Resilience: From Practice to Theory and Back Again

Macrae, Carl; Wiig, Siri

doi:10.1007/978-3-030-03189-3_15

Cited by 28 publications

(27 citation statements)

References 7 publications

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“…Involving next of kin contributed not only to informing the investigation but also to transparency and trust building at the individual level and potentially to the restoration of resilience at a systemic level because next of kin changed the way regulators investigated and generated new information that could be used for system improvement. 29 …”

Section: Discussionmentioning

confidence: 99%

Next of Kin Involvement in Regulatory Investigations of Adverse Events That Caused Patient Death: A Process Evaluation (Part I – The Next of Kin’s Perspective)

et al. 2021

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Objective The aim of the study was to explore experiences from the next of kin’s perspective of a new involvement method in the regulatory investigation process of adverse events causing patient death. Methods The study design was a qualitative process evaluation of the new involvement method in two Norwegian counties. Next of kin who had lost a close family member in an adverse event were invited to a 2-hour face-to-face meeting with regulatory inspectors to shed light on the event from the next of kin’s perspective. Data collection involved 18 interviews with 29 next of kin who had participated in the meeting and observations (20 hours) of meetings from 2017 to 2018. Data were analyzed using a thematic content analysis. Results Next of kin wanted to be involved and had in-depth knowledge about the adverse event and the healthcare system. Their involvement extended beyond sharing information, and some experienced it as having a therapeutic effect and contributing to transparency and trust building. The inspectors’ professional, social, and human skills determined the experiences of the involvement and were key for next of kin’s positive experiences. The meeting was emotionally challenging, and some next of kin found it difficult to understand the regulators’ independent role and suggested improving information given to the next of kin before the meeting. Conclusions Although the meeting was emotionally challenging, the next of kin had a positive experience of being involved in the investigation and believed that their information contributed to improving the investigation process.

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Section: Discussionmentioning

confidence: 99%

Next of Kin Involvement in Regulatory Investigations of Adverse Events That Caused Patient Death: A Process Evaluation (Part I – The Next of Kin’s Perspective)

et al. 2021

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“…All narratives were developed in researcher pairs according to a predefined template agreed upon in the research team. The narrative development covered the following dimensions based on Macrae and Wiig [ 34 ]: Defining the phenomena of resilience (ca 150–200 words on each question): Resilience for what? (What goals and objectives are resilience supporting?)…”

Section: Methodsmentioning

confidence: 99%

Balancing adaptation and innovation for resilience in healthcare – a metasynthesis of narratives

Lyng

Macrae

Guise

et al. 2021

BMC Health Serv Res

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Background Adaptation and innovation are both described as instrumental for resilience in healthcare. However, the relatedness between these dimensions of resilience in healthcare has not yet been studied. This study seeks to develop a conceptual understanding of adaptation and innovation as a basis for resilience in healthcare. The overall aim of this study is therefore to explore how adaptation and innovation can be described and understood across different healthcare settings. To this end, the overall aim will be investigated by identifying what constitutes adaptation and innovation in healthcare, the mechanisms involved, and what type of responses adaptation and innovation are associated with. Methods The method used to develop understanding across a variety of healthcare contexts, was to first conduct a narrative inquiry of a comprehensive dataset from various empirical settings (e.g., maternity, transitional care, telecare), that were later analysed in accordance with grounded theory. Narrative inquiry provided a contextually informed synthesis of the phenomenon, while the use of grounded theory methodology allowed for cross-contextual comparison of adaptation and innovation in terms of resilience in healthcare. Results The results identified an imbalance between adaptation and innovation. If short-term adaptations are used too extensively, they may mask system deficiencies and furthermore leave the organization vulnerable, by relying too much on the efforts of a few individuals. Hence, short-term adaptations may end up a barrier for resilience in healthcare. Long-term adaptations and innovation of products, processes and practices proved to be of a lower priority, but had the potential of addressing the flaws of the system by proactively re-organizing and re-designing routines and practices. Conclusions This study develops a new conceptual account of adaptation and innovation as a basis for resilience in healthcare. Findings emerging from this study indicate that a balance between adaptation and innovation should be sought when seeking resilience in healthcare. Adaptations can furthermore be divided into short-term and long-term adaptations, creating the need to balance between these different types of adaptations. Short-term adaptations that adopt the pattern of firefighting can risk generating complex and unintended outcomes, but where no significant changes are made to organization of the system. Long-term adaptations, on the other hand, introduce re-organization of the system based on feedback, and therefore can provide a proactive response to system deficiencies. We propose a pattern of adaptation in resilience in healthcare: from short-term adjustments, to long-term reorganizations, to innovations.

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“…2 There is a particular lack of empirical investigations of macro-level activities (ie, actions of governments and regulatory agencies) and their relation to the resilience of healthcare systems. 11,[21][22][23] While the resilience literature on public health responses to natural disasters and outbreaks of infectious disease addresses macro-level concerns, a recent review found that these studies often focus on service delivery, leaving issues such as governance underexplored. 6 As a result, a need exists for investigations of the relationship between government actions and the capacity for resilient performance in healthcare.…”

Section: Introductionmentioning

confidence: 99%

Government Actions and Their Relation to Resilience in Healthcare During the COVID-19 Pandemic in New South Wales, Australia and Ontario, Canada

Smaggus

Long

Ellis

et al. 2021

Int J Health Policy Manag

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Background: Resilience, a system's ability to maintain a desired level of performance when circumstances disturb its functioning, is an increasingly important concept in healthcare. However, empirical investigations of resilience in healthcare (RiH) remain uncommon, particularly those that examine how government actions contribute to the capacity for resilient performance in the healthcare setting. We sought to investigate how governmental actions during the coronavirus disease 2019 (COVID-19) pandemic related to the concept of resilience, how these actions contributed to the potential for resilient performance in healthcare, and what opportunities exist for governments to foster resilience within healthcare systems. Methods: We conducted case studies of government actions pertaining to the COVID-19 pandemic in New South Wales, Australia and Ontario, Canada. Using media releases issued by each government between December 2019 and August 2020, we performed qualitative content analysis to identify themes relevant to the resilience potentials (anticipate, monitor, respond, learn) and RiH. Results: Direct references to the term 'resilience' appeared in the media releases of both governments. However, these references focused on the reactive aspects of resilience. While actions that constitute the resilience potentials were evident, the media releases also revealed opportunities to enhance learning (eg, a need to capitalize on opportunities for double-loop learning and identify strategies appropriate for complex systems) and anticipating (eg, incorporating the concept of hedging into frameworks of RiH). Conclusion:Though fostering RiH through government action remains a challenge, this study suggests opportunities to realize this goal. Articulating a proactive vision of resilience and recognizing the complex nature of current systems could enhance governments' ability to coordinate resilient performance in healthcare. Reflection on how anticipation relates to resilience appears necessary at both the practical and conceptual levels to further develop the capacity for RiH.

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Resilience: From Practice to Theory and Back Again

Cited by 28 publications

References 7 publications

Next of Kin Involvement in Regulatory Investigations of Adverse Events That Caused Patient Death: A Process Evaluation (Part I – The Next of Kin’s Perspective)

Next of Kin Involvement in Regulatory Investigations of Adverse Events That Caused Patient Death: A Process Evaluation (Part I – The Next of Kin’s Perspective)

Balancing adaptation and innovation for resilience in healthcare – a metasynthesis of narratives

Government Actions and Their Relation to Resilience in Healthcare During the COVID-19 Pandemic in New South Wales, Australia and Ontario, Canada

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