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.

Relationship between management and resilience in healthcare: a study protocol for a systematic review

INTRODUCTION

Management has been identified as a critical component of organisational resilience when responding to adverse events and crises, as managers must ensure an effective operational response and provide direction and guidance to teams. While there are many management approaches, strategies and interventions that have been applied and studied in healthcare, the impact of them in relation to resilience in healthcare has not been explored, particularly at the organisational level. Understanding the impact of management approaches, strategies and interventions on resilience has the potential to inform healthcare organisations on how to better use management to prepare and respond to organisational adverse events. The objective of this mixed-methods systematic review is to understand the relationship between management and organisational resilience in healthcare, including management approaches and strategies that promote resilience in healthcare.

METHODS AND ANALYSIS

A search through MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PubMed and EMBASE will be conducted between 1 August 2021 and 31 December 21. This review will consider empirical quantitative, qualitative and mixed-methods studies published in English from 2010 to the present that meet the inclusion and exclusion criteria. Selected studies will be assessed in detail and extracted data will be reviewed by two independent reviewers. Results of the search will be reported in full in the final systematic review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram. This review will follow a convergent integrated approach to data synthesis and integration.

ETHICS AND DISSEMINATION

This systematic literature review includes no collection of primary data; hence ethical approval will not be sought. The outcomes from this review will be disseminated in a peer-reviewed journal, as conference presentation, and as condensed summary for managers in healthcare and policy-makers.

PROSPERO REGISTRATION NUMBER

CRD42020223362.

Resilient trade-offs between safety and profitability: perspectives of sharp-end drivers in the Beijing taxi service system

Background. Trade-offs are common behaviors of resilient systems, when the systems adapt to changing situations to meet multiple goals. Objective. In the context of the Beijing taxi service system (BTSS), this work investigates the sharp-end taxi drivers' trade-offs between work safety and business profitability, demonstrates their resilience in balancing these two goals and identifies factors that contribute to the trade-offs. Methods. An empirical framework incorporating questionnaire surveys, semi-structured interviews, field observation, data screening and categorization was adopted. Data were collected from a random sample of 70 taxi drivers. Results. In the drivers' decisions we found a slight bias in favor of profitability rather than safety (regardless of their finances), and a high level of resilience that the drivers had developed in making strategies for the trade-offs. Trip distance, possibility of traffic congestion, redundant consumption, weather conditions, road features and real-time broadcast information were identified as determinants of the drivers' decision-making. Conclusion. The findings inform BTSS organizational layers and regulators about the sharp-end drivers' needs for productive safety, and provide an evidence base for making more definitive recommendations about support provision and resource re-allocation in an effective and proactive manner.

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.

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

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.

A Mixed Rough Sets/Fuzzy Logic Approach for Modelling Systemic Performance Variability with FRAM

The task to understand systemic functioning and predict the behavior of today’s sociotechnical systems is a major challenge facing researchers due to the nonlinearity, dynamicity, and uncertainty of such systems. Many variables can only be evaluated in terms of qualitative terms due to their vague nature and uncertainty. In the first stage of our project, we proposed the application of the Functional Resonance Analysis Method (FRAM), a recently emerging technique, to evaluate aircraft deicing operations from a systemic perspective. In the second stage, we proposed the integration of fuzzy logic into FRAM to construct a predictive assessment model capable of providing quantified outcomes to present more intersubjective and comprehensible results. The integration process of fuzzy logic was thorough and required significant effort due to the high number of input variables and the consequent large number of rules. In this paper, we aim to further improve the proposed prototype in the second stage by integrating rough sets as a data-mining tool to generate and reduce the size of the rule base and classify outcomes. Rough sets provide a mathematical framework suitable for deriving rules and decisions from uncertain and incomplete data. The mixed rough sets/fuzzy logic model was applied again here to the context of aircraft deicing operations, keeping the same settings as in the second stage to better compare both results. The obtained results were identical to the results of the second stage despite the significant reduction in size of the rule base. However, the presented model here is a simulated one constructed with ideal data sets accounting for all possible combinations of input variables, which resulted in maximum accuracy. The same should be further optimized and examined using real-world data to validate the results.

Empirical study of gap and correlation between philosophies Safety-I and Safety-II: A case of Beijing taxi service system

In contrast to the conventional safety philosophy (Safety-I) which focuses on 'what goes wrong', a newborn one (Safety-II) focusing on 'what goes right' endows people with more opportunities to realize productive safety in complex socio-technical systems. Yet, it is challenging to make the best of both the philosophies in a period of knowledge transition when they may have to coexist. This work investigates how Safety-II may resemble, differ from, and correlate to Safety-I. From individual, environmental and organizational aspects, 9 impacting factors are identified and expounded comparatively in the two philosophies. To examine impact of the factors on accidents and resilience respectively, an empirical approach is presented in the context of Beijing taxi service system (BTSS). Multiple means such as questionnaire surveys, semi-structured interviews, and statistical analysis with bi-method (Correlation Analysis, and Data Envelopment Analysis) cross-checking are utilized comprehensively to support the empirical study. The results show that: a) individual factors play a dominant role in system risk/performance management, in respect to views of both Safety-I and II; and b) organizational factors are more influential in creating and maintaining system resilience. Based on the findings, possible patterns of integrating the two philosophies are instantiated through mutually complementary application to BTSS. Despite the context of BTSS, this work provides a feasible way of comparing between Safety-I and Safety-II, for beneficial reference of other socio-technical systems.

Digital health technology enhances resilient behaviour: evidence from the ward

Purpose

In the healthcare management domain, there is a lack of knowledge concerning the role of resilience practices in improving patient safety. The purpose of this paper is to understand the capabilities that enable healthcare resilience and how digital technologies can support these capabilities.

Design/methodology/approach

Within- and cross-case research methodology was used to study resilience mechanisms and capabilities in healthcare and to understand how digital health technologies impact healthcare resilience. The authors analyze data from two Italian hospitals through the lens of the operational failure literature and anchor the findings to the theory of dynamic capabilities.

Findings

Five different dynamic capabilities emerged as crucial for managing operational failure. Furthermore, in relation to these capabilities, medical, organizational and patient-related knowledge surfaced as major enablers. Finally, the findings allowed the authors to better explain the role of knowledge in healthcare resilience and how digital technologies boost this role.

Practical implications

When trying to promote a culture of patient safety, the research suggests healthcare managers should focus on promoting and enhancing resilience capabilities. Furthermore, when evaluating the role of digital technologies, healthcare managers should consider their importance in enabling these dynamic capabilities.

Originality/value

Although operations management (OM) research points to resilience as a crucial behavior in the supply chain, this is the first research that investigates the concept of resilience in healthcare systems from an OM perspective, with only a few authors having studied similar concepts, such as “workaround” practices.