Resilience of hospitals in an age of disruptions: a systematic literature review on resources and capabilities

ABSTRACT

Hospitals play a critical role in ensuring continuous and effective healthcare delivery, especially during crises. However, the COVID-19 pandemic exposed vulnerabilities in hospital systems, prompting a need to enhance resilience—the ability to withstand, absorb, respond to, recover from, and learn from disasters. A systematic literature review, grounded in the resource-based view, identified organizational characteristics, in terms of resources and capabilities, and their synergistic effects that bolster hospital resilience. The results demonstrate that digital technologies impact on anticipation and adaptation abilities, organizational capabilities to reorganize roles, tasks, and spaces enhance adaptability, and Inter-organizational collaborations increase the responsiveness of the hospitals. The study provides substantial theoretical and practical contributions. It expands knowledge of hospital resilience in light of recent disruptive events and promotes integration capabilities as determinants for the majority of resilience dimensions. All organisational and inter-organisational collaboration, cooperation, and coordination are deemed crucial for hospital resilience.

1. Introduction

Globally, the healthcare system faced severe challenges over the years, from climate change and natural disasters to financial crises and infectious diseases outbreaks (Biddle et al., 2020). Among all the stakeholders which support the healthcare system, hospitals play a critical role in delivering healthcare services because, as centres and providers of medical services, they must guarantee the continuation of the cure even and especially when the crisis occur (Cristian, 2018). The most recent pandemic, more than ever before, threatened the overriding goal of hospitals to effectively provide timely and good-quality treatments. In particular, one of the most critical aspects revolved around a lack of understanding regarding how to sustain care delivery, as several weaknesses have badly compromised the overall healthcare services in hospitals (Achour et al., 2022; Tippong et al., 2022). Among weaknesses, there are the interruption or cancellation of medical services, inadequate staff, insufficiency of equipment and spaces on hospital sites, inappropriate coordination between facilities and suppliers, and inaccessibility of facilities (Donelli et al., 2022; Tantri & Amir, 2022). Given its uniqueness, COVID-19 provides a rare opportunity to assess the preparedness of hospitals to respond to major disasters, and to understand why some hospitals overcame this disruptive event better than others. A current and notable area of research focuses on integrating the concept of resilience into the healthcare context. The objective is to provide healthcare organisations with the essential abilities to absorb, adapt, and transform in the face of disruptive events (D. Q. Chen et al., 2013; Marmo et al., 2022; S. K. Sharma & Sharma, 2020). Previous literature reviews have explored the multifaceted concept of resilience within the healthcare domain from various perspectives (Table 1). These reviews exhibit diversity in their scopes, with some encompassing the broader response of the entire healthcare system to crises (Biddle et al., 2020; Iflaifel et al., 2020), while others specifically opted for a more focused examination, concentrating on the resilience of the healthcare organisations (Khademi Jolgehnejad et al., 2021; C. Khalil et al., 2022; Mahmoud et al., 2023). Arji et al. (2023) have examined the resilience of healthcare supply chains, delving into the role of digital technologies in mitigating disruptions along the supply chain. The primary emphasis in earlier research has centred around the conceptualisation and implementation of the concept of resilience in the healthcare context. This is evident in their exclusive examination of empirical literature (Arji et al., 2023; Barasa et al., 2018; Biddle et al., 2020; Iflaifel et al., 2020; Khademi Jolgehnejad et al., 2021). Drawing upon organisational resilience concepts from industrial settings, Barasa et al. (2018) systematically reviewed organisational factors impacting resilience of healthcare organisations, among which material resources, information management, governance processes, social networks, and collaboration. Furthermore, Iflaifel et al. (2020) identified factors and methods that enable workers, teams, units, and organisations to adapt effectively to diverse situations.

Table 1.

Representative healthcare resilience literature.

Authors	Aim	Research methodologies adopted by the retrieved studies	Organisational characteristics	Context	Resilience dimensions
Arji et al. (2023)	How the main digital technologies foster resilience within the healthcare supply chain	Empirical, case study, modelling, analytical studies	Resources (Digital technologies)	Healthcare SC	None
Mahmoud et al. (2023)	How disruptive events impact on healthcare systems	Simulation studies	Resources (structural, non-structural components, equipment)	Hospital	None
Barasa et al. (2018)	Identifying the factors that influence Organisational resilience	Empirical studies	Resources (i.e., material resources; governance processes, human capital, organisational culture, leadership) and Capability (redundancy)	Organizations	None
Iflaifel et al. (2020)	How literature conceptualises the Resilience in Healthcare, highlighting the research methods employed and the essential factors for its development.	Empirical, case study, modelling, analytical studies	Resources (managerial skills: redesign socio-technical systems; teamwork; staff experience, adherence to guidelines and protocols, workaround)	Healthcare system	Anticipate, monitor, respond and learn
Khademi Jolgehnejad et al. (2021)	Identifying the influencing factors on Hospital resilience	Empirical, case study, modelling, analytical studies	Resources (Staff, Infrastructure, Management, Logistics)	Hospital	Preparedness Response Recovery and Growth
Biddle et al. (2020)	How the concept of healthcare resilience has been operationalised in empirical studies	Empirical studies	Resources (infrastructural components, staff competences) Capability (external collaborations between community, government)	Healthcare system	Absorptive, adaptive, transformative capacities
C. Khalil et al. (2022)	How literature conceptualises, operationalises, and evaluates the hospital resilience.	Qualitative, quantitative studies	Resources (Space, stuff, staff, systems, strategies, services)	Hospital	Risk assessment and planning, preparedness, response, recovery

