Abstract
Background: Resilience in the context of integrated care involves coordination and collaboration across a multitude of stakeholders, in which patients and informal caregivers constitute the main source of knowledge. Yet, few efforts have been made to describe the resilience enacted in such cross-organisational, cross-stakeholder multiteam systems, especially in complex care pathways.
Approach: The paper is based on a combination of data sources such as review of the scientific literature, observation of clinical practice in patient pathways, and interviews with patients, informal caregivers, and healthcare professionals. Based on these data sources we have developed a set of case narratives to describe how resilience is enacted in different care pathways.
Results: Across different patient pathways, we find two main components that drive resilience: relational coordination and cognitive diversity.
Relational coordination has a psychosocial component in that stakeholders share stress and ultimately reduce burden, and a processual component in that dependencies, demands, and tasks are balanced. Cognitive diversity means that the degree of variation and breadth among stakeholders contribute to the enactment of resilience through for example the degree of discussion, and the level of knowledge of others' knowledge.
Other elements of resilience in complex care pathways concern bridging of professional, social, physical and task related gaps, negotiation of boundaries to address overlaps in work practices, and the creation of space for collaboration.
Implications: The case narratives will be used to co-construct a set of tools or guidance to support resilience in complex care pathways. The guidance will primarily be aimed at increasing the awareness and competence levels among stakeholders involved.