{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:51:02Z","timestamp":1791568262361,"version":"4.3.4"},"reference-count":65,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["HERD"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The COVID-19 pandemic created unprecedented operational challenges (such as surge-capacity demands and infection-control requirements) that disturbed the equilibrium of healthcare work systems worldwide. Physical environments can play a pivotal role in mitigating or exacerbating these challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This article aims to strengthen healthcare-system resilience in future pandemics by synthesizing the findings of existing literature to identify environmental factors that supported or hindered healthcare work systems during the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic search of the CINAHL, MEDLINE, PubMed, and ScienceDirect databases and complemented this search with handsearching. We included studies if they addressed the COVID-19 pandemic, focused on physical healthcare environments, and were published in English in peer-reviewed journals. With a focus on environmental influences, we deductively coded the findings using components of the Systems Engineering Initiative for Patient Safety (SEIPS) model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty-two studies met the inclusion criteria. The analysis revealed six major operational challenges: (1) surge capacity, (2) infection control, (3) increased risk of errors, (4) rethinking of care models, (5) financial losses, and (6) the pandemic's adverse psychological impacts on staff and patients. The article documents environmental factors that influenced either the overall healthcare work system or its individual components during the COVID-19 pandemic. We identified three overarching roles for these environmental factors: they served as barriers, solutions, or facilitators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Using the SEIPS framework can enable well-orchestrated pandemic-response planning by guiding the creation of design strategies that will strengthen resilience, flexibility, and safety in future health crises.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19375867261466289","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T13:29:22Z","timestamp":1784208562000},"page":"256-276","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Healthcare Design for Pandemic Resilience: A Systems Thinking Approach"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0760-8193","authenticated-orcid":false,"given":"Seyedehnastaran","family":"Hashemi","sequence":"first","affiliation":[{"name":"University of Nevada"},{"name":"Texas Tech University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2748-1521","authenticated-orcid":false,"given":"Debajyoti","family":"Pati","sequence":"additional","affiliation":[{"name":"Texas Tech University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12961-024-01114-w"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semperi.2020.151298"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2021.04.082"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/08404704211053996"},{"key":"e_1_3_2_6_1","unstructured":"Begun J. 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