Some efforts have also been made to conduct more targeted investigations into the factors that influence resilience in the hospital context. Khademi Jolgehnejad et al. (2021) identify four main key components to achieve resilience in hospital, namely the staff, infrastructure, management, and logistics. The scoping review by C. Khalil et al. (2022) examined how hospital resilience has been conceptualised, operationalised, and evaluated in empirical studies. As result, they encapsulate the components to make hospitals resilient within the framework of the 6 S’s (space, staff, stuff, system, strategies, and services). Based on the existing literature, which has provided a general overview of the factors influencing hospital resilience, it appears that resilience develops through a series of organisational characteristics related to the structure, practices, and behaviours implemented by the organisation, since they have reduced uncertainty and risk and improved adaptation. However, a critical aspect that emerges is the fact that these factors have been treated or listed indiscriminately, such as staff preparedness, communication, equipment. In particular, most studies have mapped linear relationships between organisational characteristics and hospital resilience, but few studies have depicted the complex set of configurations and combinations of them leading to resilience. What is lacking is a more in-depth investigation into how hospitals can effectively achieve resilience. A further step in developing the concept of hospital resilience more comprehensively should lead to distinguish and detail the organisational characteristics impacting hospital resilience, highlighting the interactions and synergies among them (Ambulkar et al., 2016). Studies in the field of operations management suggest embracing a resource perspective could lead to a better understanding of how to achieve resilience (Cheng & Lu, 2017, Ambulkar et al., 2016; Kamalahmadi & Parast, 2016). To provide an integrated framework that portrays these characteristics and their synergistic effects, we adopt the theoretical lens of the Resource-Based View (Chahal et al., 2020). This theoretical perspective explains the differences between firms and how they achieve and sustain better performance, looking at resources and capabilities (Lin et al., 2012). In terms of organisational characteristics, the Resource-Based View (RBV) makes a distinction between resources and capabilities, allowing for an analysis not only of what the hospital must possess in terms of tangible and intangible resources but also of capabilities – how resources are employed, incorporating the organisational process. This aims to enhance the productivity of hospital resources and improve efficiency in the final service (Amit and Schoemaker, 1993).

For instance, Brandon-Jones et al. (2014) state that to obtain resilience performance within the supply chain, a firm must develop resources such as technological infrastructure, fast and quality information sharing, along with the capability of visibility. Adopting a perspective that considers resources, capabilities, and resilience can be extremely advantageous, as it enables the identification of the optimal combination or bundle of various organisational characteristics. This approach, as highlighted by Lin et al. (2012), translates into significant practical implications. By acknowledging, for instance, that integration capability is essential for enhancing crisis response and making the effort to identify the necessary resources for developing such capability, practitioners are equipped with a comprehensive and practical view of what is needed to build resilience.

Hence, based on the RBV theory, this study aims to answer the following research question (RQ): Which resources and capabilities of hospitals lead to resilience in an age of disruptions?

In order to answer this question, the study systematically collects all organisational characteristics of hospitals, in the form of resources and capabilities, and interprets them in the light of the resilience implications. The rest of the paper is outlined as follows. Section 2 presents the relevant background and fundamental theories on this topic. Section 3 then discusses the details of research methods of Systematic Literature Review. Finally, in Sections 4, 5, 6, and 7 we present the descripting findings, thematic analysis, discussion and future research and conclusion, respectively.

2. Theoretical background

2.1. Resilience in healthcare

The concept of resilience has become more prominent in the global healthcare sector over the past few years, as a result of the succession of shock events that have affected the healthcare systems. Although the concept of resilience is still highly fragmented due to its multidisciplinary nature, it denotes the ability of healthcare organisations, to “adjust their functioning prior to, during and following events and, thus, sustain required operations under expected and unexpected conditions” (Barasa et al., 2018; Iflaifel et al., 2020). Hospital resilience is considered an essential capacity that helps hospitals withstand, absorb, and respond to the shock of disasters without disrupting critical healthcare functions and routine operations, returning to their original state or adapting to a new one (Zhong et al., 2015). According to the literature, resilience is defined in five dimensions, namely the ability to anticipate unforeseen disruptive events, to adapt and withstanding disruptions, to respond quickly to disruptions, to recover from disruptions, returning to steady-state conditions, and to learn from what has been done and anticipate future failures (A. Ali et al., 2017; Duchek, 2020; Lundberg & Johansson, 2015). Focusing on the healthcare sector there are significant conceptualisation issues regarding the meaning of resilience. Turenne et al. (2019) state that the concept of resilience in healthcare is dependent on one’s perception, one’s discipline, one’s function. In other words, it refers to the fact that literature about resilience in healthcare sector could differ according to the type of crisis studied and the scale focus or context analysed. Referring to the first one, crisis could be internal or external to organisation, or referred to chronic stress or acute shock. Regarding the focus of the analysis, it can range from individual level, investigating how healthcare workers implement coping strategies to overcome a trauma, to organisational level, investigating the strategies implemented in healthcare organisations (i.e., local health units, hospitals, and clinics), reaching even a national level, analysing the political and governmental initiatives to improve healthcare systems (Alameddine et al., 2019; Hillmann & Guenther, 2021). In view of these different perspectives, prior studies have examined the topic of resilience with a focus on healthcare service delivery policy (Kozuki et al., 2018), healthcare workforce, or governance issues (Falegnami et al., 2018). However, from an organisational perspective, still little has been done, and the greatest challenge remains to understand how to improve resilience in hospitals. This challenge is made more complex due to the fact that, by providing a service, hospitals engage in activities with essentially intangible outputs. Services are even more dependent on information technologies and on the intangible assets associated to human skills, knowledge, and culture (Yarbrough & Powers, 2006). Hence, it can be beneficial to examine the organisational characteristics that allow hospitals to be resilient even in the face of disruptive events such as COVID-19.

