Resilience in healthcare after Covid-19: Rethinking technologies, operations, supply chain and network

The concept of resilience, defined as the ability of organizations to adapt their operations before, during, and after disruptions while ensuring the delivery of essential services, has garnered increasing attention in healthcare research. Despite its theoretical significance, hospital resilience remains underexplored in practice, with limited consensus on its contextual applications, contributing factors, and empirical validation. This thesis addresses these gaps by examining hospital resilience through the combined lenses of the Resource-Based View (RBV) and Contingent RBV (CRBV), focusing on the organizational characteristics, resources, and capabilities that underpin resilience across different crisis phases. Adopting a resource-based perspective enables a deeper understanding of hospital dynamics during crises by identifying the resources and capabilities critical for maintaining operations, adapting to challenges, and achieving resilience outcomes. Moreover, this approach emphasizes the importance of context, highlighting how internal and external contingencies shape the effectiveness of resilience strategies. First, a systematic literature review is conducted to systematize knowledge on resources and capabilities that strengthen hospital resilience, distinguishing their roles across the five resilience dimensions: anticipation, adaptation, response, recovery, and learning. This review integrates fragmented findings, highlights synergies among organizational elements, and proposes an integrated framework to guide future research. Building on these insights, the thesis empirically investigates the role of digital technologies, staff skills, and information integration capabilities in enhancing hospital resilience during crises. Through structural equation modeling (SEM) on data from 130 Italian hospitals, findings reveal that digital technologies and staff skills significantly contribute to resilience outcomes, with external information integration acting as a critical mediator. The final phase of the thesis examines the moderating role of contingencies, including service complexity and operational efficiency, on the relationships between resources, capabilities, and resilience. In this phase, data were collected through an online survey of Italian hospitals and supplemented by secondary data from databases provided by the Italian Minestry of Health to measure the moderating factors. The analysis confirms the direct effects of ICTs, digital skills, and information integration on hospital resilience, while demonstrating how these effects are influenced by contextual factors. Results show that both service complexity and operational efficiency condition the effectiveness of resources, underscoring the nuanced dynamics of hospital resilience in varying contexts. This research contributes to the theoretical and practical advancement of hospital resilience by providing a structured framework and empirical evidence to inform resource allocation, emergency planning, and strategic decision-making. It highlights the necessity of integrating diverse organizational elements and considering contextual factors to enhance resilience and ensure high-quality, safe patient care in increasingly volatile healthcare environments.