Lessons Learned From the Resilience of Chinese Hospitals to the COVID-19 Pandemic: Scoping Review

  1. Jack Stennett
  2. Renyou Hou
  3. Lola Traverson
  4. Valéry Ridde
  5. Kate Zinszer
  6. Fanny Chabrol

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Abstract

The SARS-CoV-2 pandemic has brought substantial strain on hospitals worldwide; however, although the success of China’s COVID-19 strategy has been attributed to the achievements of the government, public health officials, and the attitudes of the public, the resilience shown by China’s hospitals appears to have been a critical factor in their successful response to the pandemic.

Objective

This paper aims to determine the key findings, recommendations, and lessons learned in terms of hospital resilience during the pandemic; analyze the quality and limitations of research in this field at present; and contribute to the evaluation of the Chinese response to the COVID-19 outbreak, building on a growing literature on the role of hospital resilience in crisis situations.

Methods

We conducted a scoping review of evidence on the resilience of hospitals in China during the COVID-19 crisis in the first half of 2020. Two online databases (the China National Knowledge Infrastructure and World Health Organization databases) were used to identify papers meeting the eligibility criteria. After extracting the data, we present an information synthesis using a resilience framework. Articles were included in the review if they were peer-reviewed studies published between December 2019 and July 2020 in English or Chinese and included empirical results pertaining to the resilience of Chinese hospitals in the COVID-19 pandemic.

Results

From the publications meeting the criteria (n=59), we found that substantial research was rapidly produced in the first half of 2020 and described numerous strategies used to improve hospital resilience, particularly in three key areas: human resources; management and communication; and security, hygiene, and planning. Our search revealed a focus on interventions related to training, health care worker well-being, eHealth/telemedicine, and workplace organization, while other areas such as hospital financing, information systems, and health care infrastructure were less well represented in the literature. We also noted that the literature was dominated by descriptive case studies, often lacking consideration of methodological limitations, and that there was a lack of both highly focused research on specific interventions and holistic research that attempted to unite the topics within a resilience framework.

Conclusions

We identified a number of lessons learned regarding how China’s hospitals have demonstrated resilience when confronted with the SARS-CoV-2 pandemic. Strategies involving interprovincial reinforcements, online platforms and technological interventions, and meticulous personal protective equipment use and disinfection, combined with the creation of new interdisciplinary teams and management strategies, reflect a proactive hospital response to the pandemic, with high levels of redundancy. Research on Chinese hospitals would benefit from a greater range of analyses to draw more nuanced and contextualized lessons from the responses to the crisis.

Article activity feed

  1. Version published to 10.2196/31272
  2. Version published to 10.2196/preprints.31272
  3. ScreenIT

    SciScore for 10.1101/2021.04.22.21255908: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsField Sample Permit: Identification of articles: We conducted our searches on a collection of articles related to the COVID-19 pandemic published on the Stephen B.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    These articles were collected on the following electronic databases : Medline (Ovid and PubMed), PubMed Central, Embase, CAB Abstracts, Global Health, PsycInfo, Cochrane Library, Scopus, Academic Search Complete, Africa Wide Information, CINAHL, ProQuest Central, SciFinder, the Virtual Health Library, LitCovid, WHO COVID-19 website, CDC COVID-19 website, China CDC Weekly, Eurosurveillance, Homeland Security Digital Library, ClinicalTrials.gov, bioRxiv (preprints), medRxiv (preprints), chemRxiv (preprints), and SSRN (preprints).
    Medline
    suggested: (MEDLINE, RRID:SCR_002185)
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    PsycInfo
    suggested: (PsycINFO, RRID:SCR_014799)
    Cochrane Library
    suggested: (Cochrane Library, RRID:SCR_013000)
    bioRxiv
    suggested: (bioRxiv, RRID:SCR_003933)
    After the ATCER tool analysis and the removal of duplicates, we imported the selected references (n = 559) into Covidence, a systematic review software for screening.
    ATCER
    suggested: None
    A data extracting form was created on Excel to collect several information from the selected literature: publication type, study type, study settings – continent and hospital settings –, hospital dimension(s), objectives, results and limitations of the study, and conceptual framework or mid-range theory used (Table S1: Description of the selected studies).
    Excel
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations of the study: Firstly, as we chose to conduct a scoping review, the simplification of some steps of the systematic review to speed up the process can influence its rigor. To make these risks explicit and allow transparency, we gave a very detailed description of the method. Secondly, because of the very large amount of data available, we decided to exclude grey literature and preprints from our searches, therefore we could also have missed pertinent studies. Thirdly, we faced the analytical challenge of causality, for epistemological and methodological reasons. The first reason is the use, essentially, of a qualitative approach, and the second reason is the pandemic context, which did not facilitate a longitudinal data collection.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2021.04.22.21255908v1 on medRxiv
  5. ScreenIT

    SciScore for 10.1101/2021.03.15.21253509: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    These articles were collected from the following databases: Medline (Ovid and PubMed), PubMed Central, Embase, CAB Abstracts, Global Health, PsycInfo, Cochrane Library, Scopus, Academic Search Complete, Africa Wide Information, CINAHL, ProQuest Central, SciFinder, the Virtual Health Library, LitCovid, WHO COVID-19 website, CDC COVID-19 website, China CDC Weekly, Eurosurveillance, Homeland Security Digital Library, ClinicalTrials.gov, bioRxiv (preprints), medRxiv (preprints), chemRxiv (preprints), and SSRN (preprints).
    Medline
    suggested: (MEDLINE, RRID:SCR_002185)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    PsycInfo
    suggested: (PsycINFO, RRID:SCR_014799)
    Cochrane Library
    suggested: (Cochrane Library, RRID:SCR_013000)
    bioRxiv
    suggested: (bioRxiv, RRID:SCR_003933)
    The selection of sources of evidence was conducted following an extended iterative process, confirming the overlap of articles with searches on other platforms (e.g., Wanfang, Google Scholar, PubMed, CDC Website).
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    PubMed
    suggested: (PubMed, RRID:SCR_004846)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, this process could also represent a scientific bias that can bring into question the neutrality of the scientific research process, especially as many articles, particularly those in Chinese, did not consider the methodological limitations. Similarly, as China’s research and medical communities are not independent from politics (Chen, 2020), political factors may have played a role in the choice of papers written and published, potentially neglecting those that found negative results. These two factors: politics and the predominance of healthcare workers, as opposed to professional researchers, as authors, may also have limited the scope of articles concerning resilience issues such as finance or power structures, which can be sensitive and politicised. Inequalities were largely ignored in the selected studies. Many of the articles that examined hospital strategies to address healthcare worker health issues emphasised the physical and mental health of nurses, while often neglecting the issues faced by other healthcare providers, including doctors. One possible reason for this phenomenon is that doctors may have more difficulty discussing problems encountered in work and sharing mental health concerns with colleagues (Galbraith et al. 2020). Similarly, gender issues and differences were not discussed in the selected papers. Despite significant gender gaps existing in healthcare professions-men being overrepresented in senior healthcare roles, and underrepresented in n...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  6. Version published to 10.1101/2021.03.15.21253509v1 on medRxiv