Resilience in Australian healthcare: analysing team factors for adaptive capacity

Introduction: Resilient healthcare represents a transformative shift in healthcare systems, emphasising their capacity to adapt their functioning and sustain high-quality care despite expected or unexpected challenges or conditions. This concept has gained prominence over the past decade. It diverges from traditional safety paradigms by equally valuing the analysis of successes alongside errors. This study identified how variability and changes within teams, organisations, and national healthcare systems enable or hinder the adaptive capacity of hospital teams within two Australian hospitals.

Methods: We employed a comparative case study design focusing on teams in one public and one private hospital, examining the hindrances and enablers influencing team adaptive capacity. There were four teams from each hospital: structural (ward-based team whose members comprise different disciplines), hybrid (comprised of permanent and rotating members), responsive (react to time-limited emergencies), and coordinating (facilitate workflow across organisational units). Data collection occurred from March to November 2023. Observations and semi-structured interviews were conducted. Data were analysed utilising a combination of inductive and deductive coding according to the Concepts for Applying Resilience Engineering (CARE) model and Hollnagel’s framework of resilience potentials.

Results: Several significant factors were identified as enabling or hindering adaptive capacity, including: 1) technology and resources; 2) roles, procedures, and work; 3) staff competence and knowledge; and 4) team culture and relational factors. Access to technology and resources was essential for optimising efficiency across both hospitals, and important for monitoring patients and optimising organisational processes. Technologized trolleys used by structural teams, paging systems by responsive and hybrid teams, and electronic patient management applications by coordinating teams underscored the importance of resource availability. Well-defined roles and procedures supported teams. Structures that promoted adaptive capacity included: daily huddles by the hybrid and coordinating teams, and strategic two-member teamwork in structural and responsive teams. Staff competence and knowledge emerged as important aspects of a team’s capacity to adequately adapt to challenges. Common knowledge of pressures amongst experienced staff allowed for sufficient preparation. The need to upskill staff was particularly evident in the hybrid and responsive teams. Team culture was established as fundamental for adaptive capacity. Observations revealed that team members of all team types actively supported each other. Additionally, internal support systems fostered relational factors and promoted overall wellbeing within teams.

Conclusion: This study contributes insights into how team skills, organisational and system factors hinder or enable adaptive capacity within hospital teams of two Australian hospitals. The four identified factors contribute to an understanding of how to enhance the capacity of hospital teams and explores how macro-level and meso-level structures can effectively reinforce adaptive capacity.