This section below lists and describes scientific evidence and jurisdictional experiences regarding health system recovery plans during the COVID-19 pandemic, particularly relating to scope, key challenges that plans intend to solve, lessons learned that informed plans, barriers to success, and governance structures. The majority of the information presented is taken directly from the identified sources. 

• It was often unknown if recovery plans were specifically developed following a wave 2 or wave 3 response. Moreover, jurisdictions may have experienced waves 2 and 3 at differing times, or continued to use or updated recovery plans developed during wave 1 for waves 2 and 3. As such, although most of the recovery plans included in this Briefing Note were developed from Fall 2020 to Spring 2021, others previously developed may have also been included if relevant.
• Most of the identified recovery plans were not only focused on health system recovery, but also included economic and social system recovery priorities.

Scientific Evidence

Challenges to be Addressed

• Eight research articles (two from Canada and six from the US) highlighted that the lessons learned from the COVID-19 pandemic thus far present unprecedented opportunities for health system reform in a broad range of areas, including infrastructure, delivery (e.g., reducing low-value care, racial and ethnic disparities), public health capacity, clinical and administrative processes, care planning, insurance coverage, value-based payment approaches (e.g., capitation), telemedicine, professional scope of practice, medical education, and patient engagement and shared decision-making. For example:
  • Canada: An article (Sept 2020) observed that while progress on national physician licensure, virtual health care, and sick-at-work culture emerged as important responses to the COVID-19 pandemic, the way in which they are transformed into sustainable solutions will have a lasting impact on the post-pandemic Canadian health care system.
  • US: A commentary (Aug 2020) recommended policy changes for medical practices in the following categories after the COVID-19 crisis has passed: 1) clinical workflows (e.g., orders, signatures, and forms); 2) medication reconciliation (e.g., may be performed by support staff); 3) measurement, monitoring, and compliance; and 4) technology (e.g., telemedicine). Six principles can guide these changes: 1) evidence-based policy and regulation; 2) avoid the assumption that a task is automatically safer when performed by the highest trained practitioner; 3) financial costs of regulatory and policy requirements are often borne by the clinician closest to the patient; 4) decrease administrative requirements to record all care provided; 5) professionalism is an intrinsic lever to drive quality and safety; and 6) appropriately assign accountability for health outcomes.
  • US: A study (Nov 1, 2020) presented a model of post-epidemic recovery to advance global health security. The model focuses on the larger social, economic, physical, and natural systems that impinge upon human health and wellbeing, including support services, economic prospects, and crisis communications that help foster the recovery of affected individuals/groups according to a “whole person” model. The model also treats recovery as both a process of restoration (e.g., getting people well; making the health sector fully functional again; curbing the stigmatization of people, places, and products) and transformation (e.g., addressing the social determinants of uneven epidemic impacts; integrating resilience to epidemics into long-range planning not typically tied to health outcomes; fixing faulty environments such as substandard housing and water systems). The timeframe and activities of recovery are represented in a fluid manner, with different phases and functions overlapping and building up along a temporal continuum, from the early days of the acute response to the later years of fundamental reforms.

Research Priorities

• Canada: A research article (Aug 2020) described how the Canadian Institutes of Health Research’s Institute of Health Services and Policy Research conducted a rapid-cycle priority identification process to inform Canada’s research response to COVID-19. Seven COVID-19 priorities for health services and policy research that may contribute to improved health and health system outcomes were identified: 1) system adaptation and organization of care; 2) resource allocation decision-making and ethics; 3) rapid synthesis, and comparative policy analysis of the COVID-19 response and outcomes; 4) health care workforce; 5) virtual care; 6) long-term consequences of the pandemic; and 7) public and patient engagement. Three additional cross-cutting themes were identified: 1) supporting the health of Indigenous Peoples and vulnerable populations; 2) data and digital infrastructure; and 3) learning health systems and knowledge platforms.

