Will the “New” Become the “Normal”? Exploring Sustainability of Rapid Health System Transformations

Health, social, and community care agencies are undergoing rapid changes in response to the COVID-19 pandemic, arguably offering a “window of opportunity” for health system transformation. What is required is theoretical guidance to help determine whether rapid system responses are likely to be sustained as part of broader transformation efforts. We performed a single-phenomenon two theory integration to develop the Rapid and Sustainable Transformation (or RAST) framework, aligning theories from the disaster response and sustainability literature to propose a framework exploring the long-term impact of rapid health system changes and interventions related to COVID-19. In this chapter, the proposed theoretical framework is applied to three cases from Quebec and Ontario in Canada and The Netherlands to examine ongoing efforts to improve health system delivery prior to the pandemic. By applying the framework to these cases, this chapter demonstrates how the framework can help to identify components that require attention for studying sustainability in a disaster response environment. The RAST framework helps advance organizational research around health system transformation by demonstrating how the components of sustainability are interrelated and may be weighed differently in their influence on longer-term transformation.