An Analytic Framework to Assess Organizational Resilience

Designing a learning tool for translating resilience in healthcare into practice: A qualitative mixed methods study

There is currently a lack of tools that focus on strengthening resilient performance of healthcare systems through learning from positive healthcare events. Such tools are needed to operationalize and translate resilience in healthcare and, thus, advance the field of patient safety by learning from both positive and negative events and outcomes. The purpose of this study is to describe the developmental process of one such tool to enable operationalization of resilient healthcare and aid future tool development. The development process featured a complex, multi-step, design through involvement of a range of different stakeholders. A combination of publicly available platforms, cross-sectional knowledge, step-by step instructions and a learning tool that engages participants in collaborative practice to facilitate discussions across stakeholders and system levels is proposed as a means to create awareness of when and what contributes to resilient performance is fundamental to understanding and improving healthcare system resilience.

A bibliometric analysis of research on organizational resilience

Organizational resilience is a key concept in the study of sustainable corporate growth and indicates an organization's capacity to recover from adversity. It plays a crucial role in responding to uncertain crises. In recent years, academic interest in organizational resilience has increasingly gained prominence. This research uses CiteSpace and VOSviewer to provide a thorough visual analysis of pertinent international literature based on 342 pieces of closely linked literature about organizational resilience. The findings suggest that organizational resilience research is currently experiencing a development phase. Within this field, there is a substantial number of scholars involved, with the most prolific among them including Aleksic Aleksandar, Prayag Girish, and Griffiths Andrew. The networks of collaboration among these authors, nevertheless, are very scattered. Co-citation network research reveals the academics with the biggest sway in the field. Organizational resilience, conservation of resources theory, crisis management, corporate social responsibility, and emergency management are identified as research hotspots within the keyword co-citation network. Furthermore, to determine which countries and regions are the most influential, this study has created a cooperative network among them. China, the United States, and England are the top three nations with articles published. Not only are the highly cited journals respected in the management sector, but they also showcase noteworthy research accomplishments within the field. The purpose of this study is to investigate potential avenues for future research and offer helpful sources for choosing research subjects and developing theoretical frameworks in this area. The analysis is highly valuable as a reference for research on organizational resilience in different settings in the future.

Resilience and mindfulness among radiological personnel in Norway, their relationship and their impact on quality and safety- a questionnaire study

BACKGROUND

Stress and burnout are widespread problems among radiological personnel Individual and organizational resilience and mindfulness offer protection against burnout.

AIM

To investigate the level of resilience and mindfulness among radiological personnel, the associations between organizational resilience, individual resilience, and mindfulness, and how these factors impact the quality of care provided in radiological departments.

METHODS

An online questionnaire consisting of the Connor-Davidson Resilience Scale, the Mindful Attention Awareness Scale, the Benchmark Resilience Tool, and questions regarding burnout, and quality and safety was used. Data analysis consisted of descriptive statistics, bivariate correlation and standard multiple regression.

RESULTS AND CONCLUSION

Few participants considered burnout a significant challenge. Individual and organizational resilience were low (30.40 ± 4.92 and 63.21 ± 13.63 respectively), and mindfulness was high (4.29 ± 0.88). There was a significant correlation between individual and organizational resilience (p = 0.004), between individual resilience and mindfulness (p = 0.03), and between organizational resilience and mindfulness (p = 0.02). Individual and organizational resilience affect each other. However; neither significantly affect quality and safety, nor mindfulness.

Conceptualising learning from resilient performance: A scoping literature review

Resilient performance is a crucial characteristic of complex socio-technical systems, enabling them to sustain essential functionality during changing or stressful conditions. Resilience Engineering (RE), a sub-field of safety research, focuses on this perspective of resilience. RE emphasises its "cornerstone model", presenting the RE system goals of "anticipating, monitoring, responding and learning". The cornerstone of learning remains fragmented and undertheorized in the existing literature. This paper aims to enrich RE research and its practical implications by developing a nuanced and comprehensive understanding of the role of learning from resilient performance. To achieve this aim, a scoping literature review was conducted to assess how learning is conceptualised in the RE literature and the theoretical foundations on which previous work rest. The main findings show that RE researchers view learning as the process of understanding the system, sharing knowledge, and re-designing system properties. The application of established learning theories is limited. This paper contributes to research by proposing an organisational process for the RE cornerstone of learning, paving the way for deeper discussions in future studies about learning from resilient performance within complex socio-technical systems.