International Scan

• Organizations: Recovery frameworks were identified from the World Health Organization (Feb 24, 2021), KPMG International (Nov 2020), and X4 Health/University of Oregon (Feb 17, 2021).
  • Challenges to be Addressed: These include: COVID-19 outbreak management, mental health, supply chains, digital technologies, surveillance systems, laboratories and diagnostics, misinformation, equity and vulnerable populations, agile health workforces, and compliance and risk management.
  • Lessons Learned: Based on research evidence and past disaster recovery efforts, the following considerations are important: partnerships, project management, community resilience, and the needs of vulnerable people and economic sectors that have been most adversely impacted are important. 
  • Barriers to Success: These include: capacity and capabilities, financial resources, access to vital commodities and supplies, misinformation, other concurrent crises (e.g., wildfires, racial justice protests, cyberattacks on government systems), and “decision fatigue” of leaders.
• Jurisdictions: Recovery frameworks were identified from California (Apr 6, 2021), Geisinger Health System (2020), England (Mar 25, 2021), Wales (Mar 2021), European Union (2021), European Commission/Organisation for Economic Co-operation and Development (2020), Italy (Jan 12, 2021), New Zealand (Dec 2020), Melbourne (Sept 2020), and Western Australia (2020-21). 
  • Challenges to be Addressed: These include: COVID-19 vaccination program, public health, primary care, hospitals, surveillance systems, mental health, community and social care, integrated health systems, non-communicable diseases, infrastructure, supply chain, affordable medicines and medical devices, adaptive surge capacities, backlogs, e-health systems, telemedicine, health workforce, health inequities of vulnerable populations, Indigenous communities, ageing populations, performance measurement, health datasets, scientific research, international cooperation, and governance.  
  • Lessons Learned: Common-sense health measures generally remain (e.g., vaccination, infection prevention and control) and inform recovery plans. Prior experiences with other crises and lessons learned from the ongoing COVID-19 pandemic also inform recovery plans relating to: value-based payment models, health spending on curative care rather than prevention, surveillance systems, flexible work options, expanded scope of practice for health workers, mental wellbeing, community-led solutions, accessibility, efficiency, resilience, timely implementation, international cooperation, and strong trust in government and compliance by populations. 
  • Barriers to Success: These include: ongoing fluctuations in COVID-19 crisis, capital investments for infrastructure/facilities/equipment, increased costs of living, population growth, climate change, social justice issues, and reconciliation with Indigenous groups. 
  • Governance: Primarily cross-sector advisory groups led by government and/or experts, using scenario-based planning and risk prioritization approaches

Canadian Scan

• Organizations: The Conference Board of Canada’s report (Mar 31, 2021) described key recommendations from a roundtable discussion of Canadian health leaders on how to turn the COVID-19 crisis into an opportunity for health system reform.
  • Challenges to be Addressed: 1) prioritize value-driven investments (e.g., invest in IT infrastructure, eliminate siloed budgets); and 2) build on the strengths of the initial response to the COVID-19 crisis by accelerating integration of virtual care and digital health technologies, advancing systematic measurement and data sharing to support evidence-based decision-making, and advancing public-private partnerships.
  • Lessons Learned: The momentum created by the COVID-19 crisis for rapid system adaptation should be leveraged. For example, the speedy adoption of telehealth was facilitated in each province and territory by rapid regulatory changes around licensure requirements and physician compensation.
  • Governance: A new Resilient Healthcare Coalition, a group of health leaders/stakeholders across public, private, and not-for-profit sectors, is coming together to strengthen connections across the health system, showcase local leadership and homegrown successes, and identify and integrate models and solutions from around the world.
• Jurisdictions: Recovery plans were found from Alberta (2021) and British Columbia (2020). 
  • Challenges to be Addressed: These include: infrastructure and capacity building, surveillance systems, supply and procurement, health care work recruitment and training, mental health and addiction supports, senior care, community-based care, family and social supports, and multidisciplinary team-based care.

Ontario Scan

• Ontario Health will be partnering with the Ministry of Health (as of Mar 4, 2021) to renew the focus on health system modernization and plan to restore routine access to non-COVID-19-related health care services, as trends in key public health indicators improve. 
  • Challenges to be Addressed: These include: minimizing the downstream effects of COVID-19 on the health of Ontarians; ensuring confidence in the safety and accessibility of health services; supporting the system’s workforce; addressing deferred preventive screening, diagnostic, surgical, and non-surgical services; enhancing mental health and addiction services; and improving health equity for the most vulnerable populations.

The COVID-19 Evidence Synthesis Network is comprised of groups specializing in evidence synthesis and knowledge translation. The group has committed to provide their expertise to provide high-quality, relevant, and timely synthesized research evidence about COVID-19 to inform decision makers as the pandemic continues. The following member of the Network provided evidence synthesis products that were used to develop this Evidence Synthesis Briefing Note:

• Ontario Health (Cancer Care Ontario). (April 7, 2021). Email Communications.