Adaptive capacities of different Australian hospital teams: a qualitative analysis

Resilient healthcare, characterised by the capacity of systems (such as teams or organisations) to adjust to changes and disruptions, has become crucial in advancing patient care and safety. It plays a key role in streamlining safety approaches by focusing on effective practices that improve healthcare delivery. This study explores team adaptability and misalignments within Australian hospitals. The research included 75 hours of observations and 46 interviews with staff from two Australian hospitals. Four types of healthcare teams were examined at each hospital according to the Adaptive Team Framework: structural (e.g., aged care ward), hybrid (e.g., emergency department), responsive (e.g., intensive care unit), and coordinating (e.g., bed management). Data collection took place between March and November 2023. Thematic analysis of transcripts and fieldnotes was performed using both inductive and deductive coding, framed by the CARE model 2.0, which addresses socio-cultural and economic factors and highlights dynamic system interactions. The study found 632 instances of misalignments and 387 instances of adaptations across the eight teams. Misalignments were classified into 11 categories: equipment, staffing, communication, space, processes/procedures, workflow interruption, patient complexity/behaviour, leadership, external stressors, team/organisational culture, and time pressures/workload. Adaptations were categorised into five groups: extra-role performance, resource redistribution (equipment/staff), process and procedure modifications, prioritisation, and responses to COVID-19. Staffing issues were the most frequent misalignments, while staff redistribution was the most common adaptation. Additionally, adaptations related to COVID-19 significantly impacted staffing and equipment redistribution as major external stressors. The findings highlight the necessity of flexible and contextually appropriate adaptive strategies to ensure effective clinical care. These results have significant implications for the organisation of healthcare systems and resource distribution, emphasising the need for specific interventions to address systemic issues and enhance adaptability in various hospital environments.