Impact of an online training tool on individual and organizational resilience and mindfulness among radiological personnel in Norway

BACKGROUND

Heavy workloads and increasing demands for productivity have contributed to rising rates of stress and burnout among radiological staff. Different forms of mindfulness and resilience-training might assist with stress management and protect these employees against burnout.

AIM

The objective of this study is to evaluate the impact of an online training tool on individual and organizational resilience, mindfulness and quality of care.

METHODS

An online questionnaire was used, consisting of the Connor-Davidson Resilience Scale, the Mindful Attention Awareness Scale, the Benchmark Resilience Tool, and questions pertaining to quality, safety, and burnout (baseline = 68 participants between July 2022 - October 2022, follow-up = 13 participants between November 2022 - February 2023). Descriptive statistics and a paired-sampled t-test were used for statistical analysis.

RESULTS AND CONCLUSIONS

Few participants reported completing any of the exercises. The baseline group had significantly higher mean resilience (p = 0.018) and mindfulness scores (p = < 0.001), mean decrease in scores was 7.46 for resilience and 1.7 for mindfulness. In conclusion, both individual and organizational resilience are perceived as low among radiological personnel in Norway. However, it does not seem to affect quality and safety.

Assessing healthcare capacity crisis preparedness: development of an evaluation tool by a Canadian health authority

Introduction

The COVID-19 pandemic presented health systems across the globe with unparalleled socio-political, ethical, scientific, and economic challenges. Despite the necessity for a unified, innovative, and effective response, many jurisdictions were unprepared to such a profound health crisis. This study aims to outline the creation of an evaluative tool designed to measure and evaluate the Vitalité Health Network's (New Brunswick, Canada) ability to manage health crises.

Methods

The methodology of this work was carried out in four stages: (1) construction of an evaluative framework; (2) validation of the framework; (3) construction of the evaluative tool for the Health Authority; and (4) evaluation of the capacity to manage a health crisis.

Results

The resulting evaluative tool incorporated 8 dimensions, 74 strategies, and 109 observable elements. The dimensions included: (1) clinical care management; (2) infection prevention and control; (3) governance and leadership; (4) human and logistic resources; (5) communication and technologies; (6) health research; (7) ethics and values; and (8) training. A Canadian Health Authority implemented the tool to support its future preparedness.

Conclusion

This study introduces a methodological strategy adopted by a Canadian health authority to evaluate its capacity in managing health crises. Notably, this study marks the first instance where a Canadian health authority has created a tool for emergency healthcare management, informed by literature in the field and their direct experience from handling the SARS-CoV-2 pandemic.

Learning tools used to translate resilience in healthcare into practice: a rapid scoping review

BACKGROUND

Historically, efforts to improved healthcare provisions have focussed on learning from and understanding what went wrong during adverse events. More recently, however, there has been a growing interest in seeking to improve healthcare quality through promoting and strengthening resilience in healthcare, in light of the range of changes and challenges to which healthcare providers are subjected. So far, several approaches for strengthening resilience performance have been suggested, such as reflection and simulation. However, there is a lack of studies that appraise the range of existing learning tools, the purposes for which they are designed, and the types of learning activities they comprise. The aim of this rapid scoping review is to identify the characteristics of currently available learning tools designed to translate organizational resilience into healthcare practice.

METHODS

A rapid scoping review approach was used to identify, collect, and synthesise information describing the characteristics of currently available learning tools designed to translate organizational resilience into healthcare practice. EMBASE and Medline Ovid were searched in May 2022 for articles published between 2012 and 2022.

