Toward a theory-led meta-framework for implementing health system resilience analysis studies: a systematic review and critical interpretive synthesis

Abstract

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.

What is “hospital resilience”? A scoping review on conceptualization, operationalization, and evaluation

“…In the last decade, scholars presented numerous frameworks to understand and strengthen health systems resilience to various types of external shocks, ranging from climate-related disasters to infectious disease outbreaks to political unrest and financial crashes (5)(6)(7). Health systems resilience has been defined as a process (6,8), a capacity (5), an ability (9), an outcome (6,10), attributes (11,12), and as a policy objective (4). Despite the growing literature on this subject, this nascent topic is still under-researched, with varying and complex definitions limiting its operationalization (6,8,13).…”

“…Health systems resilience has been defined as a process (6,8), a capacity (5), an ability (9), an outcome (6,10), attributes (11,12), and as a policy objective (4). Despite the growing literature on this subject, this nascent topic is still under-researched, with varying and complex definitions limiting its operationalization (6,8,13). These complexities and divergences in definitions make it difficult to translate the concept into practice at the system-level with even greater challenges at the hospital-level.…”

Resilience of Health Systems: Understanding Uncertainty Uses, Intersecting Crises and Cross-level Interactions Comment on "Government Actions and Their Relation to Resilience in Healthcare During the COVID-19 Pandemic in New South Wales, Australia and Ontario, Canada"

“…It is acknowledged that resilience capacities need to consider the way how multi-scale dynamics are handled 16 and that the concept of health system resilience must expand beyond medicine to include social, economic and political factors in society. 8 However, intersections of the health system with other systems, or with multiple, co-occurring crises are yet neither conceptually 5 nor empirically 4 taken into account. For example, the COVID-19 pandemic in Europe has intersected with the 2008-financial crises, large-scale refugee migration in 2015, [21][22][23] and more recently with war in Ukraine.…”

“…To advance our understanding and knowledge of such 'contextualized' system resilience through analyses of uncertainty uses, systemic intersections, or cross-level interactions, we need conceptual and analytical clarity. In view of the empirical landscape on health system resilience 4 and the non-exhaustive view of the emerging literature, 5,8,10 we argue that agreement (or at least clarity) is needed whether resilience is studied as outcome, mediator, or determinant of a system's performance. Some studies use these interchangeably: resilience as underlying feature or potential, required to achieve a given outcome, while at the same time the system "was" or "proved" resilient.…”

“…4 Faculty of Educational Science, Bielefeld University, Bielefeld, Germany. 5 Research Institute Social Cohesion (FGZ/RISC), Bielefeld, Germany. 6 Working Unit Clinical Developmental Psychopathology, Faculty for Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany.…”