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Balancing COVID-19 preparedness and ‘business as usual’ in hospitals: lessons from executives in China, Norway and the UK
  1. Umar Ikram1,
  2. Hui Ren2,
  3. Laura Shields-Zeeman3,
  4. Jan Frich4,5,
  5. Daniel Northam Jones6,
  6. Jiong Wu7,
  7. Ming Kuang8,
  8. Yuanli Liu9,
  9. Jing Ma2,10
  1. 1 Department of Health Policy and Management, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  2. 2 US-China Health Summit, Boston, Massachusetts, USA
  3. 3 Department of Mental Health and Prevention, Netherlands Institute for Mental Health and Addiction, Utrecht, The Netherlands
  4. 4 South-Eastern Norway Regional Health Authority, Hamar, Norway
  5. 5 Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
  6. 6 Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
  7. 7 Cancer Hospital, Fudan University, Shanghai, China
  8. 8 The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
  9. 9 School of Public Health, Peking Union Medical College, Beijing, China
  10. 10 Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Umar Ikram, Department of Health Policy and Management, Harvard University T H Chan School of Public Health, Boston, MA 02115, USA; uikram{at}


Background During the first wave of COVID-19 pandemic, hospitals were forced to cancel or postpone non-COVID-19 care. With new outbreaks emerging, hospitals are now figuring out how to balance preparedness for future COVID-19 waves with their elective and regular services. This report discusses how four hospital systems deal with these dual responsibilities in China, Norway and the UK.

Reflections Based on the experiences and combined reflections of hospital executives, we have formulated five strategic and leadership lessons for hospitals as they manage these dual responsibilities. (1) Redesign organisation to separate COVID-19 and non-COVID-19 services both within and across hospitals. (2) Expand virtual care strategies to improve access. (3) Use data-driven models to allocate resources across COVID-19 and non-COVID-19 units. (4) Invest in programmes to promote frontline staff well-being. (5) Secure financial support to continue to deliver on the dual responsibilities.

Conclusion The COVID-19 pandemic gives rise to leadership challenges that have fuelled organisational change and new approaches to healthcare delivery. Leading hospitals during the pandemic is a balancing act—providing care for both patients with COVID-19 and non-COVID-19, while at the same time preparing for the next waves of the pandemic.

  • health system
  • health policy
  • management

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  • Contributors UI, HR, LS-Z and JM planned to write an article based on the insights from hospitals executives and organised the virtual seminar to gain these insights. JF, DNJ, JW, MK and YL provided qualitative data for the manuscript. UI analysed the qualitative data and reported the findings to all coauthors to formulate key learnings. UI and HR drafted the manuscript. All coauthors reviewed and commented on the subsequent versions of the manuscripts. UI and JM are responsible for the overall content as guarantor.

  • Funding UI was awarded the Harkness Fellowship which was funded by the Commonwealth Fund.

  • Disclaimer The views presented here are those of the authors and should not be attributed to The Commonwealth Fund or its directors, officers, or staff.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.