RESULTS

The review identified six different learning tools such as serious games and checklists to guide reflection, targeting different stakeholders, in various healthcare settings. The tools, typically, promoted self-reflection either individually or collaboratively in groups. Evaluations of these tools found them to be useful and supportive of resilience; however, what constitutes resilience was often difficult to discern, particularly the organizational aspect. It became evident from these studies that careful planning and support were needed for their successful implementation.

CONCLUSIONS

The tools that are available for review are based on guidelines, checklists, or serious games, all of which offer to prompt either self-reflection or group reflections related to different forms of adaptations that are being performed. In this paper, we propose that more guided reflections mirroring the complexity of resilience in healthcare, along with an interprofessional collaborative and guided approach, are needed for these tools to be enacted effectively to realise change in practice. Future studies also need to explore how tools are perceived, used, and understood in multi-site, multi-level studies with a range of different participants.

A framework to assess potential health system resilience using fuzzy logic

Objectives

To develop and test a framework to assess the potential of public health systems to maintain a resilient performance.

Methods

Quantitative data from public databases and qualitative data from technical reports of Brazilian health authorities were used to develop the framework which was assessed and modified by experts. Fuzzy logic was used for the mathematical model to determine scores for four resilient abilities - monitoring, anticipation, learning, and response - and an aggregated coefficient of resilient potential in health care. The coefficient measures used data from before the coronavirus disease 2019 (COVID-19) pandemic. These were compared with measures of the actual performance of health systems in 10 cities in Brazil during the pandemic.

Results

The coefficient of resilient potential in health care showed that the cities most affected by COVID-19 had lower potential for resilient performance before the pandemic. Some local health systems had adequate response capabilities, but other abilities were not well developed, which adversely affected the management of the spread of COVID-19.

Conclusions

The coefficient of resilient potential in health care is useful to indicate important areas for resilient performance and the different types of resilience capacities that can be considered in different contexts and levels of public health systems. Regular assessment of the potential of health systems for resilient performance would help highlight opportunities for continuous improvement in health system functions during chronic stress situations, which could strengthen their ability to keep functioning in the face of sudden disturbances.

The application of resilience assessment grid in healthcare: A scoping review

Background

The Resilience Assessment Grid (RAG) has attracted increasing interest in recent healthcare discourse as an instrument to understand and measure the resilience performance of socio-technical systems. Despite its growing popularity in healthcare, its applicability and utility remain unclear. This scoping review aims to understand the practical application of RAG method and its outcomes in healthcare.

Method

We followed the Arksey and O’Malley, and the Levac and colleagues’ framework for scoping reviews and the PRISMA-ScR Checklist. We conducted searches of three electronic databases [Medline, Embase and Web of Science] in May 2021. Supplementary searches included Google Scholar, web and citation searches, and hand searches of the nine seminal edited books on Resilience Engineering and Resilient Health Care. All English language, empirical studies of RAG application in the healthcare setting were included. Open Science Framework [Registration-DOI. 10.17605/OSF.IO/GTCZ3].

Results

Twelve studies met the inclusion criteria. Diversities were found across study designs and methodologies. Qualitative designs and literature reviews were most frequently used to develop the RAG and applied it in practice. Eight of the studies had qualitative designs, three studies had mixed-methods designs and one study had a quantitative design. All studies reported that the RAG was very helpful for understanding how frontline healthcare professionals manage the complexity of everyday work. While the studies gained insights from applying the RAG to analyze organizational resilience and identify areas for improvement, it was unclear how suggestions were implemented and how they contributed to quality improvement.

Conclusion

The RAG is a promising tool to manage some of the current and future challenges of the healthcare system. To realise the potential benefits of the RAG, it is important that we move beyond the development phase of the RAG tool and use it to guide implementation and management of quality initiatives.

