Harnessing instability as an opportunity for health system strengthening: A review of health system resilience

Abstract

In recent years, resilience has emerged as a prominent topic in global health systems discourse as a result of the increasing variety and volume of sources of instability inflicting strain on systems. In line with this study's intent to bring together existing literature on health system resilience as a means to understand the process through which systems achieve resilience, a review of academic literature related to health system resilience was conducted. Emerging from this review is an operational model of resilience that builds on existing health systems frameworks. The model highlights health system resilience as a process through which leaders in all sectors need to be mobilized in order to harness instability as an opportunity for health system strengthening rather than a threat to the system's sustainability and integrity.

Organizational change and everyday health system resilience: Lessons from Cape Town, South Africa

“…The contextual capacities supporting EHSR include organizational relationships and networks that can be nurtured through leadership practices that bring people together across organizational silos, as in the AMCM and Think Tank (itself, unlearning). The Area South experience also illustrates the importance of diffused power ( Kagwanja et al, 2020 ), and emphasizes the need, to nurture an enhanced sense of safety to speak up and take risks in such spaces (again, unlearning) ( Chamberland-Rowe et al, 2019 ). Research on organizational culture and improving clinical outcomes in hospitals, similarly, points to the role of leaders in fostering a learning environment, ensuring that staff feel psychologically safe and able to speak up when things go wrong; as well as deliberate management of conflict and motivation, and enabling coalitions across disciplines and levels of the hierarchy ( Mannion and Smith, 2018 ).…”

“…Mid-level managers are themselves in a critical position to nurture resilience capacities. Situated between the centre and the frontline, they can clarify central visions and directions, support collective sensemaking and coordinate integrated responses when instability arises ( Chamberland-Rowe et al, 2019 ; Rouleau, 2005 ). Canadian health reform experience illustrates this important conceptual work, highlighting mid-level managers' role in building relationships, trust and collaboration to support implementation ( Cloutier et al, 2016 ).…”

“…These practices can strengthen the commitment and motivation of staff to innovate, learn, adapt and transform. In addition, the Area South manager did two other things acknowledged to support resilience in complex systems ( Chamberland-Rowe et al, 2019 ; Petrie and Swanson, 2018 ). Alongside the CityHealth Director, she worked up the bureaucracy to leverage some slack in the system - specifically, a relaxation in compliance demands and additional resources for PHC improvement - and she pro-actively sought to use data to nurture system awareness.…”

“… Bertone and Meessen, 2013 ). Others argue that building system robustness is the first step to resilience - perhaps by creating the organizational, legal and regulatory environments that enable adaptability at meso and micro levels ( Chamberland-Rowe et al, 2019 ). However, complexity theory and wider experience suggests that reform design cannot by itself direct institutional change ( Cloutier et al, 2016 ), and the sequencing of top-down/bottom-up action is less important than paying attention to both ( Swanson et al, 2015 ).…”

Health systems research and critical systems thinking: the case for partnership

“…Barasa, Cloete, and Gilson () want to reframe this ‘vital notion';, on the basis of the theory of complex adaptive systems, to embrace ‘absorptive, adaptive and transformative strategies';. Chamberland‐Rowe, Chiocchio, and Bourgeault (), tracing the rise to prominence of the topic of resilience in the health systems discourse, seek to encourage the treatment of instability as an opportunity rather than as just a threat. Sturmberg () suggests rethinking resilience as an emergent property of health systems as a whole – ‘resilient homeostasis';.…”