Resilience Culture in the Healthcare Team During COVID-19

Abstract Background: Resilience commonly refers to the ability of an individual or organization to continue to maintain routine, normal, function despite sudden disruptions. Purpose: The purpose of this dissertation research was to provide a deeper understanding of healthcare team resilience. The goal of this research dissertation was to investigate how resilience manifested itself in the healthcare team during the COVID-19 pandemic. AIM 1: What is the concept of resilience in healthcare teams? AIM 2: Identify the barriers and facilitators of healthcare team resilience during the COVID-19 pandemic. AIM 3: Describe how the pandemic influenced healthcare team decision making. Methods: In the first manuscript we performed a comprehensive systematic analysis that delves into the concept of healthcare team resilience in the literature. Based on these results, in the second manuscript the authors utilized an adapted model developed by the research team that frames the healthcare team as a cohesive and aware entity, rather than merely a group of individuals or a subset of personnel within a healthcare system. Finally, the third manuscript uses this adapted model to present research findings from interviews on resilience culture, based on a thematic analysis. Findings: In chapter 2, we found 41 distinct definitions of the concept, with three defining attributes: 1) resilience is triggered by an a priori disruptive event that serves as a catalyst activating the healthcare team\u27s latent potential; 2) this potential leads to the actualization of skills and abilities that enable the team to respond to the disruption in an adaptive manner; 3) the team’s adaptive response enables them to continue executing responsibilities in the face of the disruption. This contributed to AIM 1 by describing the concept of resilience in healthcare teams during COVID-19. The concept analysis brought to light a significant disparity arising from the prevailing literature primarily emphasizing individual resilience as a lens to understand healthcare team resilience, thus potentially obscuring any hidden aspects of resilience within the healthcare team. This discrepancy underscored the necessity to develop a comprehensive model to explore healthcare team resilience during COVID-19 that acknowledges the healthcare team as a singular cognizant entity and not an individual or group of individuals. In chapter 3, we found by integrating knowledge and principles from the domains of resilience engineering, systems engineering, patient safety, and naturalistic decision- making we could create a framework by which AIM 2 and AIM 3 could be addressed. An adapted model was created. The exploration of the barriers and facilitators of resilience and the impact of COVID-19 on the decision-making processes in healthcare teams could be thoroughly explored using the adapted model. A qualitative descriptive study was conducted in 2021 and data were analyzed using reflexive thematic analysis. Chapter 4 presents the findings of this study related to AIM 2 and AIM 3. The study utilized the adapted model as a guide for the interview questions. The author developed the interview questions, which were reviewed and approved by faculty mentors. The author interviewed (N=22) interprofessional healthcare participants who worked during the COVID-19 pandemic. A thematic analysis of the interview data resulted in the identification of five themes related to resilience in the healthcare team during COVID-19: working in a pressure cooker; healthcare team cohesion; applying past lessons to current challenges; knowledge gaps, and altruistic behaviors. The evidence indicates that the pressures form working during COVID-19 and gaps in explicit knowledge, negatively influenced adaptive behaviors to maintain healthcare team resilience. Team cohesion, tacit knowledge and altruistic behaviors positively influenced adaptive behaviors and decision making. Conclusion: This compendium presents the exploration of resilience within healthcare teams amidst the challenges posed by the COVID-19 pandemic. The literature review revealed that the conventional approach to understanding the concept and measuring healthcare team resilience primarily focused on individual resilience. However, this research recognized the need for an adapted model that recognizes the healthcare team as a cohesive and cognizant entity to identify barriers and facilitators of resilience that may be otherwise obscured when solely emphasizing the resilience of individuals, or specific groups. Through a reflexive thematic analysis, several significant findings were identified regarding the impact of the COVID-19 pandemic on the healthcare team: 1) Emotionality played a crucial role in influencing adaptive behaviors, encompassing emotions such as fear, stress, anxiety, and frustration; 2) Drawing upon their tacit knowledge gained from prior experiences, the healthcare team demonstrated the capacity to anticipate and effectively respond to the crisis despite their lack of explicit knowledge, and 3) The solidarity and camaraderie within the healthcare team not only bolstered their overall functionality but also facilitated unified decision-making processes