2.2. Resource-based view

The Resources Based View (RBV) theory has been extensively used by scholars to ground their studies investigating the relationship between firm resilience and its resources and capabilities (Ambulkar et al., 2015; Blackhurst et al., 2011; Gupta et al., 2018). The basic concept of this theoretical lens is that firms can improve their performance, including resilience, by properly creating bundles, namely the integration of strategic and dissimilar resources and/or capabilities (Barney, 2001; Brandon-Jones et al., 2014; Pal et al., 2014). Resources, namely something a firm possesses or has access to, can be classified into two main categories, which are property- and knowledge-based resources (Kim et al., 2015; Miller & Shamsie, 1996; Yarbrough & Powers, 2006). The former refers to resources protected by regulatory practises, both tangible, such as physical resources, infrastructures, technology, and intangible, such as intellectual property rights and patents (Fahy, 2002). The second category, concerning the knowledge-based view resources, refers to intangible assets including technical know-how, skills, culture, education, and training of employees (Skilton, 2009; Tseng et al., 2007).

The RBV suggests that by creating a “bundle” (grouping or set) of resources, it is possible to develop unique capabilities that generate value and enable gaining a competitive advantage (Barney, 2001; Huemer & Wang, 2021).

For instance, exploiting and combining information technologies, human resources, and organisational culture, firm is able to develop organisational capabilities, namely information-based tangible or intangible processes (Do et al., 2022). Technological know-how, training, and information technology infrastructure components enable the development of technological capability referring to the ability to utilise recent technology to achieve innovative processes and services (Bustinza et al., 2019; Heredia et al., 2022; Krasuska et al., 2020). Exploiting resources such as technical know-how, skills, and technological resources enables firms to develop other capabilities such as visibility (M. Sharma et al., 2022), flexibility (Brusset & Teller, 2017), redundancy (Musamih et al., 2022; Ramezani & Camarinha-Matos, 2020). Finally, in a similar manner, firms are able to develop integration capabilities which involves a cooperative management of processes within the organisation (internal integration), with external actors (external integration) including supply chain partners (supply chain integration) (Chahal et al., 2020; Cheng & Lu, 2017).

In addition, according to the RBV, resources and capabilities depend on each other, namely, not only resources enable the development of capabilities but also capabilities may affect the way resources are sustained, deployed, and integrated in order to generate services and products (Größler, 2007). For instance, the effective utilisation of information technologies requires information system capabilities, which, in turn, depend on resources of a technological, human, and relational nature (Brandon-Jones et al., 2014).

This study uses the RBV to examine the resources and capabilities that enhance a hospital resilience in its five various dimensions, namely the ability to anticipate, adapt, respond, recover, and learn from disruptions, as depicted in Figure 1.

Figure 1.

Resource-capabilities-resilience framework.

3. Methodology

Literature review is a methodology which aims to map and evaluate the existing literature in order to highlight the boundaries of knowledge and identify potential research gaps (Munn et al., 2018). We conducted a review of literature following systematic review methodology according to the guidelines proposed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (Moher et al., 2010). It represents a well-established procedure for conducting a systematic literature review and has been utilised in the context of healthcare management (Barasa et al., 2018; Biddle et al., 2020). This methodology involves gathering all the evidence for a particular research question and follows a transparent and reproducible methodology for searching, assessing quality, and synthesising studies with a high degree of objectivity (Bacelar-Silva et al., 2022). The review process consisted of: 1. Source identification, 2. Screening, 3. Eligibility, 4. Analysis (see Figure 2). The overview of the article search process is presented and explained in the following subsections.

Figure 2.

Prisma flow diagram.

3.1. Source identification

The literature identification involved an initial step of selecting keywords related to the theme, followed by a more refined and structured search using these keywords (Paul & Criado, 2020). We retrieved existing literature related to hospital resilience from the Scopus, WoS and PubMed databases using the following search combinations: resilien* AND (hospital OR healthcare OR “health care”) AND NOT (“psychology* resilience” OR “personal resilience” OR “mental health”). The keyword search in Scopus and WoS was set to include titles, abstracts, and keywords in order to retrieve all the relevant publications. On those three databases, we applied filters on language (including only articles written in English), on type of document (including only articles). The search period was set to include articles published between January 2019, and December 2022. The complete search strategy is provided in Appendix 1.

Because resilience in healthcare is a multidisciplinary concept, we chose general keywords; in this manner, we avoided the issue of having overly specific and narrow keywords, which run the risk of excluding relevant articles (Mokhtar et al., 2019). As suggested by Turenne et al. (2019), we have excluded in the keyword chain all those related to the psychosocial sphere. The extraction was limited to the period from 2019 to 2022, in which disruptive events occurred more rapidly and unpredictably than ever before. Moreover, we restricted the search to publications written in English and considered exclusively articles as document type. A structured search with keywords appearing in title, abstract and article keywords yielded a total of 14,839.

Given the high number of publications, we decided to apply an additional filter, selecting only those published in journals with an Impact Factor above 2.00, as suggested by Paul et al. (2021), with a total of 10,958 records remained.

3.2. Screening

By removing duplicates, 4,832 records were eliminated. Due to the high number of retrieved publications, we followed a three-stage screening process, examining titles, abstracts, and full text (Biddle et al., 2020). After reading the titles, 5,098 irrelevant records were excluded, and following the abstract screening, an additional 680 records were eliminated. At the end of this stage, 348 publications remained for eligibility assessment.

3.3. Eligibility

During this stage, the relevance of the content of the selected publications is assessed, defining the boundaries of the analysis and clear selection criteria. Articles discussing the individual resilience of patients in the care pathway, as well as resilience to specific drugs, were excluded. Articles pertaining to the mental health of patients (oncological or chronic illnesses, elderly individuals, war veterans), providers, and caregivers were eliminated. Additionally, articles addressing resilience at community and national-level (social injustices, such as ethnic minority, health access disparity) and those describing the health policy that should be adopted by society (psychological support and resource distribution) were also eliminated. Finally, all publications addressing the resilience of materials used for technological resources such as how to enhance the resilience of information systems, wearable technology, connectivity have been excluded. After this stage, 184 articles were excluded during the full-text screening, leaving 164 articles for the analysis.

