National and regional coordination of scarce capacity and resources during the corona pandemic

Blog series 'I study the organisation of healthcare due to and during COVID-19'
During the coronavirus pandemic, the capacity of hospitals was severely put to the test, and it was a challenge to allocate scarce resources well. How is the national and regional coordination for the management of this allocation organised? And what are the effects on the availability and use of resources?

Taco van der Vaart (Professor of Supply Chain Management), Paul Buijs (assistant professor) and Gerdien Regts (assistant professor and postdoctoral researcher) from the University of Groningen are investigating various issues in the study: 'National and regional coordination in times of scarcity'. They tell us more about this study in this blog.

Tackling scarcity

Shortly after the start of the first coronavirus wave, Paul Buijs helped as a volunteer in distributing personal protective equipment across the healthcare institutions in the North of the Netherlands. Many healthcare organisations – especially from the care sector – complained about a lack of personal protective equipment, whereas sufficient resources were often available at the regional level. Similar problems occurred in the national spread of coronavirus patients. Whereas a number of hospitals came dangerously close to "code black", it became apparent that there was still sufficient capacity at other hospitals. Although safeguarding the continuity of care was the main concern in this phase, the allocation of resources and capacity is also a major logistics challenge for which existing logistics knowledge can be useful and new insights can be acquired. This formed an important motivation for the current research.

In this project, we are investigating the coordination at the regional level of the way in which capacity and resources are made available and used optimally. The aim is not only to obtain insights, but also to formulate important lessons learned. We seek to realise an optimised and empirically supported approach that can be used in the wake of the coronavirus pandemic. This approach could also be used in other, increasingly more common situations in healthcare where there is a lack of resources.

Interviews with professionals about the coordination

For this project, we interviewed a large number professionals from a wide range of disciplines within healthcare. We conducted more than 70 interviews, for instance with purchasers, bed coordinators, intensive care physicians, coordinators of the Regional Capacity and Patient Transfer Service (RCPS) and the employees of the National Coordination Centre Patient Transfer Service (LCPS). During these interviews, we wanted to find out more about the coordination concerning capacity, occupancy, patient transfer and resources. How was this coordination realised, how was it organised and what did or did not work well.

Interests and considerations

Many interests and considerations played a role in the spread of patients. For a time, these interests and considerations remained implicit for many of the parties involved. During the first coronavirus wave, some Dutch hospitals suddenly had to process a very high influx of COVID-19 patients. However, from the second wave in the Netherlands onwards, there was a strong focus on the equal allocation of patients with the help of national and regional plans for upscaling. That is because the (too) late transfer of patients from (over)crowded hospitals does not benefit the quality of the provided care. Fortunately, the focus on the equal allocation of patients based on plans for upscaling in the second wave had an effect, and from then onwards, the spread of patients was realised with a considerable degree of success. However, regions with less influx in their own area had to keep beds free for COVID-19 care that was subsequently not always immediately used. This sometimes meant that plannable care had been unnecessarily deferred.

This research also shows how difficult it is to gain a good understanding of the exact capacity of local hospitals from a central vantage point. After all, this depends on the availability of many different resources and also personnel. This, in turn, strongly depends on local choices and interests – such as which elective care will continue to be provided – and therefore constantly changes. This could possibly be prevented by a larger role in the coordination and decision-making of existing regional networks, such as the intensive care networks, in which people frequently work on the basis of trust, making mutual concessions and knowing each other's hospital well.

Based on the lessons learned so far, we expect to be able to soon publish an advisory report. This will detail how the allocation of resources and capacity can be effectively coordinated, for example, by demonstrating how detailed the data need to be at the local, regional and national levels so that the right decisions can be taken in times of scarcity.

More information

Context organisation of healthcare

This research is one of the ten studies on the subject' organisation of healthcare'. The COVID-19 pandemic has had a negative impact on the entire healthcare system in the Netherlands. The results from this study are helping to organise healthcare in such a way that it is possible to continue providing high-quality care. This applies to hospital care, general practice, mental healthcare and home care.

Together with researchers, patients, healthcare professionals, data professionals and international partners, ZonMw is examining possibilities to use research and knowledge, both now and in the future, to contribute to solutions in the fight against the coronavirus and COVID-19 and its impact on society.