Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.
Background Traditional approaches to safety management in health care have focused primarily on counting errors and understanding how things go wrong. Resilient Health Care (RHC) provides an alternative complementary perspective of learning from incidents and understanding how, most of the time, work is safe. The aim of this review was to identify how RHC is conceptualised, described and interpreted in the published literature, to describe the methods used to study RHC, and to identify factors that develop RHC.
Methods Electronic searches of PubMed, Scopus and Cochrane databases were performed to identify relevant peer-reviewed studies, and a hand search undertaken for studies published in books that explained how RHC as a concept has been interpreted, what methods have been used to study it, and what factors have been important to its development. Studies were evaluated independently by two researchers. Data was synthesised using a thematic approach.
Results Thirty-six studies were included; they shared similar descriptions of RHC which was the ability to adjust its functioning prior to, during, or following events and thereby sustain required operations under both expected and unexpected conditions. Qualitative methods were mainly used to study RHC. Two types of data sources have been used: direct (e.g. focus groups and surveys) and indirect (e.g. observations and simulations) data sources. Most of the tools for studying RHC were developed based on predefined resilient constructs and have been categorised into three categories: performance variability and Work As Done, cornerstone capabilities for resilience, and integration with other safety management paradigms. Tools for studying RHC currently exist but have yet to be fully implemented. Effective team relationships, trade-offs and health care ‘resilience’ training of health care professionals were factors used to develop RHC.
Conclusions Although there was consistency in the conceptualisation of RHC, methods used to study and the factors used to develop it, several questions remain to be answered before a gold standard strategy for studying RHC can confidently be identified. These include operationalising RHC assessment methods in multi-level and diverse settings and developing, testing and evaluating interventions to address the wider safety implications of RHC amidst organisational and institutional change.
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Posted 13 Apr, 2020
On 10 Apr, 2020
On 03 Apr, 2020
On 02 Apr, 2020
On 01 Apr, 2020
On 01 Apr, 2020
On 29 Feb, 2020
Received 06 Feb, 2020
Invitations sent on 31 Jan, 2020
On 31 Jan, 2020
On 20 Jan, 2020
On 19 Jan, 2020
On 19 Jan, 2020
On 02 Dec, 2019
Received 01 Dec, 2019
Received 13 Nov, 2019
On 12 Nov, 2019
Invitations sent on 08 Nov, 2019
On 08 Nov, 2019
On 14 Oct, 2019
On 13 Oct, 2019
On 13 Oct, 2019
Resilient Health Care: a systematic review of conceptualisations, study methods and factors that develop resilience.
Posted 13 Apr, 2020
On 10 Apr, 2020
On 03 Apr, 2020
On 02 Apr, 2020
On 01 Apr, 2020
On 01 Apr, 2020
On 29 Feb, 2020
Received 06 Feb, 2020
Invitations sent on 31 Jan, 2020
On 31 Jan, 2020
On 20 Jan, 2020
On 19 Jan, 2020
On 19 Jan, 2020
On 02 Dec, 2019
Received 01 Dec, 2019
Received 13 Nov, 2019
On 12 Nov, 2019
Invitations sent on 08 Nov, 2019
On 08 Nov, 2019
On 14 Oct, 2019
On 13 Oct, 2019
On 13 Oct, 2019
Background Traditional approaches to safety management in health care have focused primarily on counting errors and understanding how things go wrong. Resilient Health Care (RHC) provides an alternative complementary perspective of learning from incidents and understanding how, most of the time, work is safe. The aim of this review was to identify how RHC is conceptualised, described and interpreted in the published literature, to describe the methods used to study RHC, and to identify factors that develop RHC.
Methods Electronic searches of PubMed, Scopus and Cochrane databases were performed to identify relevant peer-reviewed studies, and a hand search undertaken for studies published in books that explained how RHC as a concept has been interpreted, what methods have been used to study it, and what factors have been important to its development. Studies were evaluated independently by two researchers. Data was synthesised using a thematic approach.
Results Thirty-six studies were included; they shared similar descriptions of RHC which was the ability to adjust its functioning prior to, during, or following events and thereby sustain required operations under both expected and unexpected conditions. Qualitative methods were mainly used to study RHC. Two types of data sources have been used: direct (e.g. focus groups and surveys) and indirect (e.g. observations and simulations) data sources. Most of the tools for studying RHC were developed based on predefined resilient constructs and have been categorised into three categories: performance variability and Work As Done, cornerstone capabilities for resilience, and integration with other safety management paradigms. Tools for studying RHC currently exist but have yet to be fully implemented. Effective team relationships, trade-offs and health care ‘resilience’ training of health care professionals were factors used to develop RHC.
Conclusions Although there was consistency in the conceptualisation of RHC, methods used to study and the factors used to develop it, several questions remain to be answered before a gold standard strategy for studying RHC can confidently be identified. These include operationalising RHC assessment methods in multi-level and diverse settings and developing, testing and evaluating interventions to address the wider safety implications of RHC amidst organisational and institutional change.
Figure 1