Care in the future—reconciling health system and individual resilience

Societal risk scenarios show pandemics as a well-known disaster waiting to happen. Yet COVID-19 hit hard and demonstrated the need for flexibility. Healthcare settings became overburdened, but frontline workers resolutely provided care for their patients in innovative ways [1, 2]. Adaptive capacity in the healthcare system was the resulting phenomenon; success depended on multiple strategies but often involved herculean organizational and individual efforts [1, 3]. Over time, healthcare professionals experienced burnout and many left their jobs [4]. Individual adaptation to cover up system failures resulted in individual breakdowns, threatening collective health system resilience.

The current state of affairs is unsustainable. There is a need for a re-recognition that resilience in healthcare requires a multifocal perspective that integrates individuals, teams, and systems. This will be a system where individual resilience is integral to, and nurtured as a prerequisite for, system resilience. We make the case here that health system resilience and individual resilience are mutually constituted. They must support each other to create the adaptive capacity necessary to deliver high-quality care over time. We will need this, as the next pandemic lies ahead.

Building blocks of resilience

Recent research into health system resilience [3, 5] and organizational resilience [6] highlights fundamental features of systems that enable resilient performance and facilitate adaptations to challenges and changes. These resilience capacities—building blocks of success—demonstrate the essential role of multiple elements in a functioning health system, including leadership and governance, leveraging community resources, empowerment, effective human resource management, universal health coverage, and preparedness for change [3, 5]. Hollnagel has persuasively pinpointed how organizations enable resilient performance through the ability to anticipate, monitor, respond, and learn [7]. Building on this, recent work [6] argues that 10 capacities are crucial for healthcare organizations’ resilient performance (Fig. 1).

Figure 1

Resilience capacities enabling resilient health system performance, adapted from [6, p.5].

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Central to this model is a systems perspective, but it is sufficiently broad and incorporates the role of the individual stakeholder working in the system as a key player, someone who adapts to disturbances and risks and takes opportunities. Thus, we do not conceptualize resilience in terms of making individuals responsible for the resilient performance of their organizations, or worse still, to blame them when things go wrong. Instead, the individual stakeholders at different system levels are essential actors in creating adaptive capacity and system performance. In essence, we need the system to adapt to individuals’ needs and individuals to adapt to the system’s needs—simultaneously [4, 8–10].

Reconciling perspectives

The answer to this thorny issue lies in reconciling the stances of the advocates of individual resilience—who want to empower people to be able to cope and bounce back from adversity, with those who seek to strengthen health systems—who emphasize a collective approach enabling adaptive capacity across healthcare systems. In practice, this means advancing resilience through collaboration between the people traditionally anchored in psychology, who are typically focused on individual resilience, with people anchored more in traditions of resilience engineering and sociology, who advocate for health system resilience. Resilient performance depends on actions at different system levels from the individual healthcare professionals through to leaders through to macro-level policymakers. It also means that we are emphasizing the collective aspects of resilience—essentially, teams and workgroups that make up ‘the system’.

We propose that a way forward is through strategies integrating these two sets of perspectives so that we focus both on the individuals, and meet their specific needs for recognition and support, and teams, and bolster their collective needs for shared relationships and healthy exchange. Hence, we are advocating for these different academic traditions to join forces to enable a better understanding of the linkages between individual and system resilience. A post-COVID perspective calls for a collaborative approach to make both healthcare systems and the individuals that comprise them move in a direction of resilient performance [4, 8, 10]. This is sorely needed in order to improve the future handling of emerging risks in complex adaptive systems.

Such strategies for actions to move us forward should include ‘research’ efforts to identify and model resilience mechanisms in the interface between individuals and systems; ‘regulatory’ efforts to increase leeway for understanding workarounds and practice improvement based on team’s and individuals’ professional experience; ‘relational leadership’ efforts promoting working environments with sustainable work–life balance tailor-made for individuals’ needs and motivation; ‘health system’ efforts to identify and de-implement bureaucratic procedures currently contributing to burnout; and ‘cross-level collaborative learning’ efforts integrating multidisciplinary competences of professionals, researchers, and policymakers to align work as imagined and work as done in healthcare—as this is currently out of balance.

Conclusion

We recommend that policymakers, leaders, and frontline staff recognize that they have two sets of needs—encapsulated in the ‘I’ and the ‘we’. Both have to be nurtured and valued if we are to encourage resilient individuals, collectives, and systems to handle the next pandemic—or indeed, any future crisis.

References

Author notes