Abstract Rationale Optimizing outcomes for both infected patients and uninfected patients hospitalized during respiratory viral surges (i.e., “bystander patients”), requires that hospitals display: (1) adaptation—the ability to improve care and outcomes for infected patients by implementing new care processes based on accumulated experience, and (2) resiliency—the ability to continue to deliver high quality care to all patients despite the presence of a surge event. However, it is unknown what enables hospitals to display adaptation and resiliency, thereby threatening care quality for all patients during viral surges. Methods We conducted an exploratory qualitative study at two Penn Medicine hospitals from disparate practice environments (suburban/community and urban/academic), previously identified as having either particularly strong intensive care unit or ward-level outcomes, respectively. We performed semi-structured virtual interviews with acute care clinicians and clinical leaders across levels of care and job roles to learn about hospital capacity strain phenomena and organizational factors that may increase or inhibit hospital adaptation and resiliency. Respondents were prompted to reflect on experiences during the COVID-19 pandemic, in non-pandemic respiratory viral surge periods, and in periods of all-cause hospital capacity strain. We utilized a thematic analysis approach to code and preliminarily analyze interview transcripts within the ATLAS.ti software environment. Results We conduced 38 interviews (mean duration 42.6 minutes) across different: levels of care (11 emergency department, 9 general medical ward, 13 intensive care unit, 5 with multiple practice locations); clinical roles (17 physicians/advanced practice providers, 14 nurses, 7 respiratory therapists); leadership roles (6 physician/advanced practice provider unit directors, 6 nurse managers, 1 respiratory therapy director); career stage (age range 24-63 years); and demographics (47% female, 16% traditionally underrepresented race/ethnicity). Within a priori parent domains, the most dominantly discussed subdomains at an interim analysis included: staff wellbeing, satisfaction/dissatisfaction, and burnout (hospital staffing); communication (hospital leadership); flexibility and re-evaluation of practices (combating strain); patient safety (hospital culture); and interdisciplinary collaboration (team dynamics). Conclusions In preliminary, exploratory analyses among frontline clinicians and clinical leaders, domains dominantly discussed with respect to hospital adaptation and resiliency during surge periods included: (1) hospital organizational practices perceived to create vulnerability for or cause burnout or degrade clinician wellbeing, and (2) hospital leadership communication strategies. Ongoing qualitative analyses will seek to identify specific organizational characteristics that may modify hospital adaptation and resiliency to serve as candidate targets for future organizational interventions. This abstract is funded by: NIH K23HL161353
Anesi et al. (Fri,) studied this question.