The resilient potential behaviours in an Internal Medicine Department: Application of resilience assessment grid

Background

The healthcare system is frequently subject to unpredictable conditions such as organisational changes and pandemics. In order to perform as required under these conditions (i.e. exhibiting resilient behaviour), it is necessary to know the current position of the organisation with respect to the four resilient potentials i.e. respond, monitor, learn and anticipate. The study aimed to understand and assess resilient performance of an Internal Medicine Department in a public hospital in Denmark using the resilience assessment grid (RAG).

Methods

A modified Delphi method was used to develop the context specific RAG, using interviews to generate items, two rounds of expert panel reviews and pilot testing the developed RAG questionnaire. The four sets of structured RAG questions were tested and revised until satisfactory face and content validity for application was achieved. The final version of the RAG (28-item Likert scale) questionnaire was sent electronically to 87 healthcare professionals (clinicians and managers) in January 2021 and 2022. The data was statistically analysed and illustrated in radar charts to assist in interpreting the resilience profiles.

Results

While the resilience profiles in 2021 and 2022 were similar, the scores in 2022 were slightly lower for some of the sub-indicators. The results indicate areas for improvement, especially related to the Internal Medicine Department’s potential to respond and learn. The results from the RAG were presented to the chief clinical consultants and managers to identify initiatives for quality improvement and for planning a new workflow at the Internal Medicine Department.

Conclusion

The RAG is a managerial tool to assess the potential resilient performance of the organisation in respect to the four resilience potentials, i.e., responding, monitoring, learning, and anticipating. It can be used to construct the resilience profile of the system over time to manage organisational changes.

Organizational resilience in maritime business: a systematic literature review

Purpose

One of the common solutions to the business problems, disruptions and new developments of the global world is enhancing the resilience of systems, countries and organizations. Applying resilience differs according to business environments and context-based requirements of industries, which create a lack of consensus regarding how to achieve and apply it. To fill this gap and answer the main question, this study proposes to handle the resilience concept from an organizational perspective. By using an organizational point of view this study aims to offer an applicable philosophy that can be used by a wide range of stakeholders.

Design/methodology/approach

The main question of the study is to figure out whether “Is there any approach/lens to achieve resilient organizations which can be applied by the stakeholders of the system.” To reach such a “common application/approach” where the stakeholders can reach a consensus, a systematic literature review has been conducted to determine the existing approaches and practices.

Findings

The contribution of the study lies in two folds: to offer a maritime business resilience definition from the organizational point of view and to show the requirement of organizational resilience management philosophy in the maritime business context. An applicable framework is offered for the stakeholders of the maritime business transport system.

Research limitations/implications

The research has some limitations. This study is designed on a systematic review to figure out existing approaches used in the maritime business field and to defend and prove the necessity of organizational resilience management philosophy in maritime business management which helps organizational survival. Further research should use different methods to empirically test the conceptual model according to different segments/stakeholders of the maritime industry. Also, this research opens a new field of study about resilience subject from the maritime context where organizational approach mentions hardly any. Therefore, future studies should investigate developing key performance indicators of components of the proposed model and its effects on maritime organizations.

Practical implications

As a volatile industry, increasing resilience capability helps maritime organizations to decrease the effects of disruptions while at the same enable them to operate the core business functions in the maritime business. Maritime business needs to solve not only one-time problems but also needs to resolve and exploit new opportunities from disruptions via resilient management philosophy, which help organizational adaption in fluctuating periods. To prevent such problems and become ready for complex environmental changes, organizational resilience management philosophy is vital.

Social implications

Organizational resilience offers maritime business a holistic approach to evaluate problems of the system by submitting multiple ways to handle problems that help to manage uncertainty and change. Resilient management philosophy enables maritime business organizations to fight against their vulnerabilities that create risk, especially in a turbulent business environment.

Originality/value

The originality of the study lies in highlighting the importance of organizational resilience management philosophy in the maritime business context. And an organizational resilience framework is offered.

Toward a theory-led meta-framework for implementing health system resilience analysis studies: a systematic review and critical interpretive synthesis

Introduction

The variety of frameworks and models to describe resilience in the health system has led researchers and policymakers to confusion and the inability to its operationalization. Therefore, the purpose of this study was to create a meta-framework using the Critical Interpretive Synthesis method.

