Resilience in Healthcare (RiH)

Healthcare quality is a highly prioritized global health issue that involves patient safety, continuity of care, patient-centeredness, and clinical outcome. The Resilience in Healthcare (RiH) project seeks 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 standardized '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 organizations 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 and patient safety, 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, organizations, and in everyday clinical work. The RiH project has five interconnected activities:1) RiH theoretical framework,2) Patient and stakeholder involvement, 3) Empirical studies of resilience in different Norwegian healthcare settings, 4) Cross-country comparative resilience studies, and 5) Collaborative learning framework (WP5). The RiH Project has developed a conceptual framework for resilience and positioned the project within the forefront of the resilience in healthcare literature. Moreover, the project has developed a Resilience Trigger Tool and an analytical framework that supports the research and conceptualization 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 projects there have been developed narratives from projects that have published results. The narratives have been analyzed by use of meta synthesis to widen the understanding of adaptive capacity in different healthcare contexts. The synthesis constitutes a backdrop for further development of collaborative learning tools and tools for patient and stakeholder involvement. Moreover, there have been conducted interviews with resilience researchers to gain increase knowledge about resilience mechanisms. Several workshops have also been organized to support the development of tools inv collaboration with coresearchers and participants with high competence from the practice field. Based on the conceptual frameworks showing the building blocks of resilience, a resilience learning tool is developed. The learning tool integrates resilience theory, patient and stakeholder involvement and collaborative learning. Active testing and implementation has been conducted in different healthcare contexts including nursing homes, homecare, hospitals to cover acute and continuity care. The evaluation shows that the resilience learning tool contributes to create reflexive spaces and increased understanding of resilience concepts in practice. It contributes to translating resilience into practice and improves understanding of how to ensure quality in healthcare organizations under diverse condition and need for adaptations and change. The tool is created in Norwegian and translated into English and is open access available for all to use and relevant across different contextual setting. Internationally, there has been conducted a study of adaptive capacity in hospital teams in 5 countries (Norway, England, the Netherlands, Japan, Australia). I all countries 4 team types (structural, hybrid, responsive, coordinating) in two hospitals have been studied. Despite having different healthcare systems the results show that a high degree of adaptations occur on a daily basis in all teams to ensure that patients receive high quality care.

Prosjektet har bidratt til å etablere ny kunnskap om resiliens og hvordan resiliens kan overføres fra teori til praksis. Prosjektet har bidratt til nytt teoretisk rammeverk, nye prinsipper for pasient og aktørinvolvering i resiliens, og til et praktisk læringsverktøy som kan anvendes av brukere i ulike typer helsetjenester. Dette verktøyet integrerer teoretiske begreper, eksempler og gjør at praksisfeltet kan ta i bruk et nytt begrepsapparat og overføre tankegangen til praksis og fokusere på forbedring av kvalitet i helsetjenesten basert på en positiv tilnærming. Prosjektet har basert på en samarbeidstilnærming laget et resiliensverktøy som har blitt testet ut og evaluert i ulike typer kontekster. Det har bidratt til økt kompetanse og forståelse for resiliens i helsetjenesten både i hjemmetjenesten, sykehus og sykehjem. Ansatte og ledere som har deltatt har fått bedre forståelse av hva resiliens er og hvordan tankegangen kan bidra til å bedre kvalitet i tjenesten basert på det som går godt og tilpasninger som må gjøres for å håndtere endringer og utfordringer i komplekse organisasjoner. Prosjektet har hatt som mål å reformere tankegangen omkring kvalitet og en forståelse av at både det som går godt og det som går galt er utgangspunkt for forbedring. Denne tilnærmingen og begrepsbruken var ikke særlig kjent i Norge og internasjonalt da prosjektet startet. I perioden har prosjektet formidlet bredt og vært meget involvert i høringer, på konferanser og i pasientsikkerhetsarbeidet på nasjonalt og internasjonalt nivå. I dag ser vi at resiliensbegrepsbruken tas i bruk mer på nasjonalt og internasjonalt nivå. I den siste Nasjonale helse og samhandlingsplanen (2024-2027), som viderefører det strategiske pasientsikkerhetsarbeidet i Norge, er resilienslæringsverktøyet RiH-prosjektet har utviklet omtalt og vist, og resiliensbegrepsbruken er integrert i planen og i det nye rammeverket for pasientsikkerhet. Her har prosjektet være meget aktivt involvert i for å spre resultatene i forvaltningen og til det internasjonale forskningsmiljøet. En sentral effekt av prosjektet er et økt internasjonalt samarbeid innen resiliensfeltet. Det har også posisjonert resilinsforskningen bedre i forskningsfeltet innen kvalitet og pasientsikkerhet. Prosjektet har bidratt til aktivt forskningssamarbeid mellom forskere i mange land. Det er gjort konkrete komparative studier i fem land, det er arrangert internasjonale konferanser og seminarer i regi av prosjektet og det er bygd opp et nytt konsortium som har fått finansiering i EU Horizon Europe programmet som tar prosjektets resultater videre i prosjektet Support4Resilience. Support4Resilience koordineres av Universitetet i Stavanger og har flere partnere som bidrog i RiH prosjektet med videre for å videreutvikle en digital verktøykasse for ledere i europeiske eldretjenester. Dette bygger videre på Resilienslæringsverktøyet og bidrar til at Norge er er forskningsfronten innen resiliens i helsetjenesten.

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.