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

Abstract

BackgroundCOVID-19 underscored the importance of building resilient health systems and hospitals. Nevertheless, evidence on hospital resilience is limited without consensus on the concept, its application, or measurement, with practical guidance needed for action at the facility-level.AimThis study establishes a baseline for understanding hospital resilience, exploring its 1) conceptualization, 2) operationalization, and 3) evaluation in the empirical literature.MethodsFollowing Arksey and O'Malley's model, a scoping review was conducted, and a total of 38 articles were included for final extraction.Findings and discussionIn this review, hospital resilience is conceptualized by its components, capacities, and outcomes. The interdependence of six components (1) space, 2) stuff, 3) staff, 4) systems, 5) strategies, and 6) services) influences hospital resilience. Resilient hospitals must absorb, adapt, transform, and learn, utilizing all these capacities, sometimes simultaneously, through prevention, preparedness, response, and recovery, within a risk-informed and all-hazard approach. These capacities are not static but rather are dynamic and should improve continuously occur over time. Strengthening hospital resilience requires both hard and soft resilience. Hard resilience encompasses the structural (or constructive) and non-structural (infrastructural) aspects, along with agility to rearrange the space while hospital's soft resilience requires resilient staff, finance, logistics, and supply chains (stuff), strategies and systems (leadership and coordination, community engagement, along with communication, information, and learning systems). This ultimately results in hospitals maintaining their function and providing quality and continuous critical, life-saving, and essential services, amidst crises, while leaving no one behind. Strengthening hospital resilience is interlinked with improving health systems and community resilience, and ultimately contributes to advancing universal health coverage, health equity, and global health security. The nuances and divergences in conceptualization impact how hospital resilience is applied and measured. Operationalization and evaluation strategies and frameworks must factor hospitals' evolving capacities and varying risks during both routine and emergency times, especially in resource-restrained and emergency-prone settings.ConclusionStrengthening hospital resilience requires consensus regarding its conceptualization to inform a roadmap for operationalization and evaluation and guide meaningful and effective action at facility and country level. Further qualitative and quantitative research is needed for the operationalization and evaluation of hospital resilience comprehensively and pragmatically, especially in fragile and resource-restrained contexts.

Role of hospitals in recovery from COVID-19: Reflections from hospital managers and frontliners in the Eastern Mediterranean Region on strengthening hospital resilience

“…Moreover, the "build back better" (BBB) is a core principle of recovery and offers the opportunity to build back more resilient hospitals, health systems, communities, and societies more broadly. A study from the natural-disasterprone Caribbean region described an efficient approach postdisaster "resilient recovery highlighting three dimensions to the BBB approach: (1) building back stronger (reconstructed infrastructure can resist more intense events), (2) building back faster (income, assets, consumptions, and services are restored as early as possible), and (3) building back more inclusively (reaching the poorest, most exposed, and most vulnerable) (10). Another interpretation of the BBB approach brought together six dimensions of communities (people, place, planet, peace, prosperity, and participation), centering governance and equity, and highlighting the impacts of healthy cities on the health and wellbeing of communities, which ultimately result in urban, sustainable, economic, human and social development (11).…”

“…Hospitals are the backbone of health systems and a main point of contact for communities during emergencies; it is, therefore, imperative to ensure their continued functionality, safety, and resilience ( 1 ). “Hospital resilience” can be conceptualized by its six interdependent components (1) space, (2) stuff, (3) staff, (4) systems, (5) strategies, and (6) services), four resilience capacities (absorptive, adaptive, transformative, and learning), resulting in the primary outcome where resilient hospitals fulfill their most essential functionality then recover to its original state or a new adaptive state in a timely and efficient manner ( 2 ). In many conflict-affected or fragile health systems, where shocks are chronic and prolonged, resilience is day-to-day, with daily opportunities to adapt and transform in response to complex challenges and various simultaneous types of hazards ( 3 ).…”

“…Furthermore, hospitals are frontlines during public health emergencies, ensuring their immediate recovery and functionality is therefore central to both health systems and community resilience ( 8 , 9 ). Despite the critical role hospitals play in DRM, across the literature, there is limited evidence related to hospital's resilience particularly in the recovery stage ( 2 ).…”

“…Resilient hospitals contribute to building stronger and more resilient health systems, and healthy communities, and ultimately impact sustainable development ( 7 ). Beyond fulfilling their primary function in service delivery, hospitals also play a critical role in essential public health functions (EPHF) such as disaster risk reduction and also contribute to social, economic, and community development, and environmental sustainability ( 2 ).…”

“…A regional study further highlighted the adaptability of EMR hospitals in addressing complex challenges to maintain operations, respond to emergencies, and protect patients and staff, while also continuously evolving to strengthen their readiness for subsequent surges and plan for recovery ( 7 , 14 ). Throughout the pandemic, hospitals (and health systems) needed to be resilient, continuously learning, absorbing, adapting, and transforming to ensure the safe and continuous delivery of critical services during emergencies ( 2 , 13 , 15 ). Hospitals exhibited these four resilience capacities throughout the prolonged COVID-19 response and overlapping recovery stages.…”