Resilient health care: a systematic review of conceptualisations, study methods and factors that develop resilience

Background Traditional approaches to safety management in health care have focused primarily on counting errors and understanding how things go wrong. Resilient Health Care (RHC) provides an alternative complementary perspective of learning from incidents and understanding how, most of the time, work is safe. The aim of this review was to identify how RHC is conceptualised, described and interpreted in the published literature, to describe the methods used to study RHC, and to identify factors that develop RHC. Methods Electronic searches of PubMed, Scopus and Cochrane databases were performed to identify relevant peer-reviewed studies, and a hand search undertaken for studies published in books that explained how RHC as a concept has been interpreted, what methods have been used to study it, and what factors have been important to its development. Studies were evaluated independently by two researchers. Data was synthesised using a thematic approach. Results Thirty-six studies were included; they shared similar descriptions of RHC which was the ability to adjust its functioning prior to, during, or following events and thereby sustain required operations under both expected and unexpected conditions. Qualitative methods were mainly used to study RHC. Two types of data sources have been used: direct (e.g. focus groups and surveys) and indirect (e.g. observations and simulations) data sources. Most of the tools for studying RHC were developed based on predefined resilient constructs and have been categorised into three categories: performance variability and Work As Done, cornerstone capabilities for resilience, and integration with other safety management paradigms. Tools for studying RHC currently exist but have yet to be fully implemented. Effective team relationships, trade-offs and health care ‘resilience’ training of health care professionals were factors used to develop RHC. Conclusions Although there was consistency in the conceptualisation of RHC, methods used to study and the factors used to develop it, several questions remain to be answered before a gold standard strategy for studying RHC can confidently be identified. These include operationalising RHC assessment methods in multi-level and diverse settings and developing, testing and evaluating interventions to address the wider safety implications of RHC amidst organisational and institutional change

Symposium on Disaster Resilience and Built Environment Education: Celebrating Project Successes: Book of Abstracts

Among many communities in the EU and beyond, disasters pose significant concerns and challenges. With growing population and infrastructures, the world’s exposure to disaster related hazards is increasing. In addition to loss of life, disasters greatly hamper the social-economic capacity of the member countries and also of the union as a whole. Swiss Re’s latest sigma report (2014) highlights the 308 disaster events in 2013, of which 150 were natural catastrophes and 158 man-made. Almost 26,000 people lost their lives or went missing in the disasters. Europe suffered the two most expensive natural disasters in insurance terms. The first was the massive flooding in Central and Eastern Europe in May and June, after four days of heavy rain that caused large-scale damage across Germany, the Czech Republic, Hungary and Poland. It led to $4.1 billion in paid claims on$16.5 billion in economic losses. The second was the hailstorm that hit Germany and France in late July, causing $3.8 billion in insurance payments on$4.8 billion in economic losses. Most of those claims came from heavily populated areas of Germany. Altogether, Europe had economic losses worth $33 billion for$15 billion in insurance payouts. For the first time in history the world has experienced three consecutive years where annual economic losses have exceeded $100 billio