Method

For this purpose, studies that provide theories, models, or frameworks for organizational or health system resilience in humanitarian or organizational crises were systematically reviewed. The search strategy was conducted in PubMed, Web of Science, Embase, and Scopus databases. MMAT quality appraisal tool was applied. Data were analysed using MAXQDA 10 and the Meta-ethnography method.

Results

After screening based on eligibility criteria, 43 studies were reviewed. Data analysis led to the identification of five main themes which constitute different framework dimensions. Health system resilience phases, attributes, tools, and strategies besides health system building blocks and goals are various dimensions that provide a systematic framework for health system resilience analysis.

Discussion

This study provides a systemic, comprehensive framework for health system resilience analysis. This meta-framework makes it possible to detect the completeness of resilience phases. It examines the system’s resilience by its achievements in intermediate objectives (resilience system attributes) and health system goals. Finally, it provides policy solutions to achieve health system resilience using tools in the form of absorptive, adaptive, and transformative strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12496-3.

Adaptive Resilience of Complex Safety-Critical Sociotechnical Systems: Toward a Unified Conceptual Framework and Its Formalization

Resilience is commonly understood as the capacity for a system to maintain a desirable state while undergoing adversity or to return to a desirable state as quickly as possible after being impacted. In this paper, we focus on resilience for complex sociotechnical systems (STS), specifically those where safety is an important aspect. Two main desiderata for safety-critical STS to be resilient are adaptive capacity and adaptation. Formal studies integrating human cognition and social aspects are needed to quantify the capacity to adapt and the effects of adaptation. We propose a conceptual framework to elaborate on the concept of resilience of safety-critical STS, based on adaptive capacity and adaptation and how this can be formalized. A set of mechanisms is identified that is necessary for STS to have the capacity to adapt. Mechanisms belonging to adaptive capacity include situation awareness, sensemaking, monitoring, decision-making, coordination, and learning. It is posited that the two mechanisms required to perform adaptation are anticipation and responding. This framework attempts to coherently integrate the key components of the multifaceted concept of STS adaptive resilience. This can then be used to pursue the formal representation of adaptive resilience, its modeling, and its operationalization in real-world safety-critical STS.

Analysis of the Safety Resilience Implementation in the Maritime Industry at Public and Private Companies (A Case Study in Indonesia)

(1) Background: The resilience concept shows performance improvement in four potential aspects consisting of the ability to respond, provide anticipatory action, control things that occur internally and externally, as well as the learning process of what is going right and what is going wrong. This study aims to analyze the safety resilience implementation in the Indonesian maritime sector. (2) Method: This is a descriptive study using semi-quantitative methods, using interview guides based on the Resilience Assessment Grid (RAG). The sampling technique is purposive sampling. (3) Results: The level of implementation of safety resilience at the public company was 75.1%, while the private company was 70.2%. The score for each safety resilience element in the public and private companies are as follows: the ability to respond (80%), learning ability (74.62%), monitoring ability (70.77%), and the ability to anticipate (66.92%). (4) Conclusion: The safety resilience implementation in Indonesian sea transportation shipping has not been optimal in implementing the safety resilience concept. The focus of implementing safety is still on preventing and controlling accidents. The other orientation of ability improvement in the safety resilience concept has not been implemented.

The impact of the COVID-19 pandemic on the safety management in Italian Seveso industries

