Resilience in Healthcare (RiH)

Healthcare quality is a highly prioritised global health issue that involves patient safety, continuity of care, patient-centeredness, and clinical outcome. The Resilience in Healthcare (RiH) project seek to reform research on healthcare quality. Traditionally, healthcare quality research has been conducted in silos (i.e. mono-disciplinary) and significant advancements have yet to be made. Furthermore, traditional research approaches rely on a range of standardised 'find and fix' methods that we claim to be inadequate to fully understand healthcare quality. By using a collaborative approach together with patients, carers, clinicians, and other stakeholders the RiH project aims at becoming an incubator for knowledge through the development of a Resilience in Healthcare framework. Resilience is an innovative concept demonstrating the ability of organisations and individuals to anticipate, monitor, respond to and learn from variability and disruptions. This involves using internal (e.g. sensemaking, experience) and external (e.g. colleagues, networks, regulation) resources to adapt everyday functioning, to successfully resolve challenging conditions to continue to operate with a sound level of quality. In contrast to traditional research on healthcare quality, which tends to focus on healthcare failures, resilience research is interested in examining the overwhelming majority of healthcare processes with successful outcomes to determine how high quality is generated across healthcare systems, organisations, and in everyday clinical work. The RiH project has five interconnected activities: RiH theoretical framework (WP1), Patient and stakeholder involvement (WP2), Empirical studies of resilience in different Norwegian healthcare settings (WP3), Cross-country comparative resilience studies (WP4), and Collaborative learning framework (WP5). The RiH Project has developed a conceptual framework for resilience and positioned the project within the resilience in healthcare literature. Moreover, the project has developed a Resilience Trigger Tool and an analytical framework that supports the research and conceptualizaton of key mechanisms in resilience. This relates to adaptive capacity as the main concept in addition to system levels, collaborative learning, patient and stakeholder involvement in different healthcare settings. Based on the resilience trigger tool and a screening tool the project has screened over 50 ongoing or completed projects. From the overall sample 25 projected were selected to be included. From these project there have been developed narratives from projects that have published results. The narratives have been analysed by use of metasynthesis to widen the understanding of adaptive capacity in different healthcare contexts. The syntesis consitutes a backdrop for futher development of collaborative learning tools and tools for patient and stakeholder involvement. Moreover these have been conducted interviews with resilience researchers to gain increase knowledge about resilience mechanisms. Several workshops have also been organised to support the development of tools inv collaboration with coresearchers and participants with high competence from the practice field. A resilience tool is developed and itegrates resilience theory, patient and stakeholder involvement and collaborative learning. Active testing and implementation is currently ongoing in different healthcare contexts (nursing homes, homecare, hosptials) to cover acute and continuity care. Internationally, data collection is ongoing in 5 countriies to understand adaptive capacity in teams through observation and interviews in different types of teams (strucural, hybrid, responsive, coordinating).

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Over the past three decades, extensive research has been undertaken to understand the components of healthcare quality, yet most efforts are conducted in silos and important challenges persist. The lack of progress has led to the conclusion that traditional research is too simplistic given the inherent complexity of healthcare systems characterized by a significant degree of performance variability within and across system levels. A radical shift is therefore necessary. Resilience in Healthcare (RiH) is an innovative and comprehensive framework modelling the ability of healthcare providers to anticipate, monitor, respond to and learn from variability and disruptions. As a crucial next step, RiH research must go beyond single-site, case-based studies to multi-site, cross-national studies and requires long-term multidisciplinary collaboration between national and international researchers interacting with multiple healthcare stakeholders. The RiH project will meet these demands to reform current research on healthcare quality. Through the development and implementation of an evidence-based RiH framework the project will confirm the consortium as an internationally prominent research group for knowledge generation and translation. The project applies a longitudinal collaborative research design (mixed methods, interventions, learning tools) to advance scientific knowledge of RiH within (a) the emergency chain, and (b) the continuity chain. Empirical data on the healthcare processes involved when patients move along these two chains will be of major analytical interest. By establishing a RiH framework, the project will shift the research focus from failures to processes with successful outcomes to determine how high quality healthcare is achieved. A collaborative learning framework centred on involvement will translate research findings into practice, placing RiH at the forefront of research gathering major stakeholders in and around the Norwegian healthcare system.