Exploring Resilience

Resilience has become an important topic on the safety research agenda and in organizational practice. Most empirical work on resilience has been descriptive, identifying characteristics of work and organizing activity which allow organizations to cope with unexpected situations. Fewer studies have developed testable models and theories that can be used to support interventions aiming to increase resilience and improve safety. In addition, the absent integration of different system levels from individuals, teams, organizations, regulatory bodies, and policy level in theory and practice imply that mechanisms through which resilience is linked across complex systems are not yet well understood. Scientific efforts have been made to develop constructs and models that present relationships; however, these cannot be characterized as sufficient for theory building. There is a need for taking a broader look at resilience practices as a foundation for developing a theoretical framework that can help improve safety in complex systems. This book does not advocate for one definition or one field of research when talking about resilience; it does not assume that the use of resilience concepts is necessarily positive for safety. We encourage a broad approach, seeking inspiration across different scientific and practical domains for the purpose of further developing resilience at a theoretical and an operational level of relevance for different high-risk industries. The aim of the book is twofold: 1. To explore different approaches for operationalization of resilience across scientific disciplines and system levels. 2. To create a theoretical foundation for a resilience framework across scientific disciplines and system levels. By presenting chapters from leading international authors representing different research disciplines and practical fields we develop suggestions and inspiration for the research community and practitioners in high-risk industries. This book is Open Access under a CC-BY licence. ; Explores different approaches for operationalization of resilience across scientific disciplines and system levels Creates a theoretical foundation for a resilience framework across scientific disciplines and system levels Develops suggestions and inspiration for the research community and practitioners in high-risk industries Presents chapters from leading international authors representing different research disciplines and practical field

Development of Disaster Resilient Coastal Communities to Enhance Economic Development and Social Welfare: Book of Abstracts

Coast at risk – the importance of risk knowledge Coastal communities all over the world are under severe pressure resulting from planned and unplanned development, population growth and human induced vulnerability, coastal hazards with increasing frequency and magnitude and impacts of global climate change. These unprecedented changes have increased the level of risk of such coastal communities from a wide range of coastal hazards arising from natural phenomena and human induced activities. In this respect the assessment and management of risk for coastal hazards plays a vital role for safety of human lives, conservation of ecosystems and protection of the built environment. It leads to the development of disaster resilient communities to enhance economic development and social welfare. Risk assessment is one of the fundamental first steps towards planning, improving and implementing effective disaster risk reduction policies and programmes. One has to know and identify risks if they are to be effectively reduced and contained. There is a need to develop simplified approaches to risk assessment to convince a wider stakeholder base that investing in risk assessments pay. Such approaches bring together so many members of civil society leading the efforts to make disaster risk reduction everyone’s business

The Use of Cognitive Work Analysis Method in Health-Care

Import 23/08/2017Cílem této bakalářské práce je zjistit, zda je využití Analýzy kognitivní práce (CWA) ve zdravotnickém sektoru přínosné, kde byla CWA využita v praxi a jaký byl přínos. Zdravotnický systém je velmi složité prostředí plné technologií, vzdělaných odborníků a stresových situací, které mohou přispívat ke vzniku lékařských chyb. Ty jsou pro pacienty nebezpečné, v extrémních případech mohou vést až ke smrti nebo trvalým následkům pacienta, a i když nastalá chyba není závažná, bývá spojena s mnoha dalšími náklady. Mnohým z těchto chyb lze předcházet, a proto je zde snaha nastavit opatření pro jejich předcházení. Pro zjišťování aktivních a latentních chyb v informačním systému, zdravotnické organizaci, regulačních orgánech, lidského faktoru nebo mnoha jiných úrovních je běžné používat spíše popisy než analýzy. Tento přístup však není přínosný tolik, jako provedení CWA, která hloubkově analyzuje stávající systém. CWA je konceptuální rámec zaměřený více na systém než na jeho uživatele, a prostřednictvím několika úrovní analýzy dokáže v sociotechnickém systému objevit problémy, což může být využito pro návrh zlepšení zkoumaného systému.In this thesis the goal is to find out if the Cognitive Work Analysis (CWA) is useful in the healthcare sector, where it´s been used and how was the reset. The healthcare system is very complex environment full of technologies, well educated proffessionals and stressfull situations, which may contribute to cause a medical error. Medical errors are dangerous for patients, in extreme cases they can lead to a death or permanent consequences, and even if the occured error is not so serious, there are many connected costs. Many of these errors are preventable so there is an effort to set precautions to avoid them. To find active and latent errors in the information system, healthcare organization, regulatory authorities, human factor or many others is used to create descriptions more than analysis. This approach is not as useful as using Cognitive Work Analysis, which deeply analyses the existing systém. CWA is a conceptual framework focused on system more than on it´s users and, through several levels of analysis can find problems in a socio-technical system, that can be used to design improvements to the investigated system.450 - Katedra kybernetiky a biomedicínského inženýrstvídobř