The paper discusses the impact of the COVID-19 pandemic on the Italian chemical and process industries, where Directive 2012/18/EU Seveso III, for the control of Major Accident Hazard (MAH), is enforced. The Safety Management System (SMS) for the control of MAH, which has been mandatory for 20 years in Italian Seveso Establishments, has been highly stressed by the external pressure, related in some way to the COVID-19 pandemic. Fairly, most companies, in particular in oil and gas sectors, have demonstrated an adequate capability to reconcile operation continuity and health requirements. This experience is providing the establishment operators and the regulators with valuable suggestions for the improvements of the SMS-MAH. Within this framework, an innovative organisational resilience model is proposed, aiming at the development of a higher capability to face future new crisis. The current SMS-MAH already includes some basic pillars to enhance resilience, which were valuable during the pandemic crisis, but a full and rationale development is still needed. Starting from the first pandemic phase experience, this paper presents a novel tool to assess the degree of "resilience" of a SMS-MAH. It is based on a questionnaire, featuring 25 questions grouped into eight items, according to the typical SMS-MAH structure. A two level AHP model has been developed in order to define the weights to be assigned to each point. The AHP panel included industrial practitioners, regulators, authorities and researchers. The results are based on the COVID-19 experience and consequently the developed model is tailored to face health emergencies, but the approach may be easily transferred to other external crises.

Safety-II and Resilience Engineering in a Nutshell: An Introductory Guide to Their Concepts and Methods

Background

Traditional safety concept, which is called Safety-I, and its relevant methods and models have much contributed toward enhancing the safety of industrial systems. However, they have proved insufficient to be applied to complex socio-technical systems. As an alternative, Safety-II and resilience engineering have emerged and gained much attention for the last two decades. However, it seems that safety professionals have still difficulty understanding their fundamental concepts and methods. Accordingly, it is necessary to offer an introductory guide to them that helps safety professionals grasp them correctly in consideration of their current practices.

Methods

This article firstly explains the limitations of Safety-I and how Safety-II can resolve them from the four points of view. Next, the core concepts of resilience engineering and Functional Resonance Analysis Method are described.

Results

Workers' performance adjustment and performance variability due to it should be the basis for understanding human-related accidents in socio-technical systems. It should be acknowledged that successful and failed work performance have the same causes. However, they are not well considered in the traditional safety concept; in contrast, Safety-II and resilience engineering have conceptual bases and practical approaches to reflect them systematically.

Conclusion

It is necessary to move from a find-and-fix and reactive approach to a proactive approach to safety management. Safety-II and resilience engineering give a set of useful concepts and methods for proactive safety management. However, if necessary, Safety-I methods need to be properly used for situations where they can still be useful as well.

Measuring Resilience Potentials: A Pilot Program Using the Resilience Assessment Grid

Researchers in the resilience engineering space have proposed the notion that organisations operating in complex socio-technical systems cannot ‘be’ resilient but can have the ‘potential for resilient performance’. This theoretical stance also suggests that organisations wanting to enhance their potential for resilience begin by measuring their operational safety performance against four key potentials, these being: the Potential to Anticipate; the Potential to Respond; the Potential to Learn; and the Potential to Monitor. Furthermore, to measure these four key resilience constructs, organisations have been recommended to use a Resilience Assessment Grid (RAG) developed as part of this theory. However, scarce research appears to have been conducted that bridges the theory and practice divide on just how organisations can pragmatically measure their current performance against these four resilience potentials using the RAG. Therefore, this research was interested in undertaking a pilot study using RAG theory in order to examine an organisation’s four resilience potentials, and was conducted within a large road transport organisation in Australia. Results indicated that measuring both the four individual potentials and a combination of the four potentials was possible using a RAG and proved effective in providing a snapshot of operational safety system resilience concepts. Recommendations on how to increase organisational resilience potentials were provided to ensure future safety endeavours would enhance the organisation’s potential to be resilience in the face of system variability and operational demands.

Developing and maintaining the resilience of interdisciplinary cancer care teams: an interventional study

Background

Providing care to cancer patients is associated with a substantial psychological and emotional load on oncology workers. The purpose of this project is to co-construct, implement and assess multidimensional intervention continuums that contribute to developing the resilience of interdisciplinary cancer care teams and thereby reduce the burden associated with mental health problems. The project is based on resources theories and theories of empowerment.

Methods

The study will involve cancer care teams at four institutions and will use a mixed-model design. It will be organized into three components:

(1) Intervention development. Rather than impose a single way of doing things, the project will take a participatory approach involving a variety of mechanisms (workshops, discussion forums, surveys, observations) to develop interventions that take into account the specific contexts of each of the four participating institutions.

