Toward a theory-led meta-framework for implementing health system resilience analysis studies: a systematic review and critical interpretive synthesis

(2022) 22:287 Foroughi et al. BMC Public Health https://doi.org/10.1186/s12889-022-12496-3 Open Access RESEARCH Toward a theory-led meta-framework for implementing health system resilience analysis studies: a systematic review and critical interpretive synthesis Zeynab Foroughi1, Parvin Ebrahimi1*, Aidin Aryankhesal1, Mohammadreza Maleki1 and Shahram Yazdani2 Abstract Introduction: The variety of frameworks and models to describe resilience in the health system has led researchers and policymakers to confusion and the inability to its operationalization. Therefore, the purpose of this study was to create a meta-framework using the Critical Interpretive Synthesis method. Method: For this purpose, studies that provide theories, models, or frameworks for organizational or health system resilience in humanitarian or organizational crises were systematically reviewed. The search strategy was conducted in PubMed, Web of Science, Embase, and Scopus databases. MMAT quality appraisal tool was applied. Data were analysed using MAXQDA 10 and the Meta-ethnography method. Results: After screening based on eligibility criteria, 43 studies were reviewed. Data analysis led to the identification of five main themes which constitute different framework dimensions. Health system resilience phases, attributes, tools, and strategies besides health system building blocks and goals are various dimensions that provide a systematic framework for health system resilience analysis. Discussion: This study provides a systemic, comprehensive framework for health system resilience analysis. This meta-framework makes it possible to detect the completeness of resilience phases. It examines the system’s resilience by its achievements in intermediate objectives (resilience system attributes) and health system goals. Finally, it provides policy solutions to achieve health system resilience using tools in the form of absorptive, adaptive, and transformative strategies. Keywords: Health system, Resilience, Meta-framework, Critical interpretive synthesis Introduction Health system resilience is known as a way to achieve universal health coverage (UHC) through health system strengthening against chronic challenges and acute shocks [1]. Although the term “resilience” has *Correspondence: 1 School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran Full list of author information is available at the end of the article been employed in engineering, psychology, and ecology sciences for more than a decade, it has been used in health system research in recent years [2]. The negative consequences of the Ebola virus outbreak on the health system in West Africa, including interruption in the delivery of essential health services and losses of many lives, contributed to the popularity of the health systems resilience concept [3, 4]. In the same way, the COVID-19 pandemic has increasingly raised the clarity of the need for resilience in health systems [5]. By © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Foroughi et al. BMC Public Health (2022) 22:287 definition, health system resilience is the ability of the system to prepare for and respond to sudden shocks and everyday challenges and its capacity to absorb deteriorations, adapt, and transform the health system to cope with them [5, 6]. The results of a concept analysis suggested that there is fragility in applying the health system resilience concept. Different researchers use various frameworks for analysing health system resilience [2]. Hence, there is no specific suggestion about achieving a resilient health system [7]. For example, Hollnagel focused on the concept of resilience engineering and defined four resilient health system capabilities as anticipating, monitoring, responding, and learning [8]. Kruk et al. also introduced the attributes of health system resilience, considering it as living organisms, including aware, diverse, self-regulating, integrated, and adaptive [9]. Blanchet et al. presented health system resilience capacities, including absorptive, adaptive, and transformative capacities [10]. The lack of a unified framework for studying health system resilience can hinder its operationalization [11]. Therefore, integration and unification of the current health system resilience frameworks are necessary for realizing its potentials [12]. Hence, we conducted this study to achieve a comprehensive framework for analysing health system resilience. This study applied reviewing and synthesis of the existing conceptual frameworks and finding the common elements among them. The initial study question was about detecting different components of a resilient health system that should be considered during resilience system analysis studies. Materials and methods This systematic review was conducted and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Supplementary File 1). Page 2 of 13 Eligibility criteria The inclusion criteria were all studies published in English with any quantitative or qualitative design and book chapters. Included studies should be introduced or defined a resilience theory, model, or framework in organizational or health system context and/or in connection with a humanitarian or organizational crisis. Also, reports published by international organizations were included. Studies related to ecological, or psychological resilience were excluded. Further, empirical studies that did not mention resilience system components were excluded. Information sources & search strategy We applied the search strategy in PubMed, Web of Science, Embase, and Scopus databases in November 2020. Keywords include Resilience, resilient combining with organiz*/organis* or system or “health system” and theory, framework, model, and synonyms. Also, reference checking of detected studies and hand searching of related jo (...truncated)