Adaptation, Transformation and Resilience in Healthcare Comment on "Government Actions and Their Relation to Resilience in Healthcare During the COVID-19 Pandemic in New South Wales, Australia and Ontario, Canada"

Abstract

Adaptive capacity is a critical component of building resilience in healthcare. Adaptive capacity comprises the ability of a system to cope with and adapt to disturbances. However, "shocks", such as the current Covid-19 pandemic, can potentially exceed critical adaptation thresholds and lead to systemic collapse. To effectively manage healthcare systems during periods of crises, both adaptive and transformative changes are necessary. This commentary discusses adaptation and transformation as two complementary, integral components of resilience and applies them to healthcare. We treat resilience as an emergent property of complex systems that accounts for multiple, often disparately distinct regimes in which multiple processes (e.g., adaptation, recovery) are subsumed and operate. We argue that Convergence Mental Health and other transdisciplinary paradigms such as Brain Capital and One Health can facilitate resilience planning and management in healthcare systems.

Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic

“…16 Reconciling the predominant focus on absorption and adaptation and the view of crises as a chance for transformation will require recognizing that endless absorptive and adaptive capacity are unsustainable since health systems are embedded in an unpredictable, constantly changing context. 82 Although the necessity to integrate and use multiple forms and sources of information is clear, it is still unclear which sources and forms are most influential on the system's ability to respond and its capacity for resilience. While connecting knowledge from sources like communities and other sectors to the response has clearly been described as beneficial, knowledge goes beyond linking sources together.…”

Metrics and indicators used to assess health system resilience in response to shocks to health systems in high income countries—A systematic review

“…The analysis therefore confirms and builds on earlier studies identifying effective resilience building strategies [ 3 , 6 , 4 ]. It is clear, however, that metrics in this review tend to relate to the absorptive and adaptive capacity of the health system, however complex adaptive systems also need to be accompanied by transformation, particularly when adaptive capacities are exhausted - often the tipping point for system innovation [ 91 ]. It would therefore be prudent to broaden resilience strategies beyond shock-specific metrics, as reported in this review, instead looking to ensure health systems can function well regardless of shock type.…”

“…Building upon these strategies, Angeler et al. [ 91 ] also highlight the important interplay between social-ecological systems and health system resilience, promoting social transformation, for example, by helping institutions and the wider public to understand health system resilience through targeted, evidence-based outreach. Finally, the measurement of health system resilience requires a less siloed view, instead incorporating external factors that take into account different population needs and contexts, for example, older people who were particularly vulnerable and disproportionately impacted during the COVID-19 pandemic [ 94 ].…”

Investigating Resilience in Healthcare: Easier Said Than Done? A Response to the Recent Commentaries

“…[13][14][15] Angeler and colleagues' model provides ideas of fields and paradigms that could help to develop this aspect of resilience in healthcare. 5 For example, ecological systems must be capable of adapting, evolving, and transforming to face emergent challenges. Ecologists have developed concepts (eg, panarchy 16,17 ) that facilitate studying how these systems fulfill these requirements.…”

“…Angeler and colleagues use their commentary to present a strong case for a transdisciplinary approach to fostering and studying resilience. 5 Within their argument, they note the dangers of “command and control” approaches that can restrict diversity of thought and contribute to an excessive focus on a single perspective or goal. These authors also provide stirring insights on the importance of “transformation” in creating resilience (echoing Øyri and Wiig’s comments on innovation).…”