(2) Intervention implementation and assessment. The purpose of this component is to implement the four interventions developed in the preceding component, assess their effects and whether they are cost effective. A longitudinal quasi-experimental design will be used. Intervention monitoring will extend over 12 months. The effects will be assessed by means of generalized estimating equation regressions. A cost-benefit analysis will be performed to assess the cost-effectiveness of the interventions, taking an institutional perspective (costs and benefits associated with the intervention).

(3) Analysis of co-construction and implementation process. The purpose of this component is to (1) describe and assess the approaches used to engage stakeholders in the co-construction and implementation process; (2) identify the factors that have fostered or impeded the co-construction, implementation and long-term sustainability of the interventions. The proposed design is a longitudinal multiple case study.

Discussion

In the four participating institutions, the project will provide an opportunity to develop new abilities that will strengthen team resilience and create more suitable work environments. Beyond these institutions, the project will generate a variety of resources (e.g.: work situation analysis tools; method of operationalizing the intervention co-development process; communications tools; assessment tools) that other oncology teams will be able to adapt and deploy elsewhere.

Hotels in contexts of uncertainty: Measuring organisational resilience

The tourism industry faces multiple changes (economic crises, climate change, technology innovation…). Because of this vulnerability, as evidenced by the COVID-19 pandemic, the study of hotel resilience is a key issue for the survival and competitiveness of organisations and destinations. Therefore, this paper proposes a holistic model to measure organisational resilience. To that end, it aims to analyse the determinants of organisational resilience, i.e. predictors of resilience (strategy and change), and to assess how they contribute to hotel resilience and performance. Firstly, the hotel context in the Canary Islands is examined to identify the level of impact, frequency and predictability of each type of change. Secondly, scales development and validation were conducted. Finally, the proposed model is validated. Findings confirm that the strategy and change dimensions have a considerable effect on hotel resilience, which positively influences hotel performance. Discussion provides hotel managers with guidelines to improve organisational resilience and performance.

Measurement of resilience potential - development of a resilience assessment grid for emergency departments

BACKGROUND

Resilience engineering has been advocated as an alternative to the management of safety over the last decade in many domains. However, to facilitate metrics for measuring and helping analyze the resilience potential for emergency departments (EDs) remains a significant challenge. The study aims to redesign the Hollnagel's resilience assessment grid (RAG) into a custom-made RAG (ED-RAG) to support resilience management in EDs.

METHODS

The study approach had three parts: 1) translation of Hollnagel's RAG into Chinese version, followed by generation of a tailored set of ED-RAG questions adapted to EDs; 2) testing and revising the tailored sets until to achieve satisfactory validity for application; 3) design of a new rating scale and scoring method. The test criteria of the ED-RAG questionnaire adopted the modified three-level scoring criteria proposed by Bloom and Fischer. The study setting of the field test is a private regional hospital.

RESULTS

The fifth version of ED-RAG was acceptable after a field test. It has three sets of open structured questions for the potentials to respond, monitor, and anticipate, and a set of structured questions for the potential to learn. It contained 38 questions corresponding to 32 foci. A new 4-level rating scale along with a novel scaling method can improve the scores conversion validity and communication between team members and across investigations. This final version is set to complete an interview for around 2 hours.

CONCLUSIONS

The ED-RAG represents a snapshot of EDs'resilience under specific conditions. It might be performed multiple times by a single hospital to monitor the directions and contents of improvement that can supplement conventional safety management toward resilience. Some considerations are required to be successful when hospitals use it. Future studies to overcome the potential methodological weaknesses of the ED-RAG are needed.

