A resilience view on health system resilience: a scoping review of empirical studies and reviews

Abstract

Background: Prompted by recent shocks and stresses to health systems globally, various studies have emerged on health system resilience. Our aim is to describe how health system resilience is operationalised within empirical studies and previous reviews. We compare these to the core conceptualisations and characteristics of resilience in a broader set of domains (specifically, engineering, socio-ecological, organisational and community resilience concepts), and trace the different schools, concepts and applications of resilience across the health literature.

Methods: We searched the Pubmed database for concepts related to 'resilience' and 'health systems'. Two separate analyses were conducted for included studies: a total of n = 87 empirical studies on health system resilience were characterised according to part of health systems covered, type of threat, resilience phase, resilience paradigm, and approaches to building resilience; and a total of n = 30 reviews received full-text review and characterised according to type of review, resilience concepts identified in the review, and theoretical framework or underlying resilience conceptualisation.

Results: The intersection of health and resilience clearly has gained importance in the academic discourse with most papers published since 2018 in a variety of journals and in response to external threats, or in reference to more frequent hospital crisis management. Most studies focus on either resilience of health systems generally (and thereby responding to an external shock or stress), or on resilience within hospitals (and thereby to regular shocks and operations). Less attention has been given to community-based and primary care, whether formal or informal. While most publications do not make the research paradigm explicit, 'resilience engineering' is the most prominent one, followed by 'community resilience' and 'organisational resilience'. The social-ecological systems roots of resilience find the least application, confirming our findings of the limited application of the concept of transformation in the health resilience literature.

Conclusions: Our review shows that the field is fragmented, especially in the use of resilience paradigms and approaches from non-health resilience domains, and the health system settings in which these are used. This fragmentation and siloed approach can be problematic given the connections within and between the complex and adaptive health systems, ranging from community actors to local, regional, or national public health organisations to secondary care. Without a comprehensive definition and framework that captures these interdependencies, operationalising, measuring and improving resilience remains challenging.

Keywords: Community resilience; Health systems; Resilience; Resilience engineering; Socio-ecological resilience.

Fig. 1

Overview of the two sub-objectives for our study

Fig. 2

Distribution of journal categories considered in this review (n = 87)

Fig. 3

Distribution of study locations (n = 87)

Fig. 4

Identified literature on health system resilience (n = 87) organised by threat or type of challenge and year (from 2004 until June 2021)

Fig. 5

Literature on health resilience (n = 87) organised by location in the health system (resilience of what?) and threat or type of challenge (resilience to what?)

Fig. 6

Analysis of specific resilience capacities or outcomes (n = 87)

Fig. 7

Literature on health resilience organised by location in the health subsystem (resilience of what?) and resilience paradigm (n = 87)

Fig. 8

Heatmap and dendogram of the approaches to build and manage resilience for the different resilience paradigms. (socio-ecological systems—social-ecological resilience; ORG—organisational resilience; SoCap—Social Capital; COMM—community resilience; RE—resilience engineering). Mapping only for papers that mention both resilience paradigm and approach

Fig. 9

The health system as an adaptive complex system, and its interdependencies to other systems, grey boxes indicate shocks or stresses to health system