Abstract
BackgroundUnderstanding the resilience of healthcare is critically important. A resilient healthcare system might be expected to consistently deliver high quality care, withstand disruptive events and continually adapt, learn and improve. However, there are many different theories, models and definitions of resilience and most are contested and debated in the literature. Clear and unambiguous conceptual definitions are important for both theoretical and practical considerations of any phenomenon, and resilience is no exception. A large international research programme on Resilience in Healthcare (RiH) is seeking to address these issues in a 5-year study across Norway, England, the Netherlands, Australia, Japan, and Switzerland (2018–2023). The aims of this debate paper are: 1) to identify and select core operational concepts of resilience from the literature in order to consider their contributions, implications, and boundaries for researching resilience in healthcare; and 2) to propose a working definition of healthcare resilience that underpins the international RiH research programme.Main textTo fulfil these aims, first an overview of three core perspectives or metaphors that underpin theories of resilience are introduced from ecology, engineering and psychology. Second, we present a brief overview of key definitions and approaches to resilience applicable in healthcare. We position our research program with collaborative learning and user involvement as vital prerequisite pillars in our conceptualisation and operationalisation of resilience for maintaining quality of healthcare services. Third, our analysis addresses four core questions that studies of resilience in healthcare need to consider when defining and operationalising resilience. These are: resilience ‘for what’, ‘to what’, ‘of what’, and ‘through what’? Finally, we present our operational definition of resilience.ConclusionThe RiH research program is exploring resilience as a multi-level phenomenon and considers adaptive capacity to change as a foundation for high quality care. We, therefore, define healthcare resilience as: the capacity to adapt to challenges and changes at different system levels, to maintain high quality care. This working definition of resilience is intended to be comprehensible and applicable regardless of the level of analysis or type of system component under investigation.
Highlights
To fulfil these aims, first an overview of three core perspectives or metaphors that underpin theories of resilience are introduced from ecology, engineering and psychology
The Resilience in Healthcare (RiH) research program is exploring resilience as a multi-level phenomenon and considers adaptive capacity to change as a foundation for high quality care
Define healthcare resilience as: the capacity to adapt to challenges and changes at different system levels, to maintain high quality care
Summary
Core perspectives of resilience: bouncing back, growing, adapting As noted, the concept of ‘resilience’ is represented in different ways in theories from many and diverse scientific disciplines [2, 4, 9, 20]. Our conceptualisation of resilience can be elaborated in the following bullet points: It focuses on maintaining a high-quality healthcare system, incorporating but not limiting it to the handling of safety and risk, and not specifying how ‘high quality healthcare’ should itself be defined and measured; It considers resilience as a set of capacities at individual, team and system level that permit high quality to be maintained through adaptation, enhancement and reorganisation – so ‘high quality’ can be a continually moving (and improving) target; It is focused on events that may provide challenges, changes or disruptions to the delivery of care – which may include the introduction of new technologies or innovative work practices, challenges in terms of funding or the emergence of new medical conditions, or disruptions in terms of serious unexpected events and stressors; It is grounded in processes of individual, team, and system adaptation, enhancement and reorganisation – which represent processes that underpin learning, growth, development and recovery; It indicates that diversity, coordination and collaboration are key elements of the processes that underpin capabilities for resilience; and It is open-ended enough to accommodate the application of diverse concepts and mechanisms from different literature, and support diverse methods and approaches to research. We expect that addressing these questions could be assisted by drawing on a broad conceptual ‘menu’ that provides core categories and concepts of resilience that are applicable to a wide range of settings and studies to help provide a common language to describe and explain resilience
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