for-latin-america-and-the-caribbean-an-intensifying-pandemic/. Accessed 28 August 2020.

  • Yin, R. K. (2009). Case study research design and methods (4th ed.). Sage.

    Google Scholar 

  • Yin, R. K. (2013). Validity and generalization in future case study evaluations. Evaluation, 19, 321–332. https://doi.org/10.1177/1356389013497081

    Article  Google Scholar 

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Funding Statement

The study was funded by the Colombian Ministry of Science, Technology and Innovation, project code 1204101577001. The call was titled ‘Invitation to present projects that contribute to solving current health problems related to the COVID-19 pandemic’ (Invitación a presentar proyectos que contribuyan a la solución de problemáticas actuales de salud relacionadas con la pandemia de COVID-19). ST also acknowledges support from ‘Fondo de Apoyo a Profesores Asistentes’ (FAPA) de la Universidad de los Andes

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Authors and Affiliations

  1. School of Management, University of Los Andes, Bogotá, Colombia

    Simon Turner, Ana María Ulloa, Vivian Valencia Godoy & Natalia Niño

Authors
  1. Simon Turner
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  2. Ana María Ulloa
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  3. Vivian Valencia Godoy
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  4. Natalia Niño
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Corresponding author

Correspondence to Simon Turner .

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Editors and Affiliations

  1. Health Services Management Centre, University of Birmingham, Birmingham, UK

    Justin Waring

  2. School of Public Health, Université de Montréal, Montréal, QC, Canada

    Jean-Louis Denis

  3. Copenhagen Business School, Copenhagen, Denmark

    Anne Reff Pedersen

  4. University of Auckland, Auckland, New Zealand

    Tim Tenbensel

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Turner, S., Ulloa, A.M., Valencia Godoy, V., Niño, N. (2021). Learning from History or Reacting to Events? Colombia's Navigation of Major System Change in Response to COVID-19. In: Waring, J., Denis, JL., Reff Pedersen, A., Tenbensel, T. (eds) Organising Care in a Time of Covid-19. Organizational Behaviour in Healthcare. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-82696-3_4

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