Abstract
Introduction: Resilient Health Care (RHC) is defined as the ability of a system to adjust its functioning prior to, during, or following changes and disturbances, so that it can sustain required operations under both expected and unexpected conditions[1]. The COVID-19 pandemic presented challenges that healthcare systems must address to maintain service quality and safety, highlighting the need for resilient and responsive healthcare systems more than ever before[2]. Only a few years ago, most of the literature in the RHC domain was theoretical[3], with limited empirical applications in existence. However, amidst the challenges, the pandemic has provided a real-world opportunity to empirically investigate resilient performance and ways that healthcare has been responsive. It was thus timely to conduct a scoping review of empirical investigations of RHC in response to the COVID-19 pandemic. In this presentation, we synthesise our findings on factors (capacities, actions, or strategies) that developed or enhanced resilient performance.
Methods: Four academic databases were searched using keywords to cover resilience and related concepts, such as Safety-II, and terms related to the COVID-19 pandemic, from January 2020–August 2022. Publication details; study context; study design; resilience tools/framework employed; and factors (i.e., actions, strategies, or plans) that developed or enhanced systems and their propensity towards resilience were extracted. Factors were identified using a hybrid inductive and deductive framework, based on the ‘capacities’ for resilience outlined by Lyng et al.[4].
Results: Fifty publications were included in this review. Concordant with previous research, eight key resilience capacities were identified that can support, develop or enhance resilient performance, namely: structure, alignment, coordination, learning, involvement, risk awareness, leadership, and communication. Across the capacities, there was great emphasis placed of the the need for teamwork and collaboration during COVID-19. There were also clear interdependencies between the capacities; for example, between structure and leadership, given that leaders often facilitated the implementation and adherence to different structural features such as technology, guidelines or learning arenas; and between coordination and learning given that the greatest number of learning efforts related to team training and coordinating efforts to tackle the challenges related to COVID-19.
Discussion: The pandemic provided a unique opportunity to examine RHC in practice, and uncovered emerging new evidence on RHC theory and system factors that contribute to resilient performance at micro, meso and macro levels. These findings will enable leaders and other stakeholders to strengthen health system resilience when responding to future challenges and unexpected events.
References
1.Hollnagel, E., J. et al, Preface: on the need for resilience in health care. Resilient health care. Farnham: Ashgate Publishing, 2013: p. 2-3.
2.Wiig, S. and J.K. O’Hara, Resilient and responsive healthcare services and systems: challenges and opportunities in a changing world. BMC Health Services Research, 2021. 21(1): p. 1-5.
3.Ellis, L.A., et al., Patterns of resilience: a scoping review and bibliometric analysis of resilient health care. Safety Science, 2019. 118: p. 241-257.
4.Lyng, H.B., et al., Capacities for resilience in healthcare; a qualitative study across different healthcare contexts. BMC health services research, 2022. 22(1): p. 1-14.