Healthcare Team Resilience During COVID-19: A Qualitative Study

Abstract

BACKGROUND Resilience has been identified as the ability to maintain the safety and the performance of healthcare systems and is aligned with the principles of anticipation, monitoring, adaptation, and learning. In early 2020, the COVID-19 pandemic challenged the resilience of US healthcare systems due to the lack of equipment, supply interruptions, and a shortage of personnel. The purpose of this qualitative research was to describe resilience in the healthcare team during the COVID-19 pandemic with the healthcare team situated as a singular cognizant entity defined by its collective identity, purpose, competence, and actions. METHODS We developed a descriptive model which considered the healthcare team as a unified cognizant entity. This model combined elements from the Patient Systems Engineering Initiative for Patient Safety (SEIPS) and the Advanced Team Decision Making (ADTM) models. Using a qualitative descriptive design and guided by our adapted model, we conducted individual interviews with healthcare team members across the United States. Data were analyzed using thematic analysis and extracted codes were organized within the adapted model framework. To ensure the rigor of our study, we utilized the input of an expert in qualitative researcher and maintained an audit trail throughout the analysis process. Additionally, we explored factors participants’ described that may have either hindered or enhanced the resilience potentials within the healthcare team. RESULTS Five themes were identified from the interviews with acute care professionals across the US (N = 22): working in a pressure cooker, consistent with working in a high stress environment; healthcare team cohesion, applying past lessons to present challenges, congruent with transferring past skills to current situations; knowledge gaps, and altruistic behaviors, aligned with sense of duty and personal responsibility to the team. Participants’ described how their ability to adapt to their environment was negatively impacted by uncertainty, inconsistent communication of information, and emotions of anxiety, fear, frustration, and stress. Cohesion with co-workers, transferability of skills, and altruistic behavior enhanced healthcare team performance. CONCLUSION Working within the extreme unprecedented circumstances of COVID-19 affected the ability of the healthcare team to anticipate and adapt to the rapidly changing environment. Both team cohesion and altruistic behavior promoted resilience. The adapted model was useful to describe the healthcare team as a singular cognizant entity. Our research contributes to a growing understanding of the importance of resilience in healthcare and provides a bridge between individual and organizational resilience.

From Threatening Chaos to Temporary Order through a Complex Process of Adaptation: A Grounded Theory Study of the Escalation of Intensive Care during the COVID-19 Pandemic

“…Initially, insufficient response at the mesolevel and the macrolevel led to bottom-up initiatives and self-organization at the microlevel, which is a common invoked strength of a CAS [10][11][12]. Competence and experiences derived from temporary team collaborations and emergency situations facilitated adaptation, flexibility, the development of innovative solutions and support, thus confirming the findings of Ambrose and colleagues [38].…”

“…Collaboration and networking are based on trust, communication and the willingness to take on roles and responsibilities that are outside one's comfort zone [27], which in the present study was facilitated by a collective sense of emergency; this point has also been emphasized by experiences in other settings, such as in Italy [39] and the US [37,38]. However, information dissemination was one of the main challenges, and as in other settings [38], this issue was mitigated only partly through established communication strategies.…”

“…The main enabler of the massive escalation of care capacity was revealed to be great commitment on the part of individuals, including their ability to take the initiative and their willingness to take on expanded responsibilities, which was also emphasized by others [22,38]. Furthermore, the dominant motive underlying such commitment was altruistic [38], as individuals were both driven by a sense of emergency and encouraged by support from civil society: "If not me, who could solve the situation?" Initially, insufficient response at the mesolevel and the macrolevel led to bottom-up initiatives and self-organization at the microlevel, which is a common invoked strength of a CAS [10][11][12].…”

“…The number of redistributed staff diluted intensive care competence and caused ordinary staff members to experience additional strain. Additionally, as in other settings [22,38], to manage these acutely altered demands and compensate for insufficient material recourses, front-line staff were required to adapt their practice. Due to these rapid alterations, a large proportion of the response was a reaction to immediate needs; however, a proactive response also existed in terms of preparing in advance based on the anticipated circumstances.…”

Enhancing Global Health System Resilience and Sustainability Post-COVID-19: A Grounded Theory Approach

“…Besides, the COVID-19 pandemic has underscored gaps in our understanding of healthcare system resilience. As Ambrose et al [29] discuss, while past research has examined the resilience of healthcare systems and workers individually, there is limited knowledge on the resilience of healthcare systems as a unified team. The pandemic created an opportunity to study how healthcare teams' function and adapt as a cohesive unit during crisis situations.…”