From Crisis To Capacity: A Qualitative Assessment Of Post-Covid-19 Institutional Resilience In Peshawar Based Medical Teaching Institutions

Abstract

The COVID-19 pandemic represented a transformative global event, inducing systemic shocks that transcended public health to destabilize national economies and social structures. The study provides a comprehensive qualitative deconstruction of institutional resilience within the primary Medical Teaching Institutions (MTIs) of Peshawar, Pakistan, specifically focusing on Lady Reading Hospital (LRH), Hayatabad Medical Complex (HMC), and Khyber Teaching Hospital (KTH). The study utilized a thematic analysis of eighteen in-depth interviews with a diverse cohort of healthcare professionals, including physicians, paramedics, administrative staff, alongside key informants and post-recovery COVID-19 patients. The findings indicate that the initial response in Peshawar was marked by a necessary but drastic suspension of routine care, characterized by a fundamental lack of pandemic preparedness, critical shortages of life-saving oxygen and personal protective equipment (PPE), and extreme psychological trauma among frontline workers. However, the subsequent institutional response demonstrated significant adaptive capacity, facilitated by the permanent establishment of public health laboratories, the establishment of isolation wards, the specialized induction of respiratory therapists, and the implementation of rigorous clinical zoning strategies. By synthesizing these results, the study customized a theoretical framework for healthcare resilience that integrates the "6S" components (Space, Staff, Stuff, System, Strategies, and Services) with the four functional capabilities of Resilient Health Care (Anticipate, Monitor, Respond, and Learn). The study concludes that while qualitative improvements in emergency protocols and triage systems have been achieved, long-term sustainability depends upon transitioning from written policies to applied, simulation-based emergency management frameworks and the remediation of inflexible architectural hospital designs.