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BackgroundResilience is a ubiquitous but often misunderstood term. It is often studied and described within the lens of individual academic disciplines, despite the complexities and interactions of today’s world. Using a meta-narrative approach, we performed a systematic literature review of healthcare resilience, tracking the research traditions which have informed this field. This paper consolidates knowledge about the definitions, measures, and concepts of healthcare resilience at meso- and macro-levels, to build an interdisciplinary, cross-sectoral, and multi-level (ICM) approach and framework. It forms part of a wider project on healthcare resilience, within a larger research group on societal resilience and guides efforts to build resilience after the COVID19 pandemic.MethodsForty-five reviews were analysed thematically, adhering to RAMESES and PRISMA guidelines. We explore issues inherent to fundamental terms and propose a unified definition spanning event timescales and applicable to multiple hierarchical levels. Studies tended to focus on individual hierarchical levels using a range of frameworks, which are frequently also used as measurement indices. Macro-level indices focusing on capacities failed to sufficiently capture the importance of relational aspects of systems resilience. Meso-level approaches and frameworks tended to swing between the extremes of disaster risk reduction strategies and patient safety approaches for normal stressors. Micro-level approaches were not a focus but tended to centre around acute psychological interventions.ResultsThe analysis allowed us to propose a unified definition and build an overall framework for healthcare resilience containing pre-, intra-, post-, and trans-event domains, which work across hierarchical levels. We also adopt a realist view by presenting a table of selected resilience frameworks, categorising them according to predominant hierarchical level and timescale. This aims to guide decision-makers about the suitability of various frameworks, at specific levels, through numerous points during crises. ConclusionThere is increasing acknowledgement of the need for inter-disciplinary, cross-sectoral, and multi-level approaches to healthcare resilience, but such work is hitherto rare. A realist approach to various resilience frameworks may help to determine best-fit for individual organisations and systems. There is a need to better understand how resilience practically works across various hierarchical levels.

Purpose of the studySARS-CoV-2 has caused healthcare systems globally to reorganise. A pandemic paradox emerged; while clinicians were desperate for information on a new disease, they had less time to find and evaluate the vast volume of publications at times of significant strain on healthcare systems.A multidisciplinary team undertook a weekly literature search capturing all COVID-19 publications. We also monitored free open access medical education (FOAMed) sources for emerging themes. Title and abstract screening pooled the most relevant papers for emergency medicine. Three summary types were created, a ‘Top 5 Flash Update’, a journal club and a rapid response to emerging FOAMed themes. From these summaries, three modes of dissemination were used: short written summaries, blogs and podcasts. These were amplified through social media.Study designA retrospective review was conducted assessing the impact of this knowledge dissemination strategy for the period of March to September 2020.ResultsIn total, 64 687 papers were identified and screened. Of the papers included in the ‘Top 5’, 28.3% were on epidemiology, 23.6% treatment, 16.7% diagnostics, 12% prognosis, 8.7% pathophysiology with the remaining 10.7% consisting of PPE, public health, well-being and ‘other’. We published 37 blogs, 17 podcasts and 18 Top 5 Flash Updates. The blogs were read 138 343 times, the Top 5 Flash Updates 68 610 times and the podcasts had 72 501 listens.ConclusionA combination of traditional academic and novel social media approaches can address the pandemic paradox clinicians are facing.