Healthcare resilience - A meta-narrative systematic review and synthesis

BackgroundResilience is a ubiquitous but often misunderstood term. It is often studied and described within the lens of individual academic disciplines, despite the complexities and interactions of today’s world. Using a meta-narrative approach, we performed a systematic literature review of healthcare resilience, tracking the research traditions which have informed this field. This paper consolidates knowledge about the definitions, measures, and concepts of healthcare resilience at meso- and macro-levels, to build an interdisciplinary, cross-sectoral, and multi-level (ICM) approach and framework. It forms part of a wider project on healthcare resilience, within a larger research group on societal resilience and guides efforts to build resilience after the COVID19 pandemic.MethodsForty-five reviews were analysed thematically, adhering to RAMESES and PRISMA guidelines. We explore issues inherent to fundamental terms and propose a unified definition spanning event timescales and applicable to multiple hierarchical levels. Studies tended to focus on individual hierarchical levels using a range of frameworks, which are frequently also used as measurement indices. Macro-level indices focusing on capacities failed to sufficiently capture the importance of relational aspects of systems resilience. Meso-level approaches and frameworks tended to swing between the extremes of disaster risk reduction strategies and patient safety approaches for normal stressors. Micro-level approaches were not a focus but tended to centre around acute psychological interventions.ResultsThe analysis allowed us to propose a unified definition and build an overall framework for healthcare resilience containing pre-, intra-, post-, and trans-event domains, which work across hierarchical levels. We also adopt a realist view by presenting a table of selected resilience frameworks, categorising them according to predominant hierarchical level and timescale. This aims to guide decision-makers about the suitability of various frameworks, at specific levels, through numerous points during crises. ConclusionThere is increasing acknowledgement of the need for inter-disciplinary, cross-sectoral, and multi-level approaches to healthcare resilience, but such work is hitherto rare. A realist approach to various resilience frameworks may help to determine best-fit for individual organisations and systems. There is a need to better understand how resilience practically works across various hierarchical levels.