A Framework for Resilience Thinking

AbstractThe first step to achieving an understanding of how complex adaptive systems such as enterprises can be made more resilient is to understand what is meant by ‘resilience’. Resilience as a concept has been contextually developed in a wide range of disciplines, providing a variety of resilience concepts of various foci and potential relevance to enterprise systems. This paper demonstrates how the use of systems thinking principles and systems thinking methods have contributed to the development of a research framework for enterprise resilience, by drawing together resilience concepts from multiple disciplines. Soft Systems Methodology is used to draw together viewpoints from fields including ecology, physics, sociology, psychology and disaster management. The incorporation of an enterprise system model enables resilience concepts to be contextualised for enterprises and is used to develop a set of key features of a resilience system, providing a framework to guide further research. Significant contributions are an inclusive theoretical framework for a resilient enterprise and an example of the use of systems thinking methods as a means of organising multi-disciplinary research, including the novel use of Wilson's Enterprise Model in developing the theoretical framework

Identifying seasonal and temporal trends in the pressures experienced by hospitals related to unscheduled care

BACKGROUND: As part of an electronic dashboard operated by Public Health Wales, senior managers at hospitals in Wales report daily 'escalation' scores which reflect management opinion on the pressure a hospital is experiencing and ability to meet ongoing demand with respect to unscheduled care. An analysis was undertaken of escalation scores returned for 18 hospitals in Wales between the years 2006 and 2014 inclusive, with a view to identifying systematic temporal patterns in pressure experienced by hospitals in relation to unscheduled care. METHODS: Exploratory data analysis indicated the presence of within-year cyclicity in average daily scores over all hospitals. In order to quantify this cyclicity, a Generalised Linear Mixed Model was fitted which incorporated a trigonometric function (sine and cosine) to capture within-year change in escalation. In addition, a 7-level categorical day of the week effect was fitted as well as a 3-level categorical Christmas holiday variable based on patterns observed in exploration of the raw data. RESULTS: All of the main effects investigated were found to be statistically significant. Firstly, significant differences emerged in terms of overall pressure reported by individual hospitals. Furthermore, escalation scores were found to vary systematically within-year in a wave-like fashion for all hospitals (but not between hospitals) with the period of highest pressure consistently observed to occur in winter and lowest pressure in summer. In addition to this annual variation, pressure reported by hospitals was also found to be influenced by day of the week (low at weekends, high early in the working week) and especially low over the Christmas period but high immediately afterwards. CONCLUSIONS: Whilst unpredictable to a degree, quantifiable pressure experienced by hospitals can be anticipated according to models incorporating systematic temporal patterns. In the context of finite resources for healthcare services, these findings could optimise staffing schedules and inform resource utilisation

Gender difference and effect of pharmacotherapy: findings from a smoking cessation service

Background: Smoking cessation services are available in England to provide assistance to those wishing to quit smoking. Data from one such service were analysed in order to investigate differences in quit rate between males and females prescribed with different treatments. Methods: A logistic regression model was fitted to the data using the binary response of self-reported quit (failed attempt = 0, successful attempt = 1), validated by Carbon Monoxide (CO) monitoring, 4 weeks after commencing programme. Main effects fitted were: client gender; age; region; the type of advisory sessions; and pharmacotherapy, Nicotine Replacement Therapy (NRT) or Varenicline. A second model was fitted including all main effects plus two-way interactions except region. These models were repeated using 12-week self-reported quit as the outcome. Results: At 4 weeks, all main effects were statistically significant, with males more likely (odds ratio and 95 % CI, females v males = 0.88 [0.79–0.97]), older smokers more likely (adjusted odds ratios [OR] and 95 % confidence interval [CI] respectively for groups 20–29, 30–49, 50–69 and 70+ vs 12–19 age group: 1.79 [1.39–2.31], 2.12 [1.68–2.68], 2.30 [1.80–2. 92] and 2.47 [1.81–3.37] and for overall difference between groups, χ 2 (4) = 53.5, p < 0.001) and clients being treated with Varenicline more likely to have successfully quit than those on NRT (adjusted OR and 95 % CI for Varenicline vs NRT = 1.41 [1.21–1.64]). Statistically significant interactions were observed between (i) gender and type of counselling, and (ii) age and type of counselling. Similar results were seen in relation to main effects at 12 weeks except that type of counselling was non-significant. The only significant interaction at this stage was between gender and pharmacotherapy (adjusted OR and 95 % CI for females using Varenicline versus all other groups = 1.43 [1.06–1.94]). Conclusion: Gender and treatment options were identified as predictors of abstinence at both 4 and 12 weeks after quitting smoking. Furthermore, interactions were observed between gender and (i) type of counselling received (ii) pharmacotherapy. In particular, the quit rate in women at 12 weeks was significantly improved in conjunction with Varenicline use. These findings have implications for service delivery

