What the COVID-19 pandemic has taught us about system change

May 10, 2020

One of the many unique aspects of the COVID-19 pandemic is that it is hitting the entire country at the same time. In contrast, most floods, hurricanes, disease outbreaks, and other disasters are local or regional in impact. Given COVID-19’s universal reach, it is not surprising that we look for national-level response systems.

When issues seem bigger than any individual organization, we look for systems. While many of us looked to systems we thought could guide us through COVID-19, we discovered that there were no systems where we expected to find them. What we are calling “system failure” is really system “expectation” failure.

Advocates often work to shift systems to have the greatest impact on the most people, but we must consider whether there is a system to change in the first place and whether a system can create the change we’re seeking. Here are three questions to consider:

1. Does the system have the necessary reach?

Are there limits to the area or people (jurisdiction) the system operates in and is the system taken seriously (credibility) within their jurisdiction?

While the Polk County Health Department may be credible on some issues, their jurisdiction is limited to Polk County.

When the Centers for Disease Control and Prevention (CDC) proposed the initial test kits for the COVID-19 virus, their recommendations were accepted as coming from a credible national organization. States turned to the Strategic National Stockpile, housed within the U.S. Department of Health and Human Services (HHS), for needed personal protection equipment (PPE) and supplies, because they thought it was a national, credible organization. While we saw both national systems as credible in responding to COVID-19, we discovered other problems in the systems.

2. Is the system competent?

Had the test kits proposed by CDC been effective, they would have been used because they worked, not because they were required. But, since they were not effective, questions were raised about CDC’s competence for the given task.

Multiple requests to the Strategic National Stockpile in previous disasters had been managed effectively by the HHS indicating their competence, but then a new challenge arose.

3. Does the system have the capacity to deliver?

While CDC can recommend which test kits states and communities could/should use, they do not have the formal authority to require anyone to use those kits. As such, when the CDC kits were not effective, communities chose other kits, creating a confusing and disjointed response.

Because the requests for resources from the SNS exceeded the inventory, HHS did not have the capacity to effectively respond, causing hospitals and organizations to scramble to find their own PPE.

Opportunities for system change:

When the system can effectively reach (jurisdiction and credibility) the desired population, is competent to provide what is needed, and has the capacity (authority and resources) to make it happen, the essentials of a system are in place.

These elements were not in place to expect a systemic response for testing or to address the PPE shortage during the COVID-19 pandemic.  These were not system failures. There were no systems to fail.

In these cases, communities have a couple of options to create a “system-like” response where a system doesn’t exist.

1. Provide a missing piece in the system.

Polk County Emergency Management is positioning itself as the clearinghouse for PPE in Polk County. Organizations submit their needs. Donors submit their resources and Polk County Emergency Management gets the latter to the former. They provide a missing piece.

2. Leverage power to create consistency.

In an attempt to end a lot of the confusion around testing, the State of Iowa signed a large contract for an external partner to operate the Test Iowa program. Their intent was to establish a program big enough to discourage other communities from choosing other products or competitors, using their leverage to create consistency in testing.

3. Build new capacity.

Polk County established a Medical Coordination Committee (comprised of the hospitals, federally qualified health centers, the local health department and other providers) to ensure coordination and collaboration that doesn’t happen (and often cannot happen due to anti-trust restrictions) on a day-to-day basis. They built new capacity.

System-level change can be an effective and efficient way to create positive change or minimize negative change in our communities. But, only, if the system really exists.

Related Issues & Ideas

Report

2021 Community Health Needs Assessment

View 2021 Community Health Needs Assessment
White Paper

The Link Between Stillbirth & Maternal Mortality and Morbidity: Firsthand Accounts from American Women

View The Link Between Stillbirth & Maternal Mortality and Morbidity: Firsthand Accounts from American Women
White Paper

Strengths of Latinx Immigrants Despite Legal Violence

View Strengths of Latinx Immigrants Despite Legal Violence
Article

Why building community power is vital for philanthropy

View Why building community power is vital for philanthropy
Report

Surgeon General's Advisory on Protecting Youth Mental Health

View Surgeon General's Advisory on Protecting Youth Mental Health
Report

A Caring, Connected Community: How Greater Des Moines nonprofits met our needs during the pandemic

View A Caring, Connected Community: How Greater Des Moines nonprofits met our needs during the pandemic
Report

Champions for Change: A Collective Commitment to Children's Health

View Champions for Change: A Collective Commitment to Children's Health
Report

Why aren't kids a policy priority?

