The concept of resilient health systems (multiple reviews)
What is this? Maintaining an effectively functioning health service and delivering services to the community are core components of a resilient health system, in particular if it is to support effective health service provision during times of humanitarian crises, disasters and other health emergencies. This summary presents information about the concept of resilient health systems from five relevant systematic reviews that were published in 2022 or 2023.
What was found: Overall, the studies included in these reviews emphasize the need for policies and preparedness plans to support hospital resilience and effective health service delivery during health emergencies such as economic crises, terrorist attacks and disasters.
The Foroughi review that was published in BMC Public Health (search done in November 2020) outlined five phases of health system resilience aimed to support health systems in reaching their goals: (1) anticipation, (2) preparation, (3) response, (4) recovery, and (5) growth. The authors of the review stated that preparedness and response are dependent on differing contexts (such as the emergency situation in each country).
The Khalil review (search done in 2021) found that strengthening hospital resilience involves both hard and soft components of resilience. Hard resilience involves both structural and non-structural aspects of the hospital (the space). Soft resilience involves all other aspects, including staff, community engagement, information, and systems. Both are essential to an optimally functioning, resilient hospital that entrenches the 6S (space, staff, stuff, systems, strategies, and services) and the four capacities (absorptive, adaptive, transformative, and learning).
The Foroughi review that was published in BMC Health Services Research (research up to March 2022) stated that the focus of countries was on shorter-term policies that aimed to deliver necessary care during times of economic crises, prioritizing the safety of patients and quality of service delivery, over cost-saving methods.
The Schorscher review (research up to 2018) found that preparedness lessons from terrorist attacks include effective triage and treatment, and psychiatric support on-site regardless of the country, terrorist attack and the casualties reported.
The Tan review (research up to November 2022) presented an overview of healthcare resilience, consolidating information on this topic across a range of disciplines and paradigms, underscoring its complexity, and creating a guide for healthcare workers and system managers to understand the operational environments of each other. They also emphasized lessons learned from the global impact of the COVID-19 pandemic on healthcare systems.
What are the reviews:
Citation: Foroughi Z, Ebrahimi P, Aryankhesal A, et al. Toward a theory-led meta-framework for implementing health system resilience analysis studies: a systematic review and critical interpretive synthesis. BMC Public Health. 2022;22:287.
Language: Abstract and full text available in EN.
Free to view: Yes.
Funding source: Iran University of Medical Sciences.
The authors searched for studies that provided theories and frameworks for resilient health systems in humanitarian crises. They restricted their searches to articles published in English and did the search in November 2020. They included 43 studies.
Citation: Khalil M, Ravaghi H, Samhouri D, et al. What is “hospital resilience”? A scoping review on conceptualization, operationalization, and evaluation. Frontiers in Public Health. 2022;10:1009400.
Language: Abstract and full text available in EN.
Free to view: Yes.
Funding source: Nothing noted.
The authors searched for studies on hospital resilience, exploring its conceptualization, operationalization, and evaluation. They restricted their searches to articles published in English, Arabic, and French since 2011, and did the search in 2021. They included 38 studies.
Citation: Foroughi Z, Ebrahimi P, Aryankhesal A, et al. Hospitals during economic crisis: a systematic review based on resilience system capacities framework. BMC Health Services Research. 2022;22:977.
Language: Abstract and full text available in EN.
Free to view: Yes.
Funding source: School of Health Management and Information Sciences, Iran University of Medical Sciences.
The authors searched for studies that assessed hospitals policy solutions during economic crises. They restricted their searches to articles published in English before 1 March 2022. They included 78 studies.
Citation: Schorscher N, Kippnich M, Meybohm P, et al. Lessons learned from terror attacks: thematic priorities and development since 2001 – results from a systematic review. European Journal of Trauma and Emergency Surgery. 2022;48:2613-38.
Language: Abstract and full text available in EN.
Free to view: Yes.
Funding source: The authors reported that they had no external funding for this review.
The authors searched for studies that assessed lessons learned from terrorist attacks that took place between 2001 and 2017, in the context of hospital emergency preparedness. They restricted their searches to articles published in English and included 68 articles.
Citation: Tan MZY, Prager G, McClelland A, et al. Healthcare resilience: a meta-narrative systematic review and synthesis of reviews. BMJ Open. 2023;13:e072136.
Registration: This review was prospectively registered on PROSPERO (CRD42022314729).
Language: Abstract and full text available in EN.
Free to view: Yes.
Funding source: The authors of the review reported no external funding for this review.
The authors searched for studies and papers that defined and measured concepts of healthcare resilience. They restricted their searches to articles published in English from 2008 to November 2022 and did their final search November 2022. They included 45 studies.
This summary was prepared by Yasmeen Saeed and Jawaria Karim, checked by Cristián Mansilla and Ana Pizarro, and finalized by Mike Clarke.