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

Carolyn Steele Gray*, G. Ross Baker, Mylaine Breton, Karin Kee, Mirella Minkman, James Shaw, Maike Tietschert, Paul Wankah, Walter Wodchis, Nick Zonneveld, Henk Nies

*Corresponding author for this work

Research output: Chapter in Book / Report / Conference proceedingChapterAcademicpeer-review


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.

Original languageEnglish
Title of host publicationOrganising Care in a Time of Covid-19
Subtitle of host publicationImplications for Leadership, Governance and Policy
EditorsJustin Waring, Jean-Louis Denis, Anne Reff Pedersen, Tim Tenbensel
PublisherPalgrave / MacMillan
Number of pages31
ISBN (Electronic)9783030826963
ISBN (Print)9783030826956, 9783030826987
Publication statusPublished - 2021

Publication series

NameOrganizational Behaviour in Healthcare (OBHC)
ISSN (Print)2662-1053
ISSN (Electronic)2662-1045

Bibliographical note

Publisher Copyright:
© 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.


  • Covid-19
  • Health System Transformation
  • Sustainability Transformation


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