AUTHOR=Berman Peter , Cheng Michael , Bridget Elvira , Brubacher Laura Jane , Ruck Candice 

TITLE=How Public Health Organizational Structure Affected the Response to the COVID-19 Pandemic: A Case Study in British Columbia, Canada

JOURNAL=International Journal of Public Health

VOLUME=Volume 69 - 2024

YEAR=2024

URL=https://www.ssph-journal.org/journals/international-journal-of-public-health/articles/10.3389/ijph.2024.1606638

DOI=10.3389/ijph.2024.1606638

ISSN=1661-8564

ABSTRACT=This study sought to examine how public health organizational structures affected decisionmaking and provides recommendations to strengthen future public health crisis preparedness.The Institutions-Politics-Organizations-Governance (IPOG) framework and an organizational lens was applied to the analysis of COVID-19 governance within British Columbia (BC). Organizational charts detailing the structure of public health systems were compiled using available data and supplemented with data collected through key informant interviews.In response to the COVID-19 pandemic, BC initiated several changes in its public health organization. BC's COVID-19 response attempted to utilize a centralized command structure within a decentralized health system. Four key themes were identified pertaining to the (1) locus of decision-making and action; (2) role of emergency structures; (3) challenges in organizational structure; and (4) balance between authority and participation in decision-making.The organizational adaptations enabled a substantively effective response. However, our findings also illustrate deficiencies in organizational structure in the current public health system. Two recommendations for consideration are: (1) a more formal vertical organizational structure; and(2) developing new mechanisms to link health and general emergency response structures.