3.4. Inclusion

In this phase, no additional publications were identified for inclusion in cross-referencing, maintaining the total eligible publications at 164. Subsequently, information pertaining to each publication, including authors, publication year, journal, country of study, methodology, and key findings were recorded.

3.5. Analysis

The critical analysis of the articles represents the last step of the SLR and involves summarising the findings of the remaining articles and highlighting key messages that require greater attention from researchers and practitioners. The data analysis was performed using Microsoft Excel and the articles were then read and classified according to the proposed resources-capabilities-resilience framework.

4. Descriptive findings

4.1. Historical series

Figure 3 shows the distribution per year of the reviewed papers across the study time frame. Looking at the resulting sample, over the past 4 years, the increasing number of articles published emphasises the higher level of relevance of the topic that has drawn attention from more researchers.

Figure 3.

Distribution of the reviewed papers across the period 2019–2022.

4.2. Academic journals

Table 2 reports the journals that published hospital resilience-related articles from 2019 to 2022, citing only the journals publishing at least two papers on the topic. The top contributor is BMC Health Services Research (8 papers), followed by IEEE Access (7 papers) and PLoS ONE (6 papers). Disaster Medicine and Public Health Preparedness, BMJ Leader, Frontiers in Public Health published four papers on the topic, while International Journal of Lean Six Sigma, International Journal of Environmental Research and Public Health, International Journal of Disaster Risk Reduction, IEEE Transactions on Industrial Informatics and International Journal of Operations & Production Management contributed publishing three papers on the topic. The journals publishing two papers will follow: Safety Science, Multimedia Tools and Applications, International Journal of Logistics Management, BMJ Open, Applied Ergonomics, Annals of Operations Research, IEEE Internet of Things Journal, Supply Chain Management: An International Journal, International Journal of Health Policy and Management.

Table 2.

Number of papers by journal.

Journal title	Number of articles
BMC Health Services Research	8
IEEE Access	7
PLoS ONE	6
Disaster Medicine and Public Health Preparedness	4
BMJ Leader	4
Frontiers in Public Health	4
International Journal of Lean Six Sigma	3
International Journal of Environmental Research and Public Health	3
International Journal of Disaster Risk Reduction	3
International Journal of Operations & Production Management	3
IEEE Transactions on Industrial Informatics	3
Safety Science	2
Multimedia Tools and Applications	2
International Journal of Logistics Management	2
BMJ Open	2
Applied Ergonomics	2
Annals of Operations Research	2
IEEE Internet of Things Journal	2
Supply Chain Management: An International Journal	2
International Journal of Health Policy and Management	2
Others	98
Grand Total	164

4.3. Geographical distribution

Table 3 reports the articles according to the geographical context which they focus on. As challenges are progressively taking on a global scale, the analysis of the national context provides an essential perspective to understand which states are addressing these challenges and how they are responding to them. Among the 164 papers, 19 specifically addressed the United States, 12 concentrated on the United Kingdom (UK), and 6 delved into Italy. In addition, five studies considered multiple countries across different continents: Brazil, Chile, Argentina, Australia, the UK (Tonetto et al., 2021); Brazil, Mexico, Chile, Argentina, USA, Australia, the UK, and Canada (Marques da Rosa et al., 2021; and Tortorella et al., 2021); and a global investigation conducted by Bhaskar, Bradley, Chattu, Adisesh, Nurtazina, Kyrykbayeva, Sakhamuri, Yaya, et al. (2020), Harland et al. (2021), Zhang and Qi (2021); Sanford et al. (2022) and Capolongo et al. (2020).

Table 3.

Geographical distribution of the reviewed papers.

Country of the study	Number of articles	References
Australia	5	Austin et al. (2022); Shaw et al. (2022); Hodgins et al. (2021); Ziser et al. (2021); Pomare et al. (2022)
Brazil	3	Alemsan et al. (2022); Furstenau et al. (2022), Tortorella et al. (2022)
Canada	2	Tremblay et al. (2022); Snowdon and Wright (2022)
China	6	Lim et al. (2020); Liu et al. (2020); W. Chen et al. (2022); Jiang et al. (2022); Wong et al. (2022); R. H. Xu et al. (2022)
Eastern Mediterranean Region (EMR)	1	Ravaghi et al. (2022)
Finland	1	Kihlström et al. (2022)
France	3	De La Garza and Lot (2022); Bessis et al. (2022); Minka et al. (2021)
Global	5	Zhang and Qi (2021); Sanford et al. (2022); Capolongo et al. (2020); Harland et al. (2021); Bhaskar et al. (2020);
Italy	6	Rubbio et al. (2019); Casiraghi et al. (2020); Trucco et al. (2022); Donelli et al. (2022); Ferorelli et al. (2020); Aldrighetti et al. (2019)
Japan	2	Hirano et al. (2020); W. Chen et al. (2022)
Kenya	1	Kagwanja et al. (2020)
Nepal	1	Moitinho De Almeida et al. (2021)
Netherlands	2	Gifford et al. (2022); Kuiper et al. (2022)
Norway	4	Ree et al. (2021); Barrett (2022); Lyng et al. (2021); Fagerdal et al. (2022)
Palestine	1	Sabateen et al. (2022)
Peru	1	Ceferino et al. (2020)
Scotland	1	Scala and Lindsay (2021)
Sweden	2	Appelbom et al. (2021); Hybinette et al. (2021)
Switzerland	1	Juvet et al. (2021)
Turkey	3	Ortiz-Barrios et al. (2020); Turan (2021); Pamucar et al. (2022)
United Kingdom	12	Ballantyne and Achour (2023); Borek et al. (2022); MacKinnon et al. (2022); McLeod et al. (2019); Sacoor et al. (2020); Shah et al. (2021); Till and McGivern (2020); Veerapen and McKeown (2021); Garcia-Perez et al. (2022a); Grailey et al. (2022); Pandit (2021); Mervyn et al. (2019)
United States	19	Cimellaro et al. (2018); Hassan and Mahmoud (2020); Rusinko (2020); Shahverdi et al. (2020); Hines and Reid (2021); Mandel-Ricci and Belfi (2022); Bohnett et al. (2022); Sawyer et al. (2022); Chiu et al. (2021); Hannan et al. (2021); Moss et al. (2021); Spiva et al. (2020); Wei et al. (2019); Croghan et al. (2021); C. Khalil et al. (2022); Khuntia et al. (2022); Koch et al. (2022); Ladak et al. (2021); Jordan et al. (2022)
Germany	2	Ölcer et al. (2021); Litke et al. (2022)
Pakistan	2	Hussain et al. (2023); Malik et al. (2021)
Multiple countries from various continents	3	Tortorella et al. (2021); Marques da Rosa et al. (2021); Tonetto et al. (2021)
Multiple European Countries	3	Papalexi et al. (2022); Spieske et al. (2022); Winkelmann et al. (2022)
Poland	1	Łukasik and Porębska (2022)
Taiwan	1	Wang (2022)
Austria	1	Kaleta et al. (2022)
Iran	1	Kazemi Matin et al. (2021)

