Resilience in action: team factors influencing adaptive capacity in Australian hospitals

Introduction: Resilient healthcare focuses on the ability of systems to adapt and maintain high-quality care amidst various challenges, emphasising the importance of learning from both successes and errors. This study explores how variability and changes within teams, organisations, and national healthcare systems affect the adaptive capacity of hospital teams in two Australian hospitals.

Methods: We utilised a comparative case study design, examining teams in one public and one private hospital. Four team types were investigated: structural (ward-based, multidisciplinary), hybrid (comprising both permanent and rotating members), responsive (handling time-limited emergencies), and coordinating (facilitating workflow across units). Data collection spanned from March to November 2023, including observations and semi-structured interviews. Analysis employed the Concepts for Applying Resilience Engineering (CARE) model and Hollnagel’s framework of resilience potentials.

Results: This study identified several significant factors impacting adaptive capacity: technology and resources; roles, procedures, and work; staff competence and knowledge; and team culture and relational factors. Access to technology was crucial for enhancing efficiency and patient monitoring. Key resources included technologised trolleys, paging systems, and electronic patient management tools. Well-defined roles and procedures, such as daily huddles and strategic teamwork, supported adaptive capacity. Staff competence and knowledge were critical, with experienced staff’s shared understanding enabling better preparation for challenges. The need for upskilling was particularly evident in hybrid and responsive teams. Team culture was fundamental, with strong internal support systems enhancing relational factors and overall well-being.

Conclusion: This study contributes insights into how various team, organisational, and system factors influence adaptive capacity within Australian hospital teams. Understanding these factors helps identify strategies to enhance adaptive capacity, demonstrating the importance of macro- and meso-level structures in reinforcing team resilience.