Table 1.

Logic model of SLHD integrated response to summarise our findings.

CONTEXTUAL PROBLEMS	INTERVENTION/RESPONSE [INPUT]. DESCRIPTION OF SLHD INTEGRATED RESPONSE WHICH ADDRESS THE CONTEXTUAL PROBLEMS, ACROSS THE PHASES OF ABSORB, ADAPT, AND TRANSFORM FOR HEALTH SYSTEM RESILIENCE	ACTIVATION OF THE THEORISED WHO 5 STRATEGIES AS MECHANISMS WITHIN LOCAL CONTEXTUAL SYDNEY LOCAL HEALTH DISTRICT STRUCTURES TO RESULT IN PROXIMAL OUTCOMES	AUSTRALIAN GOVERNMENT HEALTH POLICY OUTCOMES FOR THE COVID- 19 RESPONSE
Global pandemic timelines that required a rapid response to address the uncertainties, and to prevent overwhelming of the health system, and address staff and communities fears.	Integrated response to ABSORB: Rapid public health response needed such as the flying squad, guidelines for infection control, care of positive patients, preparing the system, quarantine measures to be put in place	The context of strong leadership, established infrastructure, and epidemic preparedness, activated mechanisms of accountability and governance [4], to result in swift responses and early detection of COVID-19. The context of underlying partnerships and a culture of innovation, activated mechanisms of coordination [2] within and across agencies, to result in efficient and streamlined care.	“Minimise the number of people [including staff] who become infected or sick with COVID19; Minimise how sick these people become & how many people die; Reduce the burden on our health systems, to continue to provide the regular health care ; Help Australians to reduce their own risk and the risk to their families and communities; Delivery of Vaccine”
Overseas experience [e.g., UK], highlighted how hospitals were overwhelmed, and the need to address the needs of the community and reach the vulnerable populations	Integrated response to ADAPT: Models of care to expand the reach into the community, facilitated by the telehealth/virtual hospital that was being piloted, community well-being clinics, drive through clinics set up, aged care outreach teams empowered. Engaging other sectors to address the marginalised populations.	The context of SLHD’s vision to keep all community and staff safe activated the mechanisms of empowering and engaging diverse communities [1], resulted in reduced community transmission and anxiety. The context of inter-sectoral partnerships and virtual care brought services to ‘where the people are’ activated mechanisms of reorientating the model of care [3], resulted in more equitable access to screening and testing.
In face of the uncertainties of subsequent waves, there is a need for sustainability of the integration of the model of care, workforce deployment.	Integrated response to TRANSFORM: strong infrastructure built quickly, and measures to sustain this while providing usual care in a more efficient manner.	The context of SLHD underlying ‘whole of health’ approach, and accountability structures activated mechanisms of an enabling environment [5] for the pandemic response that resulted in transformational change.

Note: WHO Framework causal mechanism legend – 1] empowerment and engagement of communities; 2] coordination of services within and across agencies; 3] reorientating model toward primary health care; 4] governance and accountability; and 5] enabling environments.