Furthermore, three studies exclusively concentrated on European countries: Winkelmann et al. (2022) investigated different European countries, Papalexi et al. (2022) focused on the UK and Greece, and Spieske et al. (2022) on Austria, Switzerland, and Germany. Ravaghi et al. (2022), on the other hand, detail the states bordering the eastern coast of the Mediterranean.

4.4. Research methodologies employed

Figure 4 provides an overview of the research methodologies employed in the sample of selected articles. Four different categories of research methodologies are found: quantitative including analytical and mathematical model and simulation; empirical concerning case studies (exploratory, longitudinal, multiple, single), and involving data collection through observations, interviews, and surveys to obtain descriptive findings or test hypotheses using regression analysis; review including systematic literature review, topic modelling, review synthesis; and finally, researchers’ perspectives including commentary and conceptual framework. The analysis reveals that the majority of articles (84 out of 164) relied on empirical studies as the primary method of investigation. Most of these papers (77/84) employ the case study method for data collection and analysis. These articles share the common objective of collecting direct testimonies from hospitals regarding the strategies implemented to mitigate the effects of the crisis. Data collection involves interviews with healthcare professionals and hospital managers, as well as observational studies (Liu et al., 2020; McLeod et al., 2019; Rubbio et al., 2019). The nature of these works is highly exploratory, indicating a still nascent stage of research in this field. The remaining 12 papers among the 84 empirical ones use survey methodology for data collection, with six papers conducting regression analyses in order to test hypotheses (Papalexi et al., 2022; Lim et al., 2020), while the other six used survey as collecting data with the aim of performing descriptive analyses such as factor analysis for ranking (Cimellaro et al., 2018), hierarchical clustering (Tortorella et al., 2021). The second most commonly employed methodology category is quantitative (39 papers), with 32 adopting an integrated mathematical and simulation model. This approach aims to enhance safety, transparency, and promptness in the transmission of hospital data both within the hospital and externally. This is achieved by addressing cybersecurity through blockchain, crypto system fog-based communication architecture, and edge computing. Among the remaining, seven papers develop simulations with the aim of examining the most effective patient management solution among local and regional hospital networks during natural disaster (Ceferino et al., 2020; Hassan & Mahmoud, 2020; Hossain et al., 2022; Kazemi Matin et al., 2021; Shahverdi et al., 2020), and with the goal of defining effective resource allocation during mass casualty incident (Patrone et al., 2020; Trucco et al., 2022). The third category pertains to the 29 papers that utilised researchers’ perspective. Among these, six are conceptual, leading to the definition of a theoretical framework regarding healthcare resilience (Behrens et al., 2022; Ito & Aruga, 2022; Lyng, Macrae, Guise, Haraldseid-Driftland, Fagerdal, Schibevaag, & Wiig, 2022; Lyng, Macrae, Guise, Haraldseid-Driftland, Fagerdal, Schibevaag, Alsvik, et al., 2022; Phattharapornjaroen et al., 2022; Zamiela et al., 2022). The remaining 23, on the other hand, present viewpoints and expert comments on the events that occurred. Literature reviews represent the least employed methodology category in the analysed studies, numbering 12, and among them, only 3 employ a systematic research method of analysis (Angelopoulou & Panagopoulou, 2022; Chowdhury et al., 2021; Friday et al., 2021).

Figure 4.

Employed research methodologies.

5. Thematic analysis and main findings

We conducted a thematic analysis to identify which organisational characteristics in terms of resources and capabilities affect hospital resilience, with respect to the different resilience dimensions, namely the ability to anticipate, adapt, respond, recover, and learn, as detailed in the sequel.

5.1. Ability to anticipate

The ability to anticipate, which is a proactive skill required to identify and monitor potential events or situations and changes, as well as their effects before the functioning of the hospital is affected, could be gained by hospitals by exploiting digital technologies’ resources and digital capabilities (Tortorella et al., 2022) (Figure 5). Digital technologies could be defined as interconnected digital applications, digital non-invasive care, electronics, and microstructure technologies, which leverage the main baseline technologies of IoT, big data, and cloud computing, while digital capabilities refer to the ability of hospital staff to use such digital technological tools (Tonetto et al., 2021).

Figure 5.

Resources and capabilities for the ability to anticipate.

Digital technologies create an information infrastructure and collect a great amount of relevant data, supporting information sharing, favouring communication between clinicians and among clinicians and patients, and uncovering hidden clinical information through data mining (Rubbio et al., 2019). The combination of digital technologies’ resources and digital capabilities enables, thus, to get more accurate information in real time and to predict with greater precision patient conditions (Marques da Rosa et al., 2021). In this way, digital technologies’ resources and digital capabilities help avoid complications and errors in patient processing that can require extraordinary use of personnel, space, and resources whose availability may not be guaranteed, resulting in inefficiency throughout the hospital and thus negatively affecting hospital resilience.