Defining adaptive capacity in healthcare: A new framework for researching resilient performance

Resilience principles show promise for improving the quality of healthcare, but there is a need for further theoretical development to include all levels and scales of activity across the whole healthcare system. Many existing models based on engineering concepts do not adequately address the prominence of social, cultural and organisational factors in healthcare work. Promising theoretical developments include the four resilience potentials, the CARE model and the Moments of Resilience Model, but they are all under specified and in need of further elaboration. This paper presents the Integrated Resilience Attributes Framework in which these three theoretical perspectives are integrated to provide examples of anticipating, responding, monitoring and learning at different scales of time and space. The framework is intended to guide researchers in researching resilience, especially the linkages between resilience at different scales of time and space across the whole healthcare system.

Investigating resilience in emergency management: An integrative review of literature

There is a growing need for resilience in dealing with unexpected events during disasters. The purpose of this review was to summarize and synthesize the literature that examined resilience in the context of emergency management (EM). Four groups of findings were synthesized: definitions, key dimensions, technical tools, and research settings employed in the research. First, definitions of resilience, improvisation, and adaptation were summarized and critically evaluated. Second, four key dimensions of EM resilience were identified: collective sensemaking, team decision making, harmonizing work-as-imagined and work-as-done, and interaction and coordination. Third, this review identified five prevalent technical tools used to enhance resilience in EM: mapmaking, event history logging, mobile communication applications, integrated information management system, and decision support tools. Fourth, two major design features of emergency simulations, incident scenarios and participant roles, are evaluated. For each finding, directions for future research efforts to improve resilience in EM are proposed.

Preliminary Human Safety Assessment (PHSA) for the Improvement of the Behavioral Aspects of Safety Climate in the Construction Industry

Occupational safety in the construction industry still represents a relevant problem at a global level. In fact, the complexity of working activities in this sector requires a comprehensive approach that goes beyond normative compliance to guarantee safer working conditions. In particular, empirical research on the factors influencing the unsafe behavior of workers needs to be augmented. Thus, the relationship between human factors and safety management issues following a bottom-up approach was investigated. In particular, an easy-to-use procedure that can be used to better address workers’ safety needs augmenting the company’s safety climate and supporting safety management issues was developed. Such an approach, based on the assessment of human reliability factors, was verified in a real case study concerning the users of concrete mixer trucks. The results showed that the majority of human failures were action and retrieval errors, underlining the importance of theoretical and practical training programs as a means to improve safety behavior. In such a context, information and communication activities also resulted beneficially to augment the company’s safety climate. The proposed approach, despite its qualitative nature, allows a clearer understanding of workers’ perceptions of hazards and their risk-taking behavior, providing practical cues to monitor and improve the behavioral aspects of safety climate. Hence, these first results can contribute to augmenting safety knowledge in the construction industry, providing a basis for further investigations on the causalities related to human performances, which are considered a key element in the prevention of accidents.

A multicountry comparative survey about organizational resilience in anaesthesia

RATIONALE, AIMS, AND OBJECTIVES

The application of resilience in health care requires the shift from a cause-effect approach to a systemic approach, yet few tools have been developed to measure resilience potential in this specific context. This study tests a resilience assessment grid (RAG) questionnaire to measure the resilience of anaesthesiologists, with a cross-country survey.

METHOD

A study was conducted with an analytic hierarchy process (AHP) questionnaire containing 57 detailed questions; 16 nations and 172 respondents were involved in the study. The data were statistically analysed to identify insights from the questionnaire, main improvements for further assessment, and confirmation of the design of the questionnaire. The questionnaire reliability was assessed by Cronbach analysis. Weak items were identified by a detailed correlations analysis and through a weight-polarization matrix. Construct validity was confirmed by principal component analysis (PCA) and factor analysis (FA).

RESULTS

The α level of Cronbach analysis is 0.910. PCA and FA confirmed the absence of underlying unexpected factors, with less than 8% from the first factor and a total of just 54% of variability explained by 17 factors. Suggestions for revising the questionnaire ensue from the analysis, with improvements for the questionnaire's significance.

CONCLUSION

The questionnaire shows the potential to assess proxy measures of resilience, even confirming the relevance of a structured weighting approach based on the AHP. The exemplar statistical cross-country analyses encourage the widespread use of a centralized resilience questionnaire to support standardized analyses and the diffusion of best practices among organizations.