Purpose Health systems are periodically confronted by crises - think of Severe Acute Respiratory Syndrome, H1N1, and Ebola - during which they are called upon to manage exceptional situations without interrupting essential services to the population. The ability to accomplish this dual mandate is at the heart of resilience strategies, which in healthcare systems involve developing surge capacity to manage a sudden influx of patients. The paper aims to discuss these issues. Design/methodology/approach This paper relates insights from resilience research to the four "S" of surge capacity (staff, stuff, structures and systems) and proposes a framework based on complexity theory to better understand and assess resilience factors that enable the development of surge capacity in complex health systems. Findings Detailed and dynamic complexities manifest in different challenges during a crisis. Resilience factors are classified according to these types of complexity and along their temporal dimensions: proactive factors that improve preparedness to confront both usual and exceptional requirements, and passive factors that enable response to unexpected demands as they arise during a crisis. The framework is completed by further categorizing resilience factors according to their stabilizing or destabilizing impact, drawing on feedback processes described in complexity theory. Favorable order resilience factors create consistency and act as stabilizing forces in systems, while favorable disorder factors such as diversity and complementarity act as destabilizing forces. Originality/value The framework suggests a balanced and innovative process to integrate these factors in a pragmatic approach built around the fours "S" of surge capacity to increase health system resilience.
The literature on paradoxes and pluralism has grown over the last decade. Although both concepts refer to multiplicity in or around organizations, they have been explored in parallel and have rarely been juxtaposed. The aim of this chapter is to discuss the possible interrelations between these concepts and their implications for the study of paradox within organizations. The chapter further seeks to contrast current notions of paradox and pluralism, and expand understanding of these phenomena by looking at them through two alternate theoretical prisms, namely Critical Management Studies (CMS) and complexity theory. In so doing, new lines of inquiry are opened up around paradoxical situations in pluralistic organizations. These alternate prisms invite further exploration into the interface between paradoxes and pluralism, and highlight the potential of performativity without instrumentality to guide strategies for balancing and benefiting from these important dimensions of contemporary organizations.
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