From theory to measurement: development and initial validation of the Resilience in Healthcare Capacities Assessment (RHCA)

In recent years, the role of resilient healthcare systems has gained prominence. The quantitative assessment of resilience systems is vital for understanding and enhancing their ability to maintain high-quality patient care under strain. This study reports the development and initial validation of the Resilience in Healthcare Capacities Assessment (RHCA), a multidimensional survey instrument designed to support healthcare organisations in measuring resilience. Grounded on the Resilience Capacities Framework, the development of the RHCA involved multiple steps including item generation, content analysis, and psychometric analysis. An initial pool of 124 items was refined to 63 through expert consensus and pilot testing. These were administered to a sample of Australian hospital staff (N = 221). Based on exploratory and confirmatory factor analysis, the item set was refined to 40. These items were then tested with a second, independent sample of Australian hospital and specialist clinic staff (N = 371) for further validation. Confirmatory factor analysis supported the final 33-item, ten-factor structure, with high internal consistency for each factor. Criterion validity was supported through significant correlations with staff well-being (Emotional Thriving, Burnout, Turnover Intention) and patient safety outcomes (Safety Climate, Patient Safety Grade). The RHCA provides a psychometrically robust, multidimensional tool for assessing resilience capacities at the micro- and meso-levels of healthcare systems. It enables organisations to identify strengths and areas for improvement, supporting targeted interventions and longitudinal monitoring. This research represents a significant advancement in the quantitative measurement of resilience capacities, providing a foundation for future research on how resilient performance can be strengthened, along with quality and safety.