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The purpose of this study was to elucidate facilitators and barriers to health system resilience and resilient responses at local and regional levels during the first year of the COVID-19 pandemic in Finland.

The authors utilized a qualitative research approach and conducted semi-structured interviews (n = 32) with study participants representing five different regions in Finland. Study participants were recruited using purposive and snowball sampling. All study participants had been in management and civil servant positions during the first year of the pandemic, representing municipalities, municipalities' social and healthcare services, hospital districts and regional state administrative agencies. All interviews were completed remotely from April to December 2021 and the recordings transcribed verbatim. The authors coded the transcripts in ATLAS.ti 9.1 using directed content analysis.

The findings highlighted a wide range of localized responses to the pandemic in Finland. Facilitators to health system resilience included active networks of cooperation, crisis anticipation, transitioning into crisis leadership mode, learning how to incorporate new modes of operation, as well as relying on the competencies and motivation of health workforce. The authors found several barriers to health system resilience, including fragmented organization and management particularly in settings where integrated health care systems were not in place, insufficient preparedness to a prolonged crisis, lack of reliable information regarding COVID-19, not having plans in place for crisis communication, pandemic fatigue, and outflux of health workforce to other positions with better compensation and working conditions.

Factors affecting health system resilience are often studied at the aggregate level of a nation. This study offers insights into what resilient responses look like from the perspective of local and regional actors in a decentralized health system. The results highlight that local capacities and context matter greatly for resilience. The authors call for more nuanced analyses on health systems and health system resilience at the sub-national level.

Health systems are periodically confronted by crises – think of Severe Acute Respiratory Syndrome, H1N1, and Ebola – during which they are called upon to manage exceptional situations without interrupting essential services to the population. The ability to accomplish this dual mandate is at the heart of resilience strategies, which in healthcare systems involve developing surge capacity to manage a sudden influx of patients. The paper aims to discuss these issues.

This paper relates insights from resilience research to the four “S” of surge capacity (staff, stuff, structures and systems) and proposes a framework based on complexity theory to better understand and assess resilience factors that enable the development of surge capacity in complex health systems.

Detailed and dynamic complexities manifest in different challenges during a crisis. Resilience factors are classified according to these types of complexity and along their temporal dimensions: proactive factors that improve preparedness to confront both usual and exceptional requirements, and passive factors that enable response to unexpected demands as they arise during a crisis. The framework is completed by further categorizing resilience factors according to their stabilizing or destabilizing impact, drawing on feedback processes described in complexity theory. Favorable order resilience factors create consistency and act as stabilizing forces in systems, while favorable disorder factors such as diversity and complementarity act as destabilizing forces.

The framework suggests a balanced and innovative process to integrate these factors in a pragmatic approach built around the fours “S” of surge capacity to increase health system resilience.

Resilient health facilities, particularly hospitals, are critical for a responsive local health system in post-disaster settings. The purpose of this paper is to look at the experiences of two hospitals (public and private) in Tacloban City, Philippines in the aftermath of a super typhoon and their respective delivery of health services in such setting.

It described the impact of Typhoon Haiyan on health services delivery capacity and the factors instrumental in the resilience of the case hospitals. Lessons learned from the hospitals’ experiences, both at the level of the hospital staff and the institution, were also drawn. Disaster preparedness of case hospitals were assessed along several domains of resilience. Key informant interviews among stakeholders were conducted with key themes on disaster resilience extracted.

Disaster preparedness scores for case hospitals were different from each other and were reflected in their experiences of health services delivery in the aftermath of the disaster.

This study on hospital resilience of two case hospitals, in the aftermath of Typhoon Haiyan, is exploratory in nature. The retrospective design of the study made it prone to recall bias. Further, the use of self-report measures for hospital resilience needs to be validated by more objective measures. The lack of baseline pre-disaster resilience indicators and the unpredictability of disasters could perhaps be addressed by a longitudinal study on hospital resilience in disasters in the future.

This study revealed several key findings. Some of the themes that emerged were: public health in disaster is the responsibility of both public and private hospitals; need for flexibility in disaster preparedness and planning, disaster resilience is an emergent process not a static construct, chaos results from zeal without coordination, and the need for integration of disaster preparedness in daily processes and structures of hospital facilities.

This paper aims to examine Cameroon’s health service resilience in the first five months (March–July 2020) of the coronavirus (COVID-19) outbreak. The motive is to diagnose sub-optimal performance in sustaining health-care services during the pandemic to identify areas for improvement and draw lessons for the future.