Perceptions of gender equity and markers of achievement in a National Institute for Health Research Biomedical Research Centre : a qualitative study.

Background: The need to improve gender equity (GE) in academic medicine is well documented. Biomedical Research Centres (BRCs), partnerships between leading National Health Service (NHS) organizations and universities in England, conduct world-class translational research funded by the National Institute for Health and Care Research (NIHR). In 2011, eligibility for BRC funding was restricted to universities demonstrating sustained GE success recognized by the Athena SWAN Charter for Women in Science Silver awards. Despite this structural change, GE research in BRC settings is underdeveloped, yet critical to the acceleration of women’s advancement and leadership. To explore both women’s and men’s perceptions of GE and current markers of achievement in a BRC setting. Methods: Thematic analysis of data from two research projects: 53 GE survey respondents’ free-text comments (34 women, 16 men), and 16 semi-structured interviews with women affiliated to the NIHR Oxford BRC. Results: Four major themes emerged from the analysis: perceptions of the Athena SWAN Charter for Women in Science (GE policy); views on monitoring GE in BRCs; views on current markers of achievement in academia and GE; and recommendations for actions to improve GE in BRC settings. Monitoring of GE in BRCs was deemed to be important, but complex. Participants felt that current markers of achievement were not equitable to women, as they did not take contextual factors into account such as maternity leave and caring responsibilities. BRC-specific organizational policies and metrics are needed in order to monitor and catalyse GE. Conclusions: Markers of achievement for monitoring GE in BRCs should consider contextual factors specific to BRCs and women’s career progression and professional advancement. GE markers of achievement should be complemented with broader aspects of equality, diversity and inclusion

Factors moderating the relative effectiveness of varenicline and nicotine replacement therapy in clients using smoking cessation services

AIMS: To assess how far the greater effectiveness of varenicline over nicotine replacement therapy (NRT) is moderated by characteristics of the smokers or setting in clinical practice. DESIGN: We used observational data from 22,472 treatment episodes between 2013 and 2016 from smoking cessation services in England to assess whether differences between varenicline and NRT were moderated by a set of smoker and setting characteristics: these included level of social deprivation, age, gender, ethnic group, nicotine dependence, and treatment context. From the above, 15,640 episodes were analysed in relation to 4-week quit and 14,273 episodes at 12 weeks. All two-way interactions involving pharmacotherapy were fitted in addition to the main effects and a parsimonious model identified using a backwards stepwise selection procedure. SETTING: England PARTICIPANTS: Clients of smoking cessation service (number of individuals in 4-week quit analysis = 15,640). MEASUREMENTS: 4-week Carbon monoxide - validated (primary outcome) and 12-week self-reported (secondary outcome) quit success/failure. FINDINGS: At both follow-up points, varenicline was associated with higher success rates overall (p<0.001 at both 4 and 12 weeks; adjusted odds ratio varenicline vs NRT = 1.82 [95%CI 1.61, 2.06] and 2.58 [95%CI 2.26, 2.94] at 4 and 12 weeks respectively). At 12 weeks, the relative benefits of varenicline were found to be influenced by the setting in which advice was provided (p<0.001 for interaction pharmacotherapy × setting; adjusted OR for varenicline × pharmacy setting = 0.53, [95% CI 0.42, 0.69] and for varenicline × General Practice setting = 0.79, [95% CI 0.64, 0.98] against a baseline of 1 for varenicline × community setting). The same trends were evident at 4 weeks but this did not translate to statistical significance. There was inconclusive evidence for moderating effects of other variables. CONCLUSIONS: Varenicline use is associated with higher smoking cessation rates than nicotine replacement therapy in routine clinical practice, irrespective of a wide range of smoker characteristics, but the difference is less in certain intervention settings, most notably pharmacy but also GP practice, compared with community setting

