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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.

This paper uses the metaphor of the dance to envision how hospitals in the Netherlands engaged in organizing and delivering care during the first months of the COVID-19 outbreak. Drawing on an ongoing ethnographic study in a Dutch university study and interviews with nurses in various hospitals, we show how hospital actors (nurses, physicians, managers, directors, patients) engaged in different dances following the changing rhythms of the virus outbreak and related policy measures, as well as mutual interactions driven by ‘old’ and ‘new’ private and collective interests. We discern three dance patterns in the unfolding crisis—learning to dance; the dance marathon; dancing to a cacophony—each requiring a new choreography of organizing and caring, rearranging personnel, spaces, and materials to adapt to (the consequences of) the virus outbreak. We argue that dance is a powerful metaphor to provide an affective narrative of how hospitals operate at different levels and in various ways to accommodate a new group of patients while flexibly finding alternative ways of organizing and caring in a highly political and uncertain context.