Abstract Issue Health system resilience is an important and desirable attribute of health systems. We have evaluated the operationalization of our step-by-step guide for conducting a resilience test. Description of the problem Preparedness planning is often siloed and does not take the entire health system into account. The objective was to develop a new methodology for policy making that is adaptable to any health system context and shock scenario. Resilience testing uses a mixed-method approach to assess resilience by understanding health system strengths and weaknesses in relation to a hypothetical shock scenario. A programme logic model, semi-structured interviews and an online questionnaire were used to evaluate the methodology and to answer the following questions: Can resilience tests be used to identify strengths and weaknesses in different health system contexts? What are the determinants for successful resilience testing? Results Three resilience tests were conducted in Finland, Greece and the Asturias region of Spain. All resilience tests identified health system strengths and weaknesses. 97% of participants agreed that the test identified broader vulnerabilities. However, 76% thought that a different scenario would identify different strengths and vulnerabilities. 94% of participants agreed or strongly agreed that the test was a valuable exercise. The semi-structured interviews consistently found that successful resilience testing requires neutral facilitation and carefully selected test participants. Lessons Resilience test results have been used in 2 out of 3 cases to develop health policy. Resilience testing needs to be initiated and supported by the ministry of health to ensure results are considered in the policy making process. Key messages • Health system resilience tests can identify health system strengths, weaknesses, and steps towards remedial policy action to improve resilience in different European health system contexts. • Successful health system resilience testing requires carefully selected facilitators and test participants as well as support from the Ministry of Health.