Measuring hospital care resilience: a systematic literature review

The recent Covid-19 pandemic has shown how even high-performing healthcare systems are often unprepared to cope with sudden and unforeseen surges in demand for healthcare services, drawing further attention on crucial factors ensuring their resilience in the face of extreme disruptive events. Despite extensive efforts to define health system resilience, a lack of consensus persists, making it difficult to operationalize the existing conceptual frameworks and to guide policy makers in developing adequate response strategies. Grounded on this, the present paper aims to systematically review how hospital resilience has been measured in high-income countries. Particularly, we intend to map out the different indicators and metrics used to quantitatively assess the hospitals' capacity to proactively face sudden health shocks, which can put clinical activity under pressure and at risk of disruption. Adhering to PRISMA guidelines, a systematic literature search was conducted until March 2023, by combining three databases. The review identified 1,261 studies of which 45 studies met the eligibility criteria. We found a wide range of methodological approaches that shared a narrow focus on single aspects of hospital resilience, without being able to measure it comprehensively and systematically and without accounting for its dynamic and feedback loop nature. Specifically, most of the studies looked at how to measure hospitals' capacity to absorb the shock and adapt to it, while almost neglecting their transformative capacity as well as the legacy or enduring impact of shocks.