Enabling Transformational Leadership to Foster Disaster-Resilient Hospitals

Hospitals' operational performance during disasters varies from failing, to being responsive and resilient, to dealing with disruption and surprise. Transformational leaders enable continuously learning hospitals that are resilient in the face of disasters by adapting regeneratively and evolving beyond undertaking conventional lesson-learning after each disaster. However, learning from successful transformational leaders in healthcare is still ad hoc with a lack of guidance on how to develop such leaders. Hence, this study sought to identify key competencies of transformational leaders by exploring hospital leaders' actions in dealing with disasters, considering the disaster cycle of prevention, preparedness, response, and recovery (PPRR). A qualitative case-study design was adopted comprising in-depth semi-structured interviews with twelve senior hospital staff with operational leadership experience with disasters. Three significant categories (themes) and seven key component competencies (sub-themes, in brackets) of transformational leaders were revealed through the analysis of transcripts: (1) 'Governance and leadership' ('transformative agency' and 'decisive accountability'); (2) 'Planning and risk assessment' ('risk navigation', 'disaster attunement', and 'planning agility'); and (3) 'Communication and network engagement' ('communication accelerator' and 'collaboration innovator'). The authors propose a transformational leadership model for hospital disaster resilience and an assessment checklist for leaders' self-reflection to support hospitals in their transition to resilient operations.

Organizational Adaptive Capacity during a Large-Scale Surprise Event: A Case Study at an Academic Institution during the COVID-19 Pandemic

OCCUPATIONAL APPLICATIONSThe COVID-19 pandemic caused large organizations and institutions to adapt their decision-making procedures and hierarchical structures to address pandemic-specific concerns. By examining a large public university, we found that effective adaptation occurred through restructuring the decision-making processes, coordinating decisions between departments, and effective monitoring of prior decisions. When considering the COVID-19 pandemic as a fundamental surprise event, our work identified strategies and decision-making that both maintained and increased adaptive capacity through the course of such an event. Through this case study, we highlight decisions that can be made by similar large organizations, to increase adaptive capacity when they are faced with similar surprise events.

Healthcare Workers' Resilience Toolkit for Disaster Management and Climate Change Adaptation

Climate change has been recognised as a multiplier of risk factors affecting public health. Disruptions caused by natural disasters and other climate-driven impacts are placing increasing demands on healthcare systems. These, in turn, impact the wellness and performance of healthcare workers (HCWs) and hinder the accessibility, functionality and safety of healthcare systems. This study explored factors influencing HCWs' disaster management capabilities with the aim of improving their resilience and adaptive capacity in the face of climate change. In-depth, semi-structured interviews were conducted with thirteen HCWs who dealt with disasters within two hospitals in Queensland, Australia. Analysis of the results identified two significant themes, HCWs' disaster education and HCWs' wellness and needs. The latter comprised five subthemes: HCWs' fear and vulnerability, doubts and uncertainty, competing priorities, resilience and adaptation, and needs assessment. This study developed an 'HCWs Resilience Toolkit', which encourages mindfulness amongst leaders, managers and policymakers about supporting four priority HCWs' needs: 'Wellness', 'Education', 'Resources' and 'Communication'. The authors focused on the 'Education' component to detail recommended training for each of the pre-disaster, mid-disaster and post-disaster phases. The authors conclude the significance of the toolkit, which provides a timely contribution to the healthcare sector amidst ongoing adversity.

Muddling through troubled water: resilient performance of incident management teams during Hurricane Harvey

Modern communities face escalating threats from natural disasters. Thus, the resilience of incident management teams (IMTs) during adverse events becomes crucial to protect lives and physical systems. However, prior studies have only partially highlighted factors related to IMT resilience. To provide a holistic understanding of the resilience of the IMTs, this study conducted semi-structured interviews with 10 experienced IMT personnel during Hurricane Harvey. Thematic analysis revealed six characteristics of resilient IMTs during a hurricane event: (i) establishing a common operating picture, (ii) adopting and adapting plans and protocols, (iii) proactive, re-prioritizing, and unconventional decision-making, (iv) enhancing resourcefulness and redundancy, (v) learning for improved anticipation and response readiness, and (vi) inter-organisational relationship to promote IMT functions. As an empirical investigation of the resilience of the IMTs, the findings inform future endeavours for developing incident information technologies and strategies to harmonise pre-established plans with adaptive actions in the field and fostering capabilities to learn from incidents. Practitioner summary: Resilient incident management teams establish a common operating picture; effectively adopt and adapt plans and protocols; make decisions in an unconventional and anticipatory fashion; constantly re-prioritize goals and tasks; enhance resourcefulness and redundancy; continuously learn skills for improved anticipation and response readiness; and exhibit good inter-organisational coordination and planning skills.

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.