View Why aren't kids a policy priority?
Website

The United States Prosperity Index 2021

View The United States Prosperity Index 2021
Article

Building a Trust-Based Philanthropy to Shift Power Back to Communities

View Building a Trust-Based Philanthropy to Shift Power Back to Communities
Guide

Prenatal-to-3 State Policy Roadmap

View Prenatal-to-3 State Policy Roadmap
Website

Frameworks Institute: Changing the conversation on social issues

View Frameworks Institute: Changing the conversation on social issues
Website

Framing best practices with Topos Partnership

View Framing best practices with Topos Partnership
Report

Systems Change & Deep Equity

View Systems Change & Deep Equity
Website

Iowa Public Health Association

View Iowa Public Health Association
Report

Cultivating Change: How the HealthConnect Fellowship lifted a network of advocates to improve children's health in central Iowa

View Cultivating Change: How the HealthConnect Fellowship lifted a network of advocates to improve children's health in central Iowa
Report

Shifting the Lens: How The ACE Study sparked action to collectively improve our community's health

View Shifting the Lens: How The ACE Study sparked action to collectively improve our community's health
Website

National Academy of Medicine

View National Academy of Medicine
Website

Grant Makers in Health

View Grant Makers in Health

Media's Role in Improving Health

How support to Iowa Public Radio is building awareness of factors that influence well-being

View Story
View Story

Latinx Project tells story of strength and opportunity

New report highlights central Iowa Latinos contributions and disparities and elevates Latinx leaders

View Story
View Story

Improving Health through Social Supports

MercyOne's community health worker model improves outcomes for families.

View Story
View Story

Re-Imagining How Iowa's Systems Work Together to Best Serve Families

The Vision Council has led conversations on how Iowa's families and children can be safe, secure, healthy, and well in our communities.

View Story
View Story

Champions for Change: A Collective Commitment to Children's Health

Outcomes from Mid-Iowa Health Foundation's HealthConnect Fellowship, October 2019-June 2021

View Story
View Story

Elevating the Latinx Community

How nonprofit leaders brought attention to the Latinx community and built new systems of support during the pandemic

View Story
View Story

Protecting Those Who Protect Our Kids

Iowa ACEs 360 shares this story about how supervisors in the Polk County Dept. of Human Services’ Child Welfare Division are addressing trauma in their workforce.

View Story
View Story

A New Approach to Supporting Youth in Juvenile Detention

Teenagers in jumpsuits lying on yoga mats, their eyes closed, their bodies still. This is the image Megan Hoxhalli describes as remarkable for juvenile detention, a place where youth arrive shaken, dysregulated, and scared about their future.

View Story
View Story

4 ways to measure system-change progress

System change
May 31, 2022
View Post

Health disparities for Black pregnant Iowans: What you should know

View Post

5 reasons why youth should lead systems-change work

View Post

What we mean by 'system change'

System change
Apr 6, 2022
View Post

4 insights from researching housing instability in central Iowa

View Post

Iowa youth aging out of foster care: How are they doing?

View Post

7 lessons learned from Sesame Street partnership

Foundation grants
Jan 31, 2022
View Post

A closer look at mental health in schools during the pandemic

Community response
Nov 29, 2021
View Post

Get to Know Dr. Nalo Johnson

Foundation news
Nov 24, 2021
View Post

4 questions for nonprofit and community leaders

View Post

5 questions for leaders in philanthropy

Funder practices
Nov 5, 2021
View Post

5 ways to think about your personal brand as a part of your work

Leadership
Nov 1, 2021
View Post

4 issues impacting children’s health during the pandemic

View Post

7 lessons learned about systems change work

System change
Sep 9, 2021
View Post

The Foundation's role in the HealthConnect Fellowship

Funder practices
Sep 8, 2021
View Post

Go ahead: Brag a little

Leadership
Aug 5, 2021
View Post

Planning from strength: questions to ask your team

Advocacy
Apr 26, 2021
View Post

Preparing yourself to center the voices of those impacted by issues

View Post

Vision vs. Tactics: How we can achieve the change we want to see

Action planning
Feb 22, 2021
View Post

System-change achievements advocates are making for central Iowa’s kids

View Post