Hope is Not a Strategy: Key Lessons from COVID-19 for Future Health Crises.

Introduction: The COVID-19 pandemic disrupted global economies, social structures, and public health systems. However, Denmark stood out as an exception, maintaining steady life expectancy during this period. This raises important questions about the factors that strengthened the Danish healthcare system and society against the pandemic's challenges. Methods: The Danish healthcare system serves 5.8 million citizens with free care, advanced digital infrastructure, and comprehensive health registers. Under the auspices of the Danish Society for Patient Safety, insights from Denmark's response to COVID-19 were collected from the onset of the pandemic. This paper builds on these collected experiences, covering crucial areas such as strategies to reduce transmission, digitalization, management of non-COVID diseases, tracking adverse events, workplace well-being, development and use of predictive models, and maintaining public trust. Patient-level data on contacts, contact types, and clinical procedures were obtained from health administrative systems and clinical quality registries. All results were reported as raw counts, with no statistical analyses applied. Results: During COVID-19, Denmark's healthcare system demonstrated resilience by adapting swiftly, achieving a high vaccination rate, shifting to virtual care, enhancing response capacity through real-time adverse event tracking, and supporting healthcare workers through crisis teams minimizing prolonged sick leave. Predictive models accurately forecasted healthcare demands, while public health strategies focused on monitoring public behavior and trust in authorities. Discussion: A key lesson from Denmark's handling of COVID-19 is that much of the observed resilience stemmed from pre-existing structures that could be reused, further developed, and expanded. This resilience was further enhanced by an unprecedented readiness for change, cross-sectoral and interdisciplinary collaboration, and the removal of typical barriers. These experiences aim to further improve the quality and resilience of healthcare in Denmark and inspire other countries' healthcare systems. Moving forward, acknowledging chronic conflicts as the new normal, coupled with the reminder that "hope is not a strategy", could serve as a pivotal approach.