Health System Resilience: What Are We Talking About? A Scoping Review Mapping Characteristics and Keywords

Abstract

Background: Health systems are based on 6 functions that need to work together at all times to effectively deliver safe and quality health services. These functions are vulnerable to shocks and changes; if a health system is unable to withstand the pressure from a shock, it may cease to function or collapse. The concept of resilience has been introduced with the goal of strengthening health systems to avoid disruption or collapse. The concept is new within health systems research, and no common description exists to describe its meaning. The aim of this study is to summarize and characterize the existing descriptions of health system resilience to improve understanding of the concept. Methods and Analysis: A scoping review was undertaken to identify the descriptions and characteristics of health system resilience. Four databases and gray literature were searched using the keywords "health system" and "resilience" for published documents that included descriptions, frameworks or characteristics of health system resilience. Additional documents were identified from reference lists. Four expert consultations were conducted to gain a broader perspective. Descriptions were analysed by studying the frequency of key terms and were characterized by using the World Health Organization (WHO) health system framework. The scoping review identified eleven sources with descriptions and 24 sources that presented characteristics of health system resilience. Frequently used terms that were identified in the literature were shock, adapt, maintain, absorb and respond. Change and learning were also identified when combining the findings from the descriptions, characteristics and expert consultations. Leadership and governance were recognized as the most important building block for creating health system resilience. Discussion: No single description of health system resilience was used consistently. A variation was observed on how resilience is described and to what depth it was explained in the existing literature. The descriptions of health system resilience primarily focus on major shocks. Adjustments to long-term changes and the element of learning should be considered for a better understating of health system resilience.

Enhancing the Understanding of Resilience in Health Systems of Low- and Middle-Income Countries: A Qualitative Evidence Synthesis

“…26 Fridell and colleagues' recent scoping review underscores the importance of adjusting to long-term changes in the health system as a key feature of resilience which reflects the country's leadership and governance. 39 Hence, health systems should first focus on building its 'everyday resilience, ' to deal with the day-today, chronic struggles arising from its weak governance and political and economic instabilities that are inherent in the system, in order to better prepare for future shocks. 12,40 Second, the foundations of resilience appear to be critical especially in resource-constrained settings to unlock the dynamic attributes of resilience suggested by Kruk et al 11 in order for the system to achieve resilience.…”

Addiction psychiatry and COVID-19: impact on patients and service provision

“…From the outpatient perspective, social distancing measures require that, in all but the most urgent circumstances, outpatients in our service switch to a telephone consultation service. Video-based telepsychiatry would be the ideal solution to this issue (Hollander & Carr, 2020), but given the relatively quick restrictions placed on services, having the necessary equipment and training in place was not possible. Consultations via telephone can have similar efficacy to face-to-face consultations but patients can feel less supported and encouraged compared to their face-to-face counterparts (Urness et al 2006).…”

“…The addition of this new treatment provided a challenge to our service as it required multiple disciplines to engage and support a new change. This tested the resilience of our service to adapt to change (Fridell et al 2020), but ultimately it provided an opportunity for us to introduce an improved evidence-based treatment for our patients.…”

Assessing COVID-19 through the lens of health systems’ preparedness: time for a change

“…- Second, the definitions of health system strengthening, as well as resilience of health systems, as we argued earlier, were still either vague, or in development up to the first half of the last decade [ 31 ]. Nevertheless, the last few years have witnessed an increased effort towards defining these concepts [ 4 , 5 , 7 , 36 , 37 ]. Most importantly, this literature now puts governance and health workforce at the heart of what needs to be strengthened for health systems to be resilient.…”