PDF(Pubmed)
Abstract：
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.
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.
摘要：
背景：最近全球卫生系统受到冲击和压力的推动，关于卫生系统弹性的各种研究已经出现。我们的目的是描述如何在实证研究和先前的评论中实施卫生系统弹性。我们将这些与更广泛的领域中的核心概念化和弹性特征进行比较(具体来说，工程,社会生态,组织和社区复原力概念)，追踪不同的学校，健康文献中韧性的概念和应用。
方法：我们在Pubmed数据库中搜索了与\'弹性\'和\'卫生系统\'相关的概念。对纳入的研究进行了两项单独的分析：根据所涵盖的部分卫生系统，共进行了n=87项关于卫生系统韧性的实证研究，威胁类型,弹性阶段，弹性范式，和建立复原力的方法；总共有n=30条审查获得了全文审查，并根据审查类型进行了表征，审查中确定的复原力概念，和理论框架或潜在的弹性概念化。
结果：健康与韧性的交集显然在学术话语中变得越来越重要，自2018年以来，大多数论文在各种期刊上发表，并应对外部威胁。或参考更频繁的医院危机管理。大多数研究集中于卫生系统的总体弹性（从而对外部冲击或压力的反应），或对医院内的弹性(从而对定期电击和手术)。对社区和初级保健的关注较少，无论是正式的还是非正式的。虽然大多数出版物没有明确研究范式，“弹性工程”是最突出的一个，其次是“社区复原力”和“组织复原力”。恢复力的社会生态系统根源应用最少，证实了我们在健康复原力文献中转化概念应用有限的发现。
结论：我们的审查表明，该领域是零散的，特别是在使用非健康弹性领域的弹性范例和方法时，以及使用这些的卫生系统设置。考虑到复杂和自适应的卫生系统内部和之间的连接，这种分散和孤立的方法可能会有问题，从社区演员到当地人，区域,或国家公共卫生组织进行二级保健。如果没有一个全面的定义和框架来捕捉这些相互依存关系，操作化，衡量和提高弹性仍然具有挑战性。
方法：我们在Pubmed数据库中搜索了与\'弹性\'和\'卫生系统\'相关的概念。对纳入的研究进行了两项单独的分析：根据所涵盖的部分卫生系统，共进行了n=87项关于卫生系统韧性的实证研究，威胁类型,弹性阶段，弹性范式，和建立复原力的方法；总共有n=30条审查获得了全文审查，并根据审查类型进行了表征，审查中确定的复原力概念，和理论框架或潜在的弹性概念化。
结果：健康与韧性的交集显然在学术话语中变得越来越重要，自2018年以来，大多数论文在各种期刊上发表，并应对外部威胁。或参考更频繁的医院危机管理。大多数研究集中于卫生系统的总体弹性（从而对外部冲击或压力的反应），或对医院内的弹性(从而对定期电击和手术)。对社区和初级保健的关注较少，无论是正式的还是非正式的。虽然大多数出版物没有明确研究范式，“弹性工程”是最突出的一个，其次是“社区复原力”和“组织复原力”。恢复力的社会生态系统根源应用最少，证实了我们在健康复原力文献中转化概念应用有限的发现。
结论：我们的审查表明，该领域是零散的，特别是在使用非健康弹性领域的弹性范例和方法时，以及使用这些的卫生系统设置。考虑到复杂和自适应的卫生系统内部和之间的连接，这种分散和孤立的方法可能会有问题，从社区演员到当地人，区域,或国家公共卫生组织进行二级保健。如果没有一个全面的定义和框架来捕捉这些相互依存关系，操作化，衡量和提高弹性仍然具有挑战性。
