Network Analysis of Organisational Resilience and Individual Resilience: Pathways to Healthcare Workforce Sustainability

Background Resilient health care (RHC) is an approach to medical settings that focuses on social science questions of how clinical teams adapt to complexity. However, little is known about how resilience at one system level shapes individual resilience and wellbeing at another. We investigated how organisational resilience capacities and individual resilience processes interrelate, and how these are associated with workforce sustainability indicators. Methods Survey data from 371 staff across two Australian hospitals were analysed using psychological network and cluster analyses to map relationships among 10 organisational-resilience capacities (from the Resilience in Healthcare Capacities Assessment), two indicators of individual resilience (Emotional Thriving, Emotional Recovery), and two workforce outcomes (Burnout, Intention to Leave). Interviews with 46 hospital staff supported interpretation of the quantitatively derived clusters. Network-derived hypotheses were tested using serial mediation. Results Network and cluster analyses identified four clusters: (1) Leadership for Growth (Leadership, Communication, Learning, Facilitators); (2) Collaborative Adaptation (Alignment, Involvement, Risk Awareness, Competence); (3) Structured Enablement (Structure, Coordination); and (4) Wellbeing and Retention (Emotional Thriving, Emotional Recovery, Burnout, Intention to leave). Emotional Thriving was the most central node, bridging organisational capacities and workforce outcomes. Serial mediation showed that Structure influenced Burnout indirectly through Learning and Competence, followed by Emotional Thriving. Qualitative accounts illustrated how chronic staff shortages and over-reliance on existing staff perpetuated a cycle of over-adaptation and burnout. Discussion RHC operates across systems levels: organisational capacities create conditions for individual thriving, and thriving is the mechanism through which resilience supports workforce sustainability. Interventions focused solely on individual resilience without restoring organisational resilience are unlikely to offset burnout or attrition.