scholarly journals A health systems resilience research agenda: moving from concept to practice

2021 ◽  
Vol 6 (8) ◽  
pp. e006779
Author(s):  
Dell D Saulnier ◽  
Karl Blanchet ◽  
Carmelita Canila ◽  
Daniel Cobos Muñoz ◽  
Livia Dal Zennaro ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Dynamic Performance ◽  
Performance Outcomes ◽  
Theoretical Research ◽  
Systems Research ◽  
Complex Adaptive ◽  
System Resilience

Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ability of complex adaptive systems that is derived from dynamic behaviour and interactions, or as both. However, there is little congruence on the theory and the existing frameworks have not been widely used, which as diluted the research applications for health system resilience. A global group of health system researchers were convened in March 2021 to discuss and identify priorities for health system resilience research and implementation based on lessons from COVID-19 and other health emergencies. Five research priority areas were identified: (1) measuring and managing systems dynamic performance, (2) the linkages between societal resilience and health system resilience, (3) the effect of governance on the capacity for resilience, (4) creating legitimacy and (5) the influence of the private sector on health system resilience. A key to filling these research gaps will be longitudinal and comparative case studies that use cocreation and coproduction approaches that go beyond researchers to include policy-makers, practitioners and the public.

scholarly journals Health system resilience – a conceptual and empirical review of health system literature

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
K Wahedi ◽  
L Biddle ◽  
K Bozorgmehr
Keyword(s):  
Health System ◽  
Health Systems ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Empirical Studies ◽  
Building Blocks ◽  
Systems Research ◽  
System Resilience ◽  
Analytical Category ◽  
Operational Frameworks

Abstract Background The concept of health system resilience has gained popularity in the global health discourse, featuring in UN policies, academic articles and conferences. The term is commonly used to refer to the ability of health systems to respond to challenges. However, there has been no comprehensive overview of how the concept is understood and assessed in health systems research (HSR). Methods We conducted a conceptual and empirical review in 3 databases using systematic methods. Quantitative and narrative synthesis was used to trace the introduction of the concept to HSR, identify relevant definitions and examine its use in research. Results From 4063 references, we identified 96 articles concerned with health system resilience from 2007 - 2017, with a recent increase in literature (45% of studies published since 2016). Many articles take a general perspective; others focus on specific HSR building blocks (e.g. 28% on service delivery) or a particular type of crisis, such as climate change (12.5%) or natural disasters (10.4%). While the concept was developed from the ecological sciences, its meaning has been adapted in HSR, with a shift towards people-centred and process-oriented definitions. We identify three frameworks operationalising resilience: the “attributes” framework by Kruk et al. (2017), the “everyday resilience” framework by Barasa et al. (2017) and the “complex adaptive systems” framework by Blanchet et al. (2017). However, we find a mismatch between these frameworks and how the concept is assessed in 13 quantitative and 8 qualitative empirical studies. Conclusions The HSR literature has converged around a definition of resilience focusing on the system’s ability to mitigate ongoing challenges. Differences in emphasis remain, resulting in a variety of operational frameworks. The frameworks require further adaptation and testing in empirical studies to demonstrate the usefulness of “resilience” as an analytical category in HSR. Key messages There is a mismatch between conceptualisation and operationalisation of resilience in the HSR literature. Existing operational frameworks of resilience require further adaptation and testing in empirical studies to demonstrate the usefulness of “resilience” as an analytical category in HSR.

scholarly journals Health System Resilience: What Are We Talking About? A Scoping Review Mapping Characteristics and Keywords

2019 ◽  
Vol 9 (1) ◽  
pp. 6-16 ◽  
Author(s):  
My Fridell ◽  
Sanna Edwin ◽  
Johan von Schreeb ◽  
Dell D. Saulnier
Keyword(s):  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
World Health ◽  
Systems Research ◽  
Quality Health ◽  
System Resilience ◽  
Health Organization ◽  
Key Terms

