A systematic approach to evaluating and enhancing resilience in healthcare systems: Bridging theory and practice in crisis management

The structure of this thesis is designed to unfold in three key articles, each contributing uniquely to the understanding and application of resilience in healthcare. Article 1: Establishing a Foundation for Resilience This thesis lays the groundwork for understanding resilience in healthcare systems, drawing from the comprehensive review and synthesis provided in Article 1. The extensive literature review provided in this article, which includes the analysis of over 260 studies, culminates in the identification and classification of resilience characteristics into seven building blocks. This foundational work is crucial for setting the stage for a systematic study of resilience in the healthcare systems, providing a clear framework that was previously lacking in the resilience discourse in this field. The insights from Article 1 not only offer a conceptual clarity around resilience but also serve as a guiding light for following research and practical resilience-enhancing strategies within the healthcare system. Article 2: Theoretical Framework Development The main objective of the thesis is to provide a detailed theoretical framework to define and assess resilience in healthcare. Building upon the foundational insights provided by Article 1, Article 2 advances the thesis by meticulously creating this detailed theoretical framework. Designed to assess and define resilience within healthcare systems, this framework is distinguished by its exceptional flexibility and adaptability, making it suitable for application across a variety of healthcare contexts. This feature addresses and overcomes the broad generalizations and practical implementation challenges identified in earlier studies. Through a comprehensive and nuanced approach, this part offers healthcare systems a tailored, actionable roadmap for enhancing resilience, specifically tailored to navigate through pre-crisis, during-crisis, and post-crisis scenarios. Article 3: Empirical Application and Testing Article 3 initiates the empirical study of the thesis, acting as the first test of the theoretical framework developed in Article 2. This segment highlights the methodology's transition from theory to practice, particularly within the complex landscape of rare diseases. As a preliminary test of the thesis's proposed approach, it explores the distinctions of applying such a framework in real-world scenarios where continuous treatment is vital and the implications of treatment disruptions can be extreme. This empirical investigation is fundamental not only for validating the framework's applicability but also for addressing the inherent challenges of decision-making when faced with limited data availability. It specifically challenges the problem of operating in "small numbers and complex situations," a common difficulty in the realm of rare diseases. By integrating specific methodologies like the SWARA method, this part of the thesis demonstrates the critical need to adapt and refine the broader theoretical approach to suit the complex and data-sparse environments healthcare professionals often navigate. This approach not only validates the resilience framework but also enriches it by showcasing the practical application of tailored methodologies in enhancing decision-making processes under the constraint of scarce data.