Moreover, digital technologies enhance vendor-managed inventory monitoring, increasing the integration of healthcare supply chain via Electronic Record Planning (ERP) and digital platforms that support supplier relationship management. In fact, cloud computing, wireless sensors, and IoT allow collecting and communicating real-time data across multiple layers of healthcare supply chains, as well as making intelligent decisions (Tortorella et al., 2021). In so doing, digital technologies help improve situational awareness by increasing the visibility of hospital supply chain, thus increasing the ability to anticipate (Chowdhury et al., 2021; Tortorella et al., 2022).

Digital technologies’ resources and digital capabilities support the ability to anticipate avoiding the risks of cyberattacks or data disasters that could disrupt the continuity of operations and activities (Awan et al., 2021; Hirano et al., 2020; Marulli et al., 2022). Specifically, cloud and fog computing are two prominent approaches to delivering timely and safe computing resources and services to end-users (Guo et al., 2021); blockchain technology, cloud-first and zero-trust security strategy are frequently used for data privacy, traceability, transparency, and immutability, giving only authorised stakeholders access to information (I. Ali & Kannan, 2022; Ejaz et al., 2021).

Recognising the importance of digital technology within the hospital, in order to facilitate the implementation process of technology, external integration between hospitals physicians and designers of Health Information Technology (HIT) could be extremely useful (Barrett, 2022). Supporting collaboration between physicians and HIT designers has a preventive function that leads to more effective implementation and acceptance of technology within hospitals.

A few selected articles suggest that the ability to anticipate could be gained by hospitals exploiting knowledge-based resources and related capabilities. As stated by Moss et al. (2021) managers’ skills in managing the drug inventory in the hospital pharmacy helps prevent shortages, significantly improving the ability to anticipate. The culture of quality and quality management in hospitals, which involves the adoption of lean management and total quality management tools, help detect vulnerabilities in internal operations and external supply chain issues (Hundal et al. 2021a; Alemsan et al. 2022; Kuiper et al., 2022). Among lean management tools, visual management, value stream mapping, and standardised work could allow hospitals to improve their transparency and visibility, as they create a visual guide of each step of the healthcare delivery processes and report critical and useful information (Hundal et al., 2021b; Papalexi et al., 2022). Studies that investigated the impact of lean tools for Inventory Management, such as Just in Time, Kanban and Kaizers, on healthcare supply chain performance, arrived at opposite conclusions. On one hand, they argued that lean tools enable hospitals to improve visibility of inventory so as promptly account for situational awareness within the healthcare supply chain, directly related to the ability to anticipate (Kuiper et al., 2022, Hussain et al., 2023; Patrone et al., 2020). On the other hand, an exaggerated waste elimination, due to the adoption of lean tools, could reduce efficiency while increasing vulnerabilities (Alemsan et al. 2022; Hundal et al., 2021a).

Finally, the hospital's ability to anticipate is also supported by the organisational capability of establishing an effective protocol implementation with the goal of preparing hospital staff for emergencies by means of a pre-established hierarchical structure and task-specific definition (Hassan & Mahmoud, 2020; Hines & Reid, 2021; Lim et al., 2020).

5.2. Ability to adapt

Hospital’s ability to adapt is related to their capacity to cope with unexpected disturbance or challenging conditions by managing and adjusting existing resources and organisational structure to guarantee proper healthcare services (A. Ali et al., 2017). Adapting involves having flexible intra- and inter-organisational processes, as well as building redundancy with extra capacity, extra personnel, and safety stocks (Behrens et al., 2022). This kind of ability to adapt to disruption is enabled both by property-based resources, such as remote technologies, and knowledge-based resources, for example skills and expertise of hospital staff in managing extraordinary situation (Figure 6). The COVID-19 pandemic accelerates digital transformation in hospitals, implementing a “new normality” in delivery services through remote technologies (Bhaskar, Bradley, Chattu, Adisesh, Nurtazina, Kyrykbayeva, Sakhamuri, Yaya, et al., 2020; Marques da Rosa et al., 2021; vanderWerf et al., 2022). These resources promote flexibility in treatment processes, give interconnected medical emergency support (Milch et al., 2021; Ölcer et al., 2021; Tortorella et al., 2022), facilitate the internal integration among hospital staff and improve external integration between hospitals, suppliers, and patients. The technologies most often utilised in remote care consultation of patients were artificial intelligence-enabled hospital platforms, telemedicine, video consultations, mHealth app, and non-invasive digital care such as wireless sensors (Bhaskar, Bradley, Chattu, Adisesh, Nurtazina, Kyrykbayeva, Sakhamuri, Moguilner, et al., 2020, vanderWerf et al. 2022; W. Chen et al., 2022; Shaw et al., 2022; Tonetto et al., 2021).

Figure 6.

Resources and capabilities for the ability to adapt.

The literature agrees on recognising the importance of knowledge-based resources for the hospital ability to adapt to disruption, acknowledging the critical role of skills and experience of medical including epidemiologist, surgeons, infectologists, virologists and administrative personnel in managing emerging pandemic-driven intensive care (de La Garza & Lot, 2022; Dichter et al., 2022; Spieske et al., 2022). To increase the availability of trained medical personnel, many hospitals engaged retired physicians and nurses, as well as research healthcare professionals (Behrens et al., 2022; Bessis et al., 2022; Lloyd-Smith, 2020). Hospitals also included dentists as part of the hospital worker force for their experience in working in stressful situations, in dealing with infection control procedures, and for their habit of wearing Personal Protection Equipment (PPE) (Sacoor et al., 2020). Moreover, the ability to adapt is built on the internal integration resulting from formal coordination mechanisms, such as protocols and guidelines, and informal collaborative relationships among staff members (de La Garza & Lot, 2022; Minka et al., 2021; Pomare et al., 2022; Ree et al., 2021). By implementing formal coordination mechanisms with the aim of standardising procedures, prioritising tasks, and redeploying or creating new roles with specific job description, hospitals have delivered continuity of care during crisis (Donelli et al., 2022; Hybinette et al., 2021; Suresh et al., 2021). The emerging informal collaborative relationships, to exchange best practices between staff members, could facilitate adjustment in processes (Juvet et al., 2021; Veerapen & McKeown, 2021).

