A health systems resilience research agenda: moving from concept to practice

Saulnier, Dell D; Blanchet, Karl; Canila, Carmelita C.; Muñoz, Daniel Cobos; Zennaro, Livia Dal; Savigny, Don de; Durski, Kara; Garcia, Fernando; Grimm, Pauline Yongeun; Kwamie, Aku; Maceira, Daniel; Marten, Robert; Peytremann‐Bridevaux, Isabelle; Poroes, Camille; Ridde, Valéry; Seematter, Laurence; Stern, B.T.; Suárez, Patricia; Teddy, Gina; Wernli, Didier; Wyss, Kaspar; Tediosi, Fabrizio

doi:10.1136/bmjgh-2021-006779

Cited by 68 publications

(79 citation statements)

References 27 publications

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“… 19 20 Few have applied resilience as a lens for the analysis of governance and government decision-making in crises to review the relevance of the domains. 21 Yet, the COVID-19 crisis highlights the importance of governance of the health systems and health. 22 The importance of assessing processes, including communication, building legitimacy and creating knowledge in the population, in addition to focussing on outcomes such as morbidity and mortality, cannot be overemphasised.…”

Section: Introductionmentioning

confidence: 99%

National health governance, science and the media: drivers of COVID-19 responses in Germany, Sweden and the UK in 2020

et al. 2021

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The COVID-19 pandemic is an unprecedented global crisis in which governments had to act in a situation of rapid change and substantial uncertainty. The governments of Germany, Sweden and the UK have taken different paths allowing learning for future pandemic preparedness. To help inform discussions on preparedness, inspired by resilience frameworks, this paper reviews governance structures, and the role of science and the media in the COVID-19 response of Germany, Sweden and the UK in 2020. We mapped legitimacy, interdependence, knowledge generation and the capacity to deal with uncertainty.Our analysis revealed stark differences which were linked to pre-existing governing structures, the traditional role of academia, experience of crisis management and the communication of uncertainty—all of which impacted on how much people trusted their government. Germany leveraged diversity and inclusiveness, a ‘patchwork quilt’, for which it was heavily criticised during the second wave. The Swedish approach avoided plurality and largely excluded academia, while in the UK’s academia played an important role in knowledge generation and in forcing the government to review its strategies. However, the vivant debate left the public with confusing and rapidly changing public health messages. Uncertainty and the lack of evidence on how best to manage the COVID-19 pandemic—the main feature during the first wave—was only communicated explicitly in Germany. All country governments lost trust of their populations during the epidemic due to a mix of communication and transparency failures, and increased questioning of government legitimacy and technical capacity by the public.

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Section: Introductionmentioning

confidence: 99%

National health governance, science and the media: drivers of COVID-19 responses in Germany, Sweden and the UK in 2020

et al. 2021

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“…This research also offers a timely response to the recent call for a shift of resilience research from theory to practice by employing a bottom-up approach to applied research [ 22 ]. The experiences and perspectives of the NGOs reflected here echo the standpoints of practitioners and communities they represent on the ground, and add a multidisciplinary lens to understanding resilience.…”

Section: Discussionmentioning

confidence: 99%

What makes health systems resilient? A qualitative analysis of the perspectives of Swiss NGOs