Background: Health systems are based on 6 functions that need to work together at all times to effectively deliver safe and quality health services. These functions are vulnerable to shocks and changes; if a health system is unable to withstand the pressure from a shock, it may cease to function or collapse. The concept of resilience has been introduced with the goal of strengthening health systems to avoid disruption or collapse. The concept is new within health systems research, and no common description exists to describe its meaning. The aim of this study is to summarize and characterize the existing descriptions of health system resilience to improve understanding of the concept. Methods and Analysis: A scoping review was undertaken to identify the descriptions and characteristics of health system resilience. Four databases and gray literature were searched using the keywords "health system" and "resilience" for published documents that included descriptions, frameworks or characteristics of health system resilience. Additional documents were identified from reference lists. Four expert consultations were conducted to gain a broader perspective. Descriptions were analysed by studying the frequency of key terms and were characterized by using the World Health Organization (WHO) health system framework. The scoping review identified eleven sources with descriptions and 24 sources that presented characteristics of health system resilience. Frequently used terms that were identified in the literature were shock, adapt, maintain, absorb and respond. Change and learning were also identified when combining the findings from the descriptions, characteristics and expert consultations. Leadership and governance were recognized as the most important building block for creating health system resilience. Discussion: No single description of health system resilience was used consistently. A variation was observed on how resilience is described and to what depth it was explained in the existing literature. The descriptions of health system resilience primarily focus on major shocks. Adjustments to long-term changes and the element of learning should be considered for a better understating of health system resilience.

scholarly journals Performance management in complex adaptive systems: a conceptual framework for health systems

2021 ◽  
Vol 6 (7) ◽  
pp. e005582
Author(s):  
Tom Newton-Lewis ◽  
Wolfgang Munar ◽  
Tata Chanturidze
Keyword(s):  
Performance Management ◽  
Health Systems ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Collective Responsibility ◽  
System Level ◽  
Empirical Literature ◽  
Current Evidence ◽  
Current Evidence Base ◽  
Complex Adaptive

Existing performance management approaches in health systems in low-income and middle-income countries are generally ineffective at driving organisational-level and population-level outcomes. They are largely directive: they try to control behaviour using targets, performance monitoring, incentives and answerability to hierarchies. In contrast, enabling approaches aim to leverage intrinsic motivation, foster collective responsibility, and empower teams to self-organise and use data for shared sensemaking and decision-making.The current evidence base is too limited to guide reforms to strengthen performance management in a particular context. Further, existing conceptual frameworks are undertheorised and do not consider the complexity of dynamic, multilevel health systems. As a result, they are not able to guide reforms, particularly on the contextually appropriate balance between directive and enabling approaches. This paper presents a framework that attempts to situate performance management within complex adaptive systems. Building on theoretical and empirical literature across disciplines, it identifies interdependencies between organisational performance management, organisational culture and software, system-level performance management, and the system-derived enabling environment. It uses these interdependencies to identify when more directive or enabling approaches may be more appropriate. The framework is intended to help those working to strengthen performance management to achieve greater effectiveness in organisational and system performance. The paper provides insights from the literature and examples of pitfalls and successes to aid this thinking. The complexity of the framework and the interdependencies it describes reinforce that there is no one-size-fits-all blueprint for performance management, and interventions must be carefully calibrated to the health system context.

scholarly journals Irrational use of antibiotics in Iran from the perspective of complex adaptive systems: redefining the challenge

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zahra Sharif ◽  
Farzad Peiravian ◽  
Jamshid Salamzadeh ◽  
Nastaran Keshavarz Mohammadi ◽  
Ammar Jalalimanesh
Keyword(s):  
Health Systems ◽  
Information Flow ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
Emergent Behavior ◽  
System Level ◽  
Antibiotics Resistance ◽  
Policy Document ◽  
Complex Adaptive ◽  
Antibiotics Use