This is principally qualitative, exploratory, analytical and descriptive research that involves the collation of empirical, primary and secondary data. A conceptual framework [health systems resilience for emerging infectious diseases (HSREID)] provides structure to the study and an anchor for interpreting the findings. The research validity has been established by analysing the aims/objectives from multiple perspectives in the research tradition of triangulation.

Cameroon has exerted much effort to combat the COVID-19 pandemic. Yet, several constraints and gaps exist. The findings reveal limitations in Cameroon’s response to the COVID-19 pandemic in the provision of fundamental health-care services under contextual themes of health infrastructure/medical supplies, human capital, communication/sensitisation/health education, governance and trust/confidence. Analysis of the identified impediments demonstrates that Cameroon’s health-care system is not resilient enough to cope with the COVID-19 pandemic and provides several insights for an enhanced response as the pandemic accelerates in the country.

This is one of the first scholarly articles to examine how Cameroon’s health-care system is faring in COVID-19 combat. Underscored by the novel HSREID model, this study provides initial insights into Cameroon’s resilience to COVID-19 with a view to enhancing the health system’s response as the pandemic unfolds and strengthens readiness for subsequent health crises.

The purpose of this paper is to investigate how and why some service ecosystems are more resilient and, consequently, more sustainable than others during turbulent times, and how resilience can be cultivated to enable pathways to service ecosystem sustainability.

This work integrates disparate literature from multiple service and sustainability literature streams, iterating through constant comparison with findings from 44 semistructured interviews conducted in the context of primary health care clinic service ecosystems.

The authors offer a novel conceptual framework comprising pillars (shared worldview, individual actor well-being and multiactor interactions), changing practices to cultivate resilience through resilience levers (orchestrators, individual actor effort, actor inclusivity and digitaltech–humanness approach), and pathways to service ecosystem sustainability (volume vs value, volume to value, volume and value). The authors demonstrate that service ecosystems need to change practices, integrating resources differently in response to the turbulent environment, emphasizing the importance of a shared worldview across the ecosystem and assessing different pathways to sustainability.

This paper offers new insights into the important intersection of service marketing, sustainability and health care. The authors provide guidance to practitioners aiming to cultivate resilience in service ecosystems to achieve pathways to sustainability in primary health care clinics. Finally, implications for theory are discussed, and directions to guide future service research offered.

Resilient hospitals have the vital role in reducing mortality, severity of injuries by providing required emergency services during accidents and disasters. This study aims to identify and prioritize key indicators on hospital resilience.

This cross-sectional study was conducted in 2019. The draft of the indicators obtained from the systematic review of the previous study was finalized, with three expert panel sessions and 14 experts in resilience fields. The outputs of these sessions were divided into three domains including constructive resilience, infrastructural resilience and administrative resilience, 17 sub-domains and 71 indicators. Then fuzzy analytic network process method was used to weight and prioritize the final indicators of hospital disaster resilience.

Administrative resilience, logistic and financial management and strategic outsourcing agreement allocated the highest weight as domain, sub-domains and indicators, respectively. The weight of each sub-domain and indicator was also determined.

Investigating the weight of domains, sub-domains and indicators shows the importance of managerial and operational issues in hospital resilience. By using the indicators and relative weights, a tool for measuring hospital disaster resilience can be created in further studies. The output of these assessments is effective in promoting safety and increasing awareness of hospital managers and health policymakers.

Health-care professionals are caring for patients in unprecedented circumstances during the COVID-19 pandemic, dealing with scarce resources, higher demand and uncertain outcomes. In this context, the purpose of this study is to explore the views of health-care professionals regarding their work conditions and perceived impacts of the pandemic on their health, as well as the role of resilience and improvisation in face of the new challenges.

This exploratory and qualitative study carried out semi-structured interviews with eleven health-care professionals from three Brazilian states that have been working in intensive care settings during the pandemic.

The pandemic has posed a great personal and professional burden on the professionals, impacting their physical and mental health. It also has required them greater resilience and improvisation capabilities to adequately perform work-related activities.

In addition to individual-level attitudes, the results suggest that aspects in the government, society, personal relationships and providers domains influence the effects of the pandemic on the health-care professionals and how they cope with the ongoing crisis. Such a multifactorial approach should therefore be considered by health managers.

With no similar effort identified, this study emphasizes the relevance of discussing the pandemic burden on frontline professionals and intends to be useful for health practitioners, managers, academics and policymakers.