Abstract
Recent health system shocks such as the Ebola outbreak of 2014-2016 and the global financial crisis of 2008 have generated global health interest in the concept of resilience. The concept is however not new, and has been applied to other sectors for a longer period of time. We conducted a review of empirical literature from both the health and other sectors to synthesize evidence on organizational resilience. We systematically searched for literature in PubMed, Econlit, EBSCOHOST databases, google, and Google Scholar and manually searched the reference lists of selected papers. We identified 34 papers that met our inclusion criteria. We analysed data from the selected papers by thematic review. Resilience was generally taken to mean a system's ability to continue to meet its objectives in the face of challenges. The concepts of resilience that were used in the selected papers emphasized not just a system's capacity to withstand shocks, but also to adapt and transform. The resilience of organizations was influenced by the following factors: Material resources, preparedness and planning, information management, collateral pathways and redundancy, governance processes, leadership practices, organizational culture, human capital, social networks and collaboration. A common theme across the selected papers is the recognition of resilience as an emergent property of complex adaptive systems. Resilience is both a function of planning for and preparing for future crisis (planned resilience), and adapting to chronic stresses and acute shocks (adaptive resilience). Beyond resilience to acute shocks, the resilience of health systems to routine and chronic stress (everyday resilience) is also key. Health system software is as, if not more important, as its hardware in nurturing health system resilience.
Highlights
Health systems globally have experienced major crisis and disruptive shocks over the past decade
The attributes of resilient organizations that we identified in this literature review, including the use of collateral pathways, governance practices that promote flexibility, nurturing of social networks and collaborations neatly map onto the view of resilience as an emergent property of complex adaptive systems (CAS)
While planning might help mitigate the effect of acute shocks to the health system, whether or not the health system is able to maintain core functions of delivering quality healthcare services in an efficient and equitable way depends on how well it adjusts to the post crisis phase
Summary
Health systems globally have experienced major crisis and disruptive shocks over the past decade. Subsequent applications of resilience, especially to social systems, recognized the complex adaptive nature of systems This recognition prompted a view of resilience as involving the adaptation and transformation of systems though the emergence of new structures such as policies, processes and organizational culture that enable organizations to continue to perform their functions in the face of challenges.[10,11] Despite the growing interest in the concept of resilience, there is scarce evidence on how to generate or strengthen resilience in health systems or in other sectors. Organizational resilience has been defined as ‘the maintenance of positive adjustment under challenging
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