A global call for action to include gender in research impact assessment

Global investment in biomedical research has grown significantly over the last decades, reaching approximately a quarter of a trillion US dollars in 2010. However, not all of this investment is distributed evenly by gender. It follows, arguably, that scarce research resources may not be optimally invested (by either not supporting the best science or by failing to investigate topics that benefit women and men equitably). Women across the world tend to be significantly underrepresented in research both as researchers and research participants, receive less research funding, and appear less frequently than men as authors on research publications. There is also some evidence that women are relatively disadvantaged as the beneficiaries of research, in terms of its health, societal, and economic impacts. Historical gender biases may have created a path dependency that means that the research system and the impacts of research are biased towards male researchers and male beneficiaries, making it inherently difficult (though not impossible) to eliminate gender bias. In this commentary, we – a group of scholars and practitioners from Africa, America, Asia, and Europe– argue that gender-sensitive research impact assessment could become a force for good in moving science policy and practice towards gender equity. Research impact assessment is the multidisciplinary field of scientific inquiry that examines the research process to maximise scientific, societal, and economic returns on investment in research. It encompasses many theoretical and methodological approaches that can be used to investigate gender bias and recommend actions for change to maximise research impact. We offer a set of recommendations to research funders, research institutions, and research evaluators who conduct impact assessment on how to include and strengthen analysis of gender equity in research impact assessment and issue a global call for action

Rapid research response to the COVID-19 pandemic: perspectives from a National Institute for Health Biomedical Research Centre

With over 5 million COVID-19 deaths at the time of writing, the response of research leaders was and is critical to developing treatments to control the global pandemic. As clinical research leaders urgently repurposed existing research programmes and resources towards the COVID-19 pandemic, there is an opportunity to reflect on practices observed in Biomedical Research Centre (BRC) settings. BRCs are partnerships between leading National Health Service organizations and universities in England conducting translational research for patient benefit funded by the National Institute for Health Research (NIHR). Oxford BRC-supported researchers have led the rapid set-up of numerous COVID-19 research studies at record speed with global impact. However, the specific contribution of BRCs to the COVID-19 pandemic in the literature is sparse. Firstly, we reflect on the strategic work of clinical research leaders, creating resilient NIHR research infrastructure to facilitate rapid COVID-19 research. Secondly, we discuss how COVID-19 rapid research exemplars supported by Oxford BRC illustrate “capacity”, “readiness” and “capability” at an organizational and individual level to respond to the global pandemic. Rapid response research in turbulent environments requires strategic organizational leadership to create resilient infrastructure and resources. The rapid research exemplars from the Oxford BRC illustrate capability and capacity at an organizational and individual level in a dynamic environment to respond during the COVID-19 public health challenge. This response was underpinned by swift adaptation and repurposing of existing research resources and expertise by the Oxford BRC to deliver rapid research to address different aspects of COVID-19

Understanding the Athena SWAN award scheme for gender equality as a complex social intervention in a complex system: analysis of Silver award action plans in a comparative European perspective

Background: Given the complex mix of structural, cultural and institutional factors that produce barriers for women in science, an equally complex intervention is required to understand and address them. The Athena SWAN Award Scheme for Gender Equality has become a widespread means to address barriers for women’s advancement and leadership in the United Kingdom, Ireland, Australia, the United States of America and Canada, while the European Commission is exploring the introduction of a similar award scheme across Europe. Methods: This study analyses the design and implementation of 16 departmental Athena SWAN Silver Action Plans in Medical Sciences at one of the world’s leading universities in Oxford, United Kingdom. Data pertaining to the design and implementation of gender equality interventions were extracted from the action plans, analysed thematically, coded using categories from the 2015 Athena SWAN Charter Awards Handbook and synthesised against a typology of gender equality interventions in the European Research Area. The results were further analysed against the complexity research literature framework, where research organisations are perceived as dynamic systems that adapt, interact and co-evolve with other systems. Results: Athena SWAN is a complex contextually embedded system of action planning within the context of universities. It depends on a multitude of contextual variables that relate in complex, non-linear ways and dynamically adapt to constantly moving targets and new emergent conditions. Athena SWAN Silver Action Plans conform to the key considerations of complexity – (1) multiple actions and areas of intervention with a focus on the complex system being embedded in local dynamics, (2) the non-linearity of interventions and the constantly emerging conditions, and (3) impact in terms of contribution to change, improved conditions to foster change and the increased probability that change can occur. Conclusions: To enact effective sustainable structural and cultural change for gender equality, it is necessary to acknowledge and operationalise complexity as a frame of reference. Athena SWAN is the single most comprehensive and systemic gender equality scheme in Europe. It can be further strengthened by promoting the integration of sex and gender analysis in research and education. Gender equality policies in the wider European Research Area can benefit from exploring Athena SWAN’s contextually embedded systemic approach to dynamic action planning and inclusive focus on all genders and categories of staff and students.</p