5.3. Ability to respond

Responding means reacting on time and efficiently in front of a disruption (Kamalahmadi & Parast, 2016). Hospitals have faced a disproportionate flow of patients seeking care, resulting in a shortage of critical resources such as hospital staff, PPE, medicines, and disinfectants. To address these challenges, hospitals reacted by leveraging specific knowledge-based resources, namely the expertise of both procurement departments and medical personnel, as well as by exploiting external integration capability (Casiraghi et al., 2020; Koch et al., 2022; Lyng et al., 2021; Mervyn et al., 2019), namely the ability to manage hospital supplies, establish cross-hospital partnerships, coordinate the supply network (Figure 7). In fact, to resolve the disparity between the growing demand for resources reported by medical personnel and the supply difficulties experienced by manufacturers, procurement departments have identified alternative suppliers or implemented new procurement initiatives and strengthened the relationship within the supply chain (Pandit, 2021; Zamiela et al., 2022). The urgency of gaining access to alternative source of supply led some hospital procurement departments to eliminate the intermediary node of distributors creating direct links with geographically dispersed suppliers (Scala & Lindsay, 2021) and to collaborate with companies from other industries for medical supplies, such as ethanol from spirits producers and automotive medical masks (Spieske et al., 2022). During disasters, the external integration capability related to the ability to establish relationships between hospitals in the form of coalitions, collaborations, consortia and expertise sharing (Jordan et al., 2022; Kazemi Matin et al., 2021; Liu et al., 2020) allowed hospitals to avoid overcrowding of patients through a redistribution of the load of care services among referral hospitals (Ceferino et al., 2020; M. Chen et al., 2022; Hines & Reid, 2021). Other forms of coalitions that have proven effective include those between external pharmacies and laboratories, as highlighted by Sigala et al. (2022), Hannan et al. (2021), Hossain et al. (2022) and Jordan et al. (2022). In particular, the hub & spoke model proved particularly efficient thanks to home healthcare management or low and medium care facilities for patients with non-serious or chronic symptoms (Bohnett et al., 2022; Donelli et al., 2022; Kihlström et al., 2022). This capillary model encourages access to care for the population, reducing patient transfers across the territory, alleviating congestion in emergency departments, and minimising hospital-based cross-contamination among users and healthcare staff (Capolongo et al., 2020). The cross-hospital relationship is not just a matter of redistributing patients, but also leads to the creation of alternative sourcing through the so-called lateral transhipment (Aldrighetti et al., 2019), which means that hospitals create shared central warehouses for most medical products (Spieske et al., 2022). Lastly, during the COVID-19 pandemic crisis, external integration capability has also resulted in a more strict collaboration between governments and hospitals, enabling timely and accurate pandemic-data sharing (Zamiela et al., 2022).

Figure 7.

Resources and capabilities for the ability to respond.

5.4. Ability to recover

Recovery refers to actions taken after the adverse event to return to the original normal state or move to a new, suitable state (A. Ali et al., 2017). This ability is enabled by managerial skills of hospital top managers as well as external integration capability (Figure 8). Both of them, resource and capability, allow hospital to jointly formulate with public authority strategic plans of reconfiguration and restoration of normal operations (Bhaskar, Bradley, Chattu, Adisesh, Nurtazina, Kyrykbayeva, Sakhamuri, Moguilner, et al., 2020; Bozorgmehr et al., 2022; Hossain et al., 2022; Scala & Lindsay, 2021). Moreover, it has been proved that place-based collaborative networks, established thanks to hospital external integration capability, not only have increased hospital resilience during disruptions but they have also improved healthcare quality and value (Wiig et al., 2021). These collaborative networks represent a fertile ground to develop a culture of learning and to foster innovation, because of they allow sharing expertise among clinicians, and to secure better health outcomes, because of they enable combined resources and assets (Harland et al., 2021; Winkelmann et al., 2022).

Figure 8.

Resources and capabilities for the ability to recover.

5.5. Ability to learn

Learning is the ability, required after a disruptive event, to recognise what happened in the past, what were successes and failures, and to improve future performance with changes in behaviour as a result of experience (Tortorella et al., 2022). The ability to learn requires the creation of frequent learning opportunities (Wiig et al., 2021). In this vein, hospital results on a higher learning ability when it provides training and education programmes to its staff, for the acquisition of new knowledge and competences (Turan, 2021). Besides training and drills, internal integration capability effectively contributes to improve organisational learning processes, based on formal and informal knowledge transfer and information sharing mechanisms (Blackhurst et al., 2011) (Figure 9). As a result of COVID-19, two training requirements for staff members arose. First, it was necessary to redesign the organisational structure (e.g., introduce new roles and generate ever-changing COVID-19 instructions) in order to address the potential staffing shortage, with a focus on emergency management-qualified personnel. To this end, hospitals implemented training programmes, tailored to the context of the pandemic, with the aim of transferring the skills inherent to the new tasks and new ways of working Johnson et al., 2020). Second, it was necessary to ensure that the healthcare workforce was adequately motivated and fully committed to the hospital mission during the emergency. To this end, hospitals provided a trauma-informed care or psychoeducation programmes to support the development of the skills required to deal with stress associated with job changes and the management of newly assigned responsibilities (Appelbom et al., 2021; Haraldseid-Driftland et al., 2021; Jordan et al., 2022).

Figure 9.

Resources and capabilities for the ability to learn.

