Healthcare resilience: a meta-narrative systematic review and synthesis of reviews
Objectives The COVID-19 pandemic has tested global healthcare resilience. Many countries previously considered ‘resilient’ have performed poorly. Available organisational and system frameworks tend to be context-dependent and focus heavily on physical capacities. This study aims to explore and synth...
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Format: | Article |
Language: | English |
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BMJ Publishing Group
2023-09-01
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Series: | BMJ Open |
Online Access: | https://bmjopen.bmj.com/content/13/9/e072136.full |
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author | Paul Dark Gabrielle Prager Mark Z Y Tan Andrew McClelland |
author_facet | Paul Dark Gabrielle Prager Mark Z Y Tan Andrew McClelland |
author_sort | Paul Dark |
collection | DOAJ |
description | Objectives The COVID-19 pandemic has tested global healthcare resilience. Many countries previously considered ‘resilient’ have performed poorly. Available organisational and system frameworks tend to be context-dependent and focus heavily on physical capacities. This study aims to explore and synthesise evidence about healthcare resilience and present a unified framework for future resilience-building.Design Systematic review and synthesis of reviews using a meta-narrative approach.Setting Healthcare organisations and systems.Primary and secondary outcome measures Definitions, concepts and measures of healthcare resilience. We used thematic analysis across included reviews to summarise evidence on healthcare resilience.Results The main paradigms within healthcare resilience include global health, disaster risk reduction, emergency management, patient safety and public health. Definitions of healthcare resilience recognise various hierarchical levels: individual (micro), facility or organisation (meso), health system (macro) and planetary or international (meta). There has been a shift from a focus on mainly disasters and crises, to an ‘all-hazards’ approach to resilience. Attempts to measure resilience have met with limited success. We analysed key concepts to build a framework for healthcare resilience containing pre-event, intra-event, post-event and trans-event domains. Alongside, we synthesise a definition which dovetails with our framework.Conclusion Resilience increasingly takes an all-hazards approach and a process-oriented perspective. There is increasing recognition of the relational aspects of resilience. Few frameworks incorporate these, and they are difficult to capture within measurement systems. We need to understand how resilience works across hierarchical levels, and how competing priorities may affect overall resilience. Understanding these will underpin interdisciplinary, cross-sectoral and multi-level approaches to healthcare resilience for the future.PROSPERO registration number CRD42022314729. |
first_indexed | 2024-03-08T03:32:20Z |
format | Article |
id | doaj.art-73f039e6f4d64deb8d229912720bf4d3 |
institution | Directory Open Access Journal |
issn | 2044-6055 |
language | English |
last_indexed | 2024-03-08T03:32:20Z |
publishDate | 2023-09-01 |
publisher | BMJ Publishing Group |
record_format | Article |
series | BMJ Open |
spelling | doaj.art-73f039e6f4d64deb8d229912720bf4d32024-02-10T17:55:07ZengBMJ Publishing GroupBMJ Open2044-60552023-09-0113910.1136/bmjopen-2023-072136Healthcare resilience: a meta-narrative systematic review and synthesis of reviewsPaul Dark0Gabrielle Prager1Mark Z Y Tan2Andrew McClelland3Intensive Care Unit, University of Manchester, Greater Manchester, UKJohns Hopkins University, Baltimore, Maryland, USAHumanitarian and Conflict Response Institute, The University of Manchester, Manchester, UKAlliance Manchester Business School, The University of Manchester, Manchester, UKObjectives The COVID-19 pandemic has tested global healthcare resilience. Many countries previously considered ‘resilient’ have performed poorly. Available organisational and system frameworks tend to be context-dependent and focus heavily on physical capacities. This study aims to explore and synthesise evidence about healthcare resilience and present a unified framework for future resilience-building.Design Systematic review and synthesis of reviews using a meta-narrative approach.Setting Healthcare organisations and systems.Primary and secondary outcome measures Definitions, concepts and measures of healthcare resilience. We used thematic analysis across included reviews to summarise evidence on healthcare resilience.Results The main paradigms within healthcare resilience include global health, disaster risk reduction, emergency management, patient safety and public health. Definitions of healthcare resilience recognise various hierarchical levels: individual (micro), facility or organisation (meso), health system (macro) and planetary or international (meta). There has been a shift from a focus on mainly disasters and crises, to an ‘all-hazards’ approach to resilience. Attempts to measure resilience have met with limited success. We analysed key concepts to build a framework for healthcare resilience containing pre-event, intra-event, post-event and trans-event domains. Alongside, we synthesise a definition which dovetails with our framework.Conclusion Resilience increasingly takes an all-hazards approach and a process-oriented perspective. There is increasing recognition of the relational aspects of resilience. Few frameworks incorporate these, and they are difficult to capture within measurement systems. We need to understand how resilience works across hierarchical levels, and how competing priorities may affect overall resilience. Understanding these will underpin interdisciplinary, cross-sectoral and multi-level approaches to healthcare resilience for the future.PROSPERO registration number CRD42022314729.https://bmjopen.bmj.com/content/13/9/e072136.full |
spellingShingle | Paul Dark Gabrielle Prager Mark Z Y Tan Andrew McClelland Healthcare resilience: a meta-narrative systematic review and synthesis of reviews BMJ Open |
title | Healthcare resilience: a meta-narrative systematic review and synthesis of reviews |
title_full | Healthcare resilience: a meta-narrative systematic review and synthesis of reviews |
title_fullStr | Healthcare resilience: a meta-narrative systematic review and synthesis of reviews |
title_full_unstemmed | Healthcare resilience: a meta-narrative systematic review and synthesis of reviews |
title_short | Healthcare resilience: a meta-narrative systematic review and synthesis of reviews |
title_sort | healthcare resilience a meta narrative systematic review and synthesis of reviews |
url | https://bmjopen.bmj.com/content/13/9/e072136.full |
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