Digital technology interventions to reduce loneliness in adults: A systematic review

Background: Loneliness is an emerging public health issue and its burden is increasing in developed countries. Loneliness is associated with social, emotional, physical and mental health issues. Tackling loneliness is important to reduce its adverse impacts on individuals with loneliness and their families. Various digital technology-based interventions are used to tackle loneliness. Assessing the effectiveness of these interventions is important from the health, social care and public health perspectives. Aim: To undertake a systematic review of published primary research on digital technology interventions to reduce loneliness in adults. Methods: Databases searched: PubMed, Medline, CINAHL, EMBASE and Web of Science. Inclusion criteria: empirical research articles involving the application of digital technology interventions for tackling loneliness; participants aged ≥18 years and publication in the English Language from 1 January 2010 to 14 January 2019. Two researchers systematically screened articles and data were extracted from shortlisted articles applying a population, intervention(s), comparator(s) and outcome(s) (PICO) framework. Results: We selected 14 studies mostly from developed countries such as the US (n = 5) and Sweden (n = 3). We found a wide variation in the sample sizes (range 5-591 participants), participants’ age (range 32-90, average 66.4-82.5 years) and the follow-up measurement period (6 weeks-12 months) in the selected studies. Digital technology interventions tested were Internet-based social activities and networking through video or phone calls (using Skype (n = 6) and Facebook (n = 2)), communicating via emails (n = 2). Most of the studies used the UCLA loneliness scale (n = 9) and reported reductions in loneliness in follow-up measurements compared to baseline measurements. Conclusions: Digital interventions are associated with reduced loneliness in adults; however, further studies such as clinical trials involving larger sample sizes are needed. Key messages: - Loneliness is associated with social, emotional, physical and mental health problems and the burden of loneliness is increasing, especially in developed countries. - Digital technology interventions help in reducing loneliness in adults but further research including clinical trials involving large sample sizes and longer follow-up periods are required.</p

Identifying seasonal and temporal trends in the pressures experienced by hospitals related to unscheduled care.

Background As part of an electronic dashboard operated by Public Health Wales, senior managers at hospitals in Wales report daily “escalation” scores which reflect management opinion on the pressure a hospital is experiencing and ability to meet ongoing demand with respect to unscheduled care. An analysis was undertaken of escalation scores returned for 18 hospitals in Wales between the years 2006 and 2014 inclusive, with a view to identifying systematic temporal patterns in pressure experienced by hospitals in relation to unscheduled care. Methods Exploratory data analysis indicated the presence of within-year cyclicity in average daily scores over all hospitals. In order to quantify this cyclicity, a Generalised Linear Mixed Model was fitted which incorporated a trigonometric function (sine and cosine) to capture within-year change in escalation. In addition, a 7-level categorical day of the week effect was fitted as well as a 3-level categorical Christmas holiday variable based on patterns observed in exploration of the raw data. Results All of the main effects investigated were found to be statistically significant. Firstly, significant differences emerged in terms of overall pressure reported by individual hospitals. Furthermore, escalation scores were found to vary systematically within-year in a wave-like fashion for all hospitals (but not between hospitals) with the period of highest pressure consistently observed to occur in winter and lowest pressure in summer. In addition to this annual variation, pressure reported by hospitals was also found to be influenced by day of the week (low at weekends, high early in the working week) and especially low over the Christmas period but high immediately afterwards. Conclusions Whilst unpredictable to a degree, quantifiable pressure experienced by hospitals can be anticipated according to models incorporating systematic temporal patterns. In the context of finite resources for healthcare services, these findings could optimise staffing schedules and inform resource utilisation.</p