Resilient Characteristics as Described in Empirical Studies on Health Care

Berg, Siv Hilde; Aase, Karina

doi:10.1007/978-3-030-03189-3_10

Cited by 41 publications

(74 citation statements)

References 19 publications

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“…A recent review study [29], has explored what key concepts or characteristics are used in resilience in healthcare studies and identified that common resilience characteristics exist across system levels (macro, meso, micro). These relate to anticipation (i.e.…”

Section: A Brief Overview Of Key Constructs In Resilience Engineeringmentioning

confidence: 99%

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

Wiig

Aase

Billett

et al. 2020

BMC Health Serv Res

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190

257

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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.

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Section: A Brief Overview Of Key Constructs In Resilience Engineeringmentioning

confidence: 99%

“…This implies the potential for a common terminology for resilience characteristics across system levels, although they may describe somewhat different contents. To illustrate, Berg and Aase [29] discuss both individual cognitive tradeoffs and competing goals trade-offs at the team level.…”

Section: A Brief Overview Of Key Constructs In Resilience Engineeringmentioning

confidence: 99%

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

Wiig

Aase

Billett

et al. 2020

BMC Health Serv Res

Self Cite

190

257

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“…In addition, this study reflect that these structures must be present for all professional groups While self-organisation is an example of emergent behaviour utilized to adapt to complex work settings (15), self-organising in response to a lack of formal support systems leaves the system brittle. Relying too heavily on individuals' capacity to adapt will eventually cause overload and burnout (18).…”

Section: Managing Uncertaintymentioning

confidence: 99%

“…HCPs make such adaptations by relying on their skills, knowledge and experience (15), and they go beyond their assigned tasks and roles to adapt to challenges and changes in everyday practice (16,17). Studies of clinical decision-making in complex care settings have found that HCPs constantly make trade-offs between competing goals, adapt to complete their work, and apply sense-making skills to increase their situational awareness of ill-structured situations (18). These strategies also apply to successful suicide risk detection and response.…”

Section: Introductionmentioning

confidence: 99%

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

Berg

Rørtveit

Walby³

et al. 2019

Preprint

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Background. Safe clinical practice for patients during a suicidal crisis is situated within a complex, non-linear and uncertain context. It involves a complex set of practices in which adaptation is perceived as a source of safety. This study aims to develop a deeper understanding of safe clinical practice and the capacity to adapt to challenges and changes in clinical care for patients hospitalised in mental health wards during a suicidal crisis. Methods. This study applied a qualitative design based on focus group and individual interviews. Twenty-five health care professionals (HCPs) participated in the focus groups, and 18 HCPs were individually interviewed. The study was conducted at open and locked wards in a university hospital in Norway that provides specialised mental health services for adults.Findings. Adaptive capacities for clinical practice were described in relation to three themes. 1) HCPs described using expertise to make sense of suicidal behaviour to support complex decision-making. Their strategies relied on setting the checklist aside to prioritise trust and making judgements beyond spoken words. They improved their understanding by seeking others’ perspectives through a collaborative sense-making process involving the health care team and the patient. 2) HCPs reported individualising the therapeutic milieu to address the diversity of patients with suicidal behaviour. Safe clinical practice was provided by creating individual clinical pathways, making trade-offs between under- and over-protection and adjusting observations 3) It was necessary for HCPs manage uncertainty to provide safe clinical practice. They did so as a team by developing mutual collegial trust, support and shared understanding. Conclusion. HCPs’ adaptive capacities are vital to the complex set of practices involved in safe clinical practice for patients hospitalised during a suicidal crisis. By using expertise, individualising the therapeutic milieu, and managing uncertainty, HCPs individually and collectively develop their capacity to adapt to challenges and changes in clinical care. Safe clinical practice cannot easily be ensured by following standards; it depends on HCP adaptations. Ward systems ensuring collegial trust and support are needed, as are arenas supporting shared understanding and collaborative sense-making. Keywords: Adaptation, sense-making, situational awareness, shared understanding, trade-offs, mental health, suicide, uncertainty

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“…Other researchers have proposed other resilience capabilities, such as rebound from unexpected events and return to equilibrium, robustness [17], planning, adapting, and noticing [18]. Berg and Aase (2019) conceptualised resilience in healthcare based on four categories: anticipation, sense making, trade-offs and adaptations, and defined it as a set of cognitive and behavioural strategies enacted by individuals within an organisational context [19]. Patriarca et al (2018) highlighted the importance of developing more advanced safety-oriented models to study resilience in order to overcome the limitations of the traditional safety approaches [15].…”

Section: Introductionmentioning

confidence: 99%

Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.

Iflaifel

Lim

Ryan

et al. 2020

Preprint

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Background Traditional approaches to safety management in health care have focused primarily on counting errors and understanding how things go wrong. Resilient Health Care (RHC) provides an alternative complementary perspective of learning from incidents and understanding how, most of the time, work is safe. The aim of this review was to identify how RHC is conceptualised, described and interpreted in the published literature, to describe the methods used to study RHC, and to identify factors that develop RHC.Methods Electronic searches of PubMed, Scopus and Cochrane databases were performed to identify relevant peer-reviewed studies, and a hand search undertaken for studies published in books that explained how RHC as a concept has been interpreted, what methods have been used to study it, and what factors have been important to its development. Studies were evaluated independently by two researchers. Data was synthesised using a thematic approach.Results Thirty-six studies were included; they shared similar descriptions of RHC which was the ability to adjust its functioning prior to, during, or following events and thereby sustain required operations under both expected and unexpected conditions. Qualitative methods were mainly used to study RHC. Two types of data sources have been used: direct (e.g. focus groups and surveys) and indirect (e.g. observations and simulations) data sources. Most of the tools for studying RHC were developed based on predefined resilient constructs and have been categorised into three categories: performance variability and Work As Done, cornerstone capabilities for resilience, and integration with other safety management paradigms. Tools for studying RHC currently exist but have yet to be fully implemented. Effective team relationships, trade-offs and health care ‘resilience’ training of health care professionals were factors used to develop RHC. Conclusions Although there was consistency in the conceptualisation of RHC, methods used to study and the factors used to develop it, several questions remain to be answered before a gold standard strategy for studying RHC can confidently be identified. These include operationalising RHC assessment methods in multi-level and diverse settings and developing, testing and evaluating interventions to address the wider safety implications of RHC amidst organisational and institutional change.

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Resilient Characteristics as Described in Empirical Studies on Health Care

Cited by 41 publications

References 19 publications

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

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

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

Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.

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