6. Discussion and research directions

This study is an effort to systematically aggregate the current body of knowledge on organisational characteristics, in the form of resources and capabilities, that support the hospital resilience in managing disturbances. Although the literature on healthcare resilience reveals an increasing interest in studying the resilience of healthcare organisations, and in investigating organisational characteristics that impact resilience (Barasa et al., 2018, Blanchet et al., 2017; Gilson et al., 2020), a critical aspect that emerges is the tendency to map linear relationships between organisational characteristics including structure, practices, and behaviours and hospital resilience. A further step would be to depict the complex set of configurations and combinations of these characteristics leading to resilience. In line with the operations management literature, which advocates for adoption of a resource-based perspective for exploring organisational resilience (Cheng & Lu, 2017, Ambulkar et al., 2015; Kamalahmadi & Parast, 2016), our study is grounded on the theoretical framework of the Resource-Based View (RBV). It formulates a framework delineating organisational characteristics in relation to resources and capabilities, illustrating the synergistic effects that emerge from their interplay.

The results reveal that even if there is no one-size-fits-all path to resilience (Lyng et al., 2021), well-performing hospitals have implemented common resources and capabilities against disruptions. Applying the RBV perspective, existing research largely suggests that hospitals can differentiate from each other, in terms of resilience performance, by leveraging digital technologies, as property-based resources, along with technical skills and managerial competences, as knowledge-based resources. Specifically, the digital information infrastructure enables the collection of a vast quantity of relevant data that supports patient-centered care, superior organisational knowledge, and synergies among hospital staff, medical personnel and patients, and hospital employees and supply partners (Marques da Rosa et al., 2021; Rusinko, 2020). As a result, digital technologies contribute to improved situational awareness, greater visibility and flexibility, namely resilience elements related to the ability to anticipate and adapt. However, while the adoption of digital technologies improve resilience, its implementation is not without criticalities. The critical aspect lies in the development and cultivation of digital capabilities, which hinges on a deep understanding of how to effectively apply digital technologies and how to combine resources, such as information technology (IT) infrastructure and skills, to create superior applications (Garcia-Perez et al., 2022a; Joyce et al., 2021; R. H. Xu et al., 2022). This knowledge must be integrated into organisational routines, leading to an enhancement in the IT skills base of hospitals (Bharadwaj, 2000). However, many studies found that improperly implemented digital technologies can cause time wastage and obstruct departmental activities (Austin et al., 2022; McLeod et al., 2019). Given these conflicting findings regarding the impact of digital technologies on hospital resilience, there is a pressing need for further research, including empirical investigations, specifically focused on unravelling the link between digital technology resources and digital capabilities to foster and nurture resilience dimensions.

Furthermore, despite the increasing interest in digital technologies within the healthcare sector, the existing studies predominantly concentrate on a restricted range of technologies, such as electronic health records or digital platforms and propose qualitative models of safe and trusted data-sharing (Hirano et al., 2020; Kaleta et al., 2022; Milch et al., 2021).

These gaps underscore the need for additional research encompassing a wider array of Industry 4.0 technologies, including cloud computing, big data technologies, blockchain, cyber-physical systems and the Internet of Things (I. Ali & Kannan, 2022). Understanding how the latest frontier of Industry 5.0 regarding a comprehensive personalised healthcare services (CPHS) in modern healthcare Internet of Thing, scan be implemented in hospitals is just as essential as clarifying its role in hospital resilience (Taimoor & Rehman, 2022; Zhang et al., 2020). For hospitals at the forefront of implementing digital technologies in healthcare, there is a growing discussion about the potential adoption of Industry 5.0 to ensure an increasingly human-centred use of technology (Nayeri et al., 2023). This would enable more efficient management of operations within the hospital. For instance, intelligent healthcare devices assist in monitoring the expiration of equipment parts, alerting the responsible team. Furthermore, doctors can swiftly locate specific medical equipment, such as an oxygen cylinder, when urgently needed, reducing the time spent searching and potentially contributing to saving the patient’s life (Tonetto et al., 2021). Furthermore, this type of technology holds promise in the early diagnosis of serious illnesses, managing to correlate various health conditions.

The SLR revealed that both knowledge-based resources, encompassing administrative, organisational, and medical competences, and the related capabilities, namely the organisational capability, the internal and external integration ones, are significant contributors to the resilience dimensions, especially for the ability to adapt, respond, and recover (Jordan et al., 2022; Kazemi Matin et al., 2021; Wang, 2022). Indeed, medical expertise empowered frontline staff to exhibit adaptive behaviours during emergencies, while the purchasing department competencies enhanced the ability to explore alternative sources for critical materials. Lastly, organisational competencies pertained the ability to adapt spaces, personnel, and delineate new roles in front of the crisis. In this context, issues related to department reorganisation, new job responsibilities, and altered work schedules were considerably more commonly reported (Litke et al., 2022). Implementing significant changes rapidly destabilised healthcare professionals who found themselves performing tasks outside their usual (Juvet et al., 2021). A good hospital leadership can be considered as an essential competence not only for detecting early warning signs of a crisis but also to effectively engage staff, facilitate collaborations within and among departments, help acquire new skills through education and training, boost staff well-being and self-care, resulting in better patient care and healthcare outcomes (Lim et al., 2020; Hodgins et al., 2021). Accordingly, hospital leadership style and behaviour is a key area to be explored further.

For successful hospital resilience, it is essential to address the availability of medical supplies, medications, drugs, and essential goods for patient care. This necessitates the improvement of the resilience of the healthcare supply chain. The purchasing department’s knowledge and skills, as well as the supply chain integration capability, have proven crucial in overcoming the barriers imposed by COVID-19. However, there is still a need to understand how the strategies of supply management and collaboration between local authorities could influence the resilience of the healthcare supply chain (Harland et al., 2021; Khuntia et al., 2022; Mervyn et al., 2019). Given the intricate complexity of the healthcare supply chain, involving actors in the upstream part such as medical device manufacturers, equipment producers, biotech firms, and pharmaceutical companies, in the central part including insurance companies, