Coping during the COVID-19 pandemic: insights from a qualitative study of organizational resilience in an English substance use support service

Introduction
The COVID-19 pandemic posed unprecedented challenges to health and care services, including substance use support, necessitating adaptations to maintain operational continuity. A lack of research exists into the factors that helped substance use services cope and maintain provision. This study aimed to elucidate the organizational resilience factors that assisted a substance use support service in sustaining operations and adapting during the COVID-19 pandemic.

Theory
The study draws on recent conceptual and theoretical developments in the study of organizational resilience, examining findings primarily through the lens of bounce-back and bounce-forward resilience, and Duchek’s three-stage framework.

Method
Participants were 36 staff members working for (n=28) or in partnership with (n=8) an organization delivering substance use support services across an area of Northern England. A multi-method qualitative approach, including digital timelines (n=16), in-depth interviews (n=17), and five focus groups (n=12), was employed. Timeline text was treated as qualitative text-based data. Interviews and focus groups were recorded and transcribed prior to coding. Data underwent Framework Analysis.

Results
Seven themes were identified: 1) pre-existing relationships and effective multiagency working; 2) prioritization of service delivery; 3) development and implementation of guidance and protocols; 4) autonomy, devolution, and deference to expertise; 5) effective communication, regular meetings, and coordinated decision-making; 6) allowing flexibility and creativity; and 7) development of new and innovative approaches to facilitate the pandemic response.

Discussion
This study identifies resilience factors that substance use and other support organizations should focus on in preparation for potential future crises, to minimise adverse impacts on vulnerable populations.