Defining the boundaries and operational concepts of resilience in the resilience in healthcare research program

Abstract

Background: Understanding the resilience of healthcare is critically important. A resilient healthcare system might be expected to consistently deliver high quality care, withstand disruptive events and continually adapt, learn and improve. However, there are many different theories, models and definitions of resilience and most are contested and debated in the literature. Clear and unambiguous conceptual definitions are important for both theoretical and practical considerations of any phenomenon, and resilience is no exception. A large international research programme on Resilience in Healthcare (RiH) is seeking to address these issues in a 5-year study across Norway, England, the Netherlands, Australia, Japan, and Switzerland (2018-2023). The aims of this debate paper are: 1) to identify and select core operational concepts of resilience from the literature in order to consider their contributions, implications, and boundaries for researching resilience in healthcare; and 2) to propose a working definition of healthcare resilience that underpins the international RiH research programme. Main text: To fulfil these aims, first an overview of three core perspectives or metaphors that underpin theories of resilience are introduced from ecology, engineering and psychology. Second, we present a brief overview of key definitions and approaches to resilience applicable in healthcare. We position our research program with collaborative learning and user involvement as vital prerequisite pillars in our conceptualisation and operationalisation of resilience for maintaining quality of healthcare services. Third, our analysis addresses four core questions that studies of resilience in healthcare need to consider when defining and operationalising resilience. These are: resilience 'for what', 'to what', 'of what', and 'through what'? Finally, we present our operational definition of resilience. Conclusion: The RiH research program is exploring resilience as a multi-level phenomenon and considers adaptive capacity to change as a foundation for high quality care. We, therefore, define healthcare resilience as: the capacity to adapt to challenges and changes at different system levels, to maintain high quality care. This working definition of resilience is intended to be comprehensible and applicable regardless of the level of analysis or type of system component under investigation.

Resilience in Healthcare (RiH): a longitudinal research programme protocol

“…Resilience should, furthermore, be explored as a multilevel phenomenon with collaborative learning and stakeholder involvement as vital prerequisite pillars. 1 Stakeholders in healthcare are any person, group or organisation who provides, receives, manages, regulates or pays for healthcare. As such, they involve patients, carers, healthcare professionals, managers, regulatory bodies, non-governmental organisations, municipalities, regional authorities and so on.…”

“…Resilience is primarily a guiding concept represented in different ways in theories from diverse scientific disciplines. 1 Engineering and human resources perspectives seek to understand and strengthen how people adapt and build adaptive capacity into technological systems or organisations. Psychological perspectives focus on individual psychological capacities to cope with adversity and is often linked to vulnerable groups.…”

“…As such, RiH is a growing research field that seeks to understand and improve system functioning from institutional, work systems and personal perspectives to deliver high quality care and safe patient care. 1 …”

“…This longitudinal research programme will address these challenges by bringing quality and safety expertise together with healthcare professionals, patients and other stakeholders, providing a unique opportunity to conduct comprehensive multidisciplinary research that goes beyond current practices in five distinct ways: First, by developing an RiH framework based on resilience as originally applied in psychology, ecology and engineering 1 ; second, by using a transdisciplinary, multilevel (micro/meso/macro) approach 23 37 ; third, by synthesising longitudinal in-depth studies in differing empirical healthcare settings to identify context specific and/or context independent features of resilience; fourth, by conducting cross-country comparative studies; and fifth, by focusing on the role that patients and other stakeholders have in RiH research and practice.…”

Adaptive capacities for safe clinical practice for patients hospitalised during a suicidal crisis: a qualitative study

“…Safe clinical practice for a patient during a suicidal crisis is situated within a dynamic, non-linear and uncertain context [18,19]. Under such complex conditions, the adaptive capacity is considered vital to handling challenges and changes in clinical care [20][21][22]. To ensure for good outcomes for patients HCPs make adaptations by relying on their skills, knowledge and experience [20], and they go beyond their assigned tasks and roles to adapt in everyday practice [23,24].…”