Grimm

Wyss

2022

Global Health

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Background Resilience has become relevant than ever before with the advent of increasing and intensifying shocks on the health system and its amplified effects due to globalization. Using the example of non-state actors based in Switzerland, the aim of this study is to explore how and to what extent NGOs with an interest in global health have dealt with unexpected shocks on the health systems of their partner countries and to reflect on the practical implications of resilience for the multiple actors involved. Consequently, this paper analyses the key attributes of resilience that targeted investments may influence, and the different roles key stakeholders may assume to build resilience. Methods This is a descriptive and exploratory qualitative study analysing the perspectives on health system resilience of Swiss-based NGOs through 20 in-depth interviews. Analysis proceeded using a data-driven thematic analysis closely following the framework method. An analytical framework was developed and applied systematically resulting in a complete framework matrix. The results are categorised into the expected role of the governments, the role of the NGOs, and practical future steps for building health system resilience. Results The following four key ‘foundations of resilience’ were found to be dominant for unleashing greater resilience attributes regardless of the nature of shocks: ‘realigned relationships,’ ‘foresight,’ ‘motivation,’ and ‘emergency preparedness.’ The attribute to ‘integrate’ was shown to be one of the most crucial characteristics of resilience expected of the national governments from the NGOs, which points to the heightened role of governance. Meanwhile, as a key stakeholder group that is becoming inevitably more powerful in international development cooperation and global health governance, non-state actors namely the NGOs saw themselves in a unique position to facilitate knowledge exchange and to support long-term adaptations of innovative solutions that are increasing in demand. The strongest determinant of resilience in the health system was the degree of investments made for building long-term infrastructures and human resource development which are well-functioning prior to any potential crisis. Conclusions Health system resilience is a collective endeavour and a result of many stakeholders’ consistent and targeted investments. These investments open up new opportunities to seek innovative solutions and to keep diverse actors in global health accountable. The experiences and perspectives of Swiss NGOs in this article highlight the vital role NGOs may play in building resilient health systems in their partner countries. Specifically, strong governance, a bi-directional knowledge exchange, and the focus on leveraging science for impact can draw greater potential of resilience in the health systems. Governments and the NGOs have unique points of contribution in this journey towards resilience and bear the responsibility to support governments to prioritise investing in the key ‘foundations of resilience’ in order to activate greater attributes of resilience. Resilience building will not only prepare countries for future shocks but bridge the disparate health and development agenda in order to better address the nexus between humanitarian aid and development cooperation.

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“…Further, systems thinking has been identified as supporting implementing change in health service delivery in implementation science (Sarkies et al, 2021); complementing and enriching the predominant reductionist approaches to health improvement (Swanson et al, 2012); dissolving the dysfunction of repeated unintended consequences from policies in healthcare (Waldman, 2007); supporting the conceptualisation of health problems and health contexts to work effectively with stakeholders (Haynes et al, 2020); and, by studying system functioning as a whole, providing insights to improve healthcare quality (Leslie et al, 2018). It is also considered a precondition in health system resilience research (Saulnier et al, 2021).…”

Section: Systems Thinking To Support Healthcare Innovationsmentioning

confidence: 99%

Using systems thinking to increase understanding of the innovation system of healthcare organisations

Linnéusson

Andersson

Kjellsdotter

et al. 2022

JHOM

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PurposeThis paper applies systems thinking modelling to enhance the dynamic understanding of how to nurture an innovative culture in healthcare organisations to develop the innovation system in practice and speed up the innovative work. The model aims to provide a holistic view of a studied healthcare organisation's innovation processes, ranging from managerial values to its manifestation in improved results.Design/methodology/approachThe study is based on empirical material from a healthcare unit that, within a few years, changed from having no innovations to repeatedly generating innovations. The study uses the modelling language of causal loop diagrams (CLDs) in the system dynamics methodology to identify the key important aspects found in the empirical material.FindingsThe proposed model, based on the stories of the interviewees, explores the dynamics of inertia when nurturing an innovative culture, identifying delays attributed to the internal change processes and system relationships. These findings underscored the need for perseverance when developing an innovative culture in the entrepreneurial phases.Practical implicationsThe approach of using systems thinking to make empirical healthcare research results more tangible through the visual notations of CLDs and mental simulations is believed to support exploring complex phenomena to induce and nurture both individual and organisational learning.Originality/valueThe results from this approach provide deepened analysis and provoke the systems view to explain how the nurturing of the culture can accelerate the innovation processes, which helps practitioners and researchers to further expand their understanding of their healthcare contexts.

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A health systems resilience research agenda: moving from concept to practice

Cited by 68 publications

References 27 publications

National health governance, science and the media: drivers of COVID-19 responses in Germany, Sweden and the UK in 2020

National health governance, science and the media: drivers of COVID-19 responses in Germany, Sweden and the UK in 2020

What makes health systems resilient? A qualitative analysis of the perspectives of Swiss NGOs

Using systems thinking to increase understanding of the innovation system of healthcare organisations

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