Toward General Principles for Resilience Engineering

Maintaining the performance of infrastructure‐dependent systems in the face of surprises and unknowable risks is a grand challenge. Addressing this issue requires a better understanding of enabling conditions or principles that promote system resilience in a universal way. In this study, a set of such principles is interpreted as a group of interrelated conditions or organizational qualities that, taken together, engender system resilience. The field of resilience engineering identifies basic system or organizational qualities (e.g., abilities for learning) that are associated with enhanced general resilience and has packaged them into a set of principles that should be fostered. However, supporting conditions that give rise to such first‐order system qualities remain elusive in the field. An integrative understanding of how such conditions co‐occur and fit together to bring about resilience, therefore, has been less clear. This article contributes to addressing this gap by identifying a potentially more comprehensive set of principles for building general resilience in infrastructure‐dependent systems. In approaching this aim, we organize scattered notions from across the literature. To reflect the partly self‐organizing nature of infrastructure‐dependent systems, we compare and synthesize two lines of research on resilience: resilience engineering and social‐ecological system resilience. Although some of the principles discussed within the two fields overlap, there are some nuanced differences. By comparing and synthesizing the knowledge developed in them, we recommend an updated set of resilience‐enhancing principles for infrastructure‐dependent systems. In addition to proposing an expanded list of principles, we illustrate how these principles can co‐occur and their interdependencies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156462/2/risa13494_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156462/1/risa13494.pd

Contribuições para gestão da complexidade organizacional em unidades de terapia intensiva

É notória a importância de estudos sobre gestão em serviços de saúde, dada a complexidade destes sistemas e a crescente demanda por serviços mais eficientes e de melhor qualidade. O tema central da tese está voltado a gestão de sistemas sócio-técnicos complexos (SSTC), em especial a abordagem de um conjunto de diretrizes de gestão de SSTC em Unidades de Terapia Intensiva (UTI). Assim, a questão de pesquisa norteadora da tese é “como as diretrizes de gestão de SSTC podem ser compreendidas em Unidade de Terapia Intensiva Adulta, tanto em situações normais quanto em situações de crise”? Para tanto, o objetivo principal da tese identificar e classificar práticas para lidar com a complexidade em UTI Adulta, em situações normais e de crise. Os objetivos específicos desdobram-se em: (i) identificar o quanto os projetos de melhoria de processos nas UTI Adulta, relatados na literatura, estão alinhados às diretrizes de gestão em SSTC; (ii) propor uma abordagem para investigação de eventos com resultados desejados em SSTC, a qual inclua a análise do papel das diretrizes de gestão de SSTC; (iii) identificar e classificar as práticas de resiliência organizacional em UTIs adultas brasileiras durante a pandemia de COVID-19, bem como lições aprendidas sob a perspectiva das diretrizes de gestão de complexidade. Como conclusão dos resultados da tese, as diretrizes foram consideradas totalmente aplicáveis e intuitivas, ao invés de adotadas explicitamente pelas intervenções. As abordagens realizadas na literatura apontaram a diretriz “projetar folgas” como sendo a mais utilizada nas ações provenientes da resiliência. Em decorrência destes artefatos ao realizar um estudo de caso mais aprofundado quanto a utilização das diretrizes em UTI’s utilizando-se do FRAM, os recursos da diretriz projetos de folga foi um meio de responder às variabilidades provindas do ambiente em pesquisa, seja de modo oportunista enquanto o evento se desenvolve (por exemplo, emprestar cânulas da unidade cirúrgica) ou com base em recursos integrados com antecedência, mesmo que isso não seja amplamente conhecido por todos os funcionários (por exemplo, o uso de equipamentos VMI em VNI). Nestes moldes, utilizando as cinco diretrizes de complexidade como uma estrutura analítica, esta tese contribuiu também, estudos que abordam como é a resiliência nas UTIs durante a pandemia. Embora 70 resiliências práticas ou condições foram identificadas, várias delas claramente não se aplicam a todas as complexidades do dia (por exemplo, adição de vários novos leitos a curto prazo). Deste modo, os resultados apontaram para diferentes manifestações das diretrizes conforme os cenários analisados, bem como para o papel central da diretriz sobre gestão de recursos folga (slack resources) em todos os cenários.The importance of studies on management in health services is notorious, given the complexity of these systems and the growing demand for more efficient and better quality services. The central theme of the thesis is focused on the management of complex sociotechnical systems (SSTC), in particular the approach of a set of SSTC management guidelines in Intensive Care Units (ICU). Thus, the research question guiding the thesis is “how can SSTC management guidelines be understood in the Adult Intensive Care Unit, both in normal situations and in crisis situations”? Therefore, the main objective of the thesis is to identify and classify practices to deal with complexity in Adult ICUs, in normal and crisis situations. The specific objectives are: (i) to identify to what extent the projects for process improvement in Adult ICUs, reported in the literature, are aligned with the management guidelines in SSTC; (ii) propose an approach to investigating events with desired outcomes in SSTC, which includes an analysis of the role of SSTC management guidelines; (iii) identify and classify organizational resilience practices in Brazilian adult ICUs during the COVID-19 pandemic, as well as lessons learned from the perspective of complexity management guidelines. As a conclusion of the thesis results, the guidelines were considered fully applicable and intuitive, rather than explicitly adopted by the interventions. The approaches taken in the literature pointed to the guideline “designing slacks” as being the most used in actions arising from resilience. As a result of these artifacts, when conducting a more in-depth case study on the use of guidelines in ICUs using the FRAM, the resources of the slack projects guideline was a means of responding to the variability arising from the research environment, whether opportunistic or opportunistic while the event unfolds (eg borrowing cannulas from the surgical unit) or based on built-in features in advance, even if this is not widely known to all staff (eg the use of VMI equipment in NIV). Along these lines, using the five complexity guidelines as an analytical framework, this thesis also contributed to studies that address the resilience of ICUs during the pandemic. Although 70 practical resiliences or conditions were identified, several of them clearly do not apply to all of the day's complexities (eg, adding several new beds in the short term). Thus, the results pointed to different manifestations of the guidelines according to the analyzed scenarios, as well as the central role of the guideline on slack resources management in all scenarios

