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6 research outputs found

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

Author: Bal Roland
Comes Tina
Copeland Samantha
Fecondo Federica
Hinrichs-Krapels Saba
Santizo Esteban Ralon
Publication venue
Publication date: 24/11/2023
Field of study

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.</p

EUR Research Repository

Hospital-based Health Technology Management: Analysing the Procurement Process from a Network Perspective

Author: Fecondo Federica (author)
Publication venue
Publication date: 14/07/2021
Field of study

From a practical perspective, the UK, like so many other countries, is struggling to have a complete HTM implementation. The sources suggest that British health care managers face financial and personnel availability pressures, and this makes it difficult to follow the instructions provided by the various organizations for the implementation of HTM activities including procurement. It is worth mentioning that the guidelines and decision-making frameworks provided by national organizations and various authors, mainly follow a project-based approach, characterized by linear HTM implementation/decision-making, and usually focusing on purely technical and legislative aspects of HTM. However, the health care sector, as well as procurement of medical devices, is characterised by complexity, constitutes an interconnected network of actors, parties and policies, and it is mainly context-dependent. Therefore, in addition to technical and legislative advice, it would be sensible to train health care managers in recognising the presence of internal networking relationships, and how to negotiate with all the actors involved in the different procurement, or more in general HTM, activities. From an academic perspective, almost all the articles analysing procurement aim to identify potential challenges, mainly related to financial and technical concerns, and subsequently provide decision-making frameworks to indicate the right path to follow when deciding which device to purchase. Very few articles perform a satisfactory analysis of the main actors involved during the procurement process and their responsibilities. Moreover, no attempts have been made to look at hospital-based procurement from a networking perspective and apply ‘Management in Networks’ theories and strategy to understand and improve it. Considering the aforementioned practical and academic issues, this study wants to investigate how hospital-based procurement could be analysed under the network point of view. Therefore, this dissertation wants to propose a new way of looking at hospital-based procurement, taking into account the presence of potential internal networks and interactions proper of an interconnected world. More specifically, this thesis project aims to provide a satisfactory description of the main procurement activities performed within the hospital, inform about who are the actors involved, how they interact, how/if they follow specif guidelines, and the main challenges encountered. Once the author will arrive at a satisfactory description of hospital-based procurement, she will analyse this last one under the paradigms of an interconnected world, explaining how the various networking strategies and paradigms can be used to understand and analyse hospital-based procurement. Finally, this research will identify factors that could be addressed by health care decision-makers to manage technology successfully. In particular, this study intends to identify valuable strategies for technology management decision-making and activities, to detect which one should be addressed by hospitals, and to establish technology management system priorities for health care managers and clinical engineers.Management of Technology (MoT

TU Delft Repository