Agility and Resilience During COVID-19 and Post-Pandemic Innovation in Brazilian Public University Hospitals.

Background: The COVID-19 pandemic prompted rapid adaptations in healthcare systems worldwide. Academic medical centers, pivotal in healthcare education and research, rapidly adopted innovations. Brazilian state-owned university hospitals experienced unprecedented pressure on their services and were compelled to adopt new approaches to education and care delivery.

Aims: Analyze the organizational agility and resilience of two Brazilian federal university hospitals during the pandemic. Identify crisis-driven innovations and propose a quantitative indicator framework to measure agility, resilience, and the embedding of innovations post-crisis.

Methods: We conducted a document analysis of the COVID-19 contingency plans, managerial reports and news items from the two hospitals, both managed by the Brazilian Hospital Services Company. Actions were inductively coded and synthesized into measurable indicators.

Results: The hospitals implemented tactical and operational adjustments, relocated resources, and improved patient care strategies. Telemedicine and strategic patient transfers empowered users during critical phases. Virtual care technologies promoted self-care and improved treatment efficacy, while staff well-being programs supported clinical teams. We present an indicator framework comprising 26 metrics, organized into pandemic-phase (agility and resilience) and post-COVID (innovation) blocks.

Conclusions: The contingency plans demonstrate strong organizational agility and resilience. The proposed framework offers a practical toolkit for benchmarking crisis readiness and tracking the institutionalization of pandemic-era innovations, thereby supporting Brazil's universal healthcare system and guiding future research.