Organisational resilience in UK acute hospitals: an exploratory case study and empirical analysis

Organisational resilience in healthcare is important if hospitals are to recover effectively from unexpected events, such as infection outbreaks and manage successfully the continuous pressure from hospital associated infections. Yet studies of resilience in hospital organisations are rare and organisational resilience theory is insufficiently developed. The aim of this thesis is to examine organisational resilience in UK acute hospitals, through a case study and empirical analysis. The objectives are to investigate what is known about the concept, associated factors and application of organisational resilience to hospitals, to explore theoretically and empirically the two contexts for organisational resilience (expected conditions and unexpected events) and finally to design and test a tool to measure organisational resilience in the context of an unexpected event. A multi-methods approach was adopted to examine organisational resilience. A literature and systematic review were carried out to establish the evidence-base for organisational resilience. These reviews informed two health care studies of organisational resilience; a micro and meso-level case study exploring an unexpected infection outbreak and a macro-level study assessing the system response to infections as continuous stressors on routine practice. The case study informed the design and testing of an organisational resilience questionnaire. The key contributions to the literature were: firstly a novel multidisciplinary resilience questionnaire from which a framework of organisational resilience constructs was developed; secondly, a modest theoretical contribution of an intermediate resilience category within a framework that identifies levels of resilient practice and associated sensemaking characteristics; and thirdly, a positive example of ICT-enabled national surveillance programmes that increased hospitals’ resilience to infection through the enrolment of clinical leaders in self-surveillance. In conclusion, this research has generated novel, empirically-derived theoretical developments to this field of study that facilitate the measurement, application and improved conceptualisation of organisational resilience.Open Acces