Abstract Background Irrational use of antibiotics is proving to be a major concern to the health systems globally. This results in antibiotics resistance and increases health care costs. In Iran, despite many years of research, appreciable efforts, and policymaking to avoid irrational use of antibiotics, yet indicators show suboptimal use of antibiotics, pointing to an urgent need for adopting alternative approaches to further understand the problem and to offer new solutions. Applying the Complex Adaptive Systems (CAS) theory, to explore and research health systems and their challenges has become popular. Therefore, this study aimed to better understand the complexity of the irrational use of antibiotics in Iran and to propose potential solutions. Method This research utilized a CAS observatory tool to qualitatively collect and analyse data. Twenty interviews and two Focus Group discussions were conducted. The data was enriched with policy document reviews to fully understand the system. MAXQDA software was used to organize and analyze the data. Result We could identify several diverse and heterogeneous, yet highly interdependent agents operating at different levels in the antibiotics use system in Iran. The network structure and its adaptive emergent behavior, information flow, governing rules, feedback and values of the system, and the way they interact were identified. The findings described antibiotics use as emergent behavior that is formed by an interplay of many factors and agents over time. According to this study, insufficient and ineffective interaction and information flow regarding antibiotics between agents are among key causes of irrational antibiotics use in Iran. Results showed that effective rules to minimize irrational use of antibiotics are missing or can be easily disobeyed. The gaps and weaknesses of the system which need redesigning or modification were recognized as well. Conclusion The study suggests re-engineering the system by implementing several system-level changes including establishing strong, timely, and effective interactions between identified stakeholders, which facilitate information flow and provision of on-time feedback, and create win-win rules in a participatory manner with stakeholders and the distributed control system.

scholarly journals Shocks, stress and everyday health system resilience: experiences from the Kenyan coast

2020 ◽  
Vol 35 (5) ◽  
pp. 522-535 ◽  
Author(s):  
Nancy Kagwanja ◽  
Dennis Waithaka ◽  
Jacinta Nzinga ◽  
Benjamin Tsofa ◽  
Mwanamvua Boga ◽  
...  
Keyword(s):  
Health System ◽  
Complex Adaptive Systems ◽  
Adaptive Systems ◽  
National Level ◽  
Resource Scarcity ◽  
Middle Level ◽  
Wide Range ◽  
Kenyan Coast ◽  
System Resilience ◽  
Health Managers

Abstract Health systems are faced with a wide variety of challenges. As complex adaptive systems, they respond differently and sometimes in unexpected ways to these challenges. We set out to examine the challenges experienced by the health system at a sub-national level in Kenya, a country that has recently undergone rapid devolution, using an ‘everyday resilience’ lens. We focussed on chronic stressors, rather than acute shocks in examining the responses and organizational capacities underpinning those responses, with a view to contributing to the understanding of health system resilience. We drew on learning and experiences gained through working with managers using a learning site approach over the years. We also collected in-depth qualitative data through informal observations, reflective meetings and in-depth interviews with middle-level managers (sub-county and hospital) and peripheral facility managers (n = 29). We analysed the data using a framework approach. Health managers reported a wide range of health system stressors related to resource scarcity, lack of clarity in roles and political interference, reduced autonomy and human resource management. The health managers adopted absorptive, adaptive and transformative strategies but with mixed effects on system functioning. Everyday resilience seemed to emerge from strategies enacted by managers drawing on a varying combination of organizational capacities depending on the stressor and context.

Leadership for Change in Complex Systems

2005 ◽  
Vol 13 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Harry Minas
Keyword(s):  
Mental Health ◽  
Health System ◽  
Complex Adaptive Systems ◽  
Mental Health System ◽  
Adaptive Systems ◽  
Adaptive System ◽  
Complex Adaptive System ◽  
Complex Adaptive ◽  
Is Value ◽  
Leadership For Change

Objectives: To examine clinician leadership for change from the perspective of complexity. Methods: The core features of complex adaptive systems are described and examples of these characteristics are identified in Australia's mental health system. The implications of conceiving of themental health system as a complex adaptive system are explored. Conclusions: It is concluded that there is value in conceiving of Australia's mental health system as a complex adaptive system and that such a conception provides useful guidance for leadership for change and for management.

Sign in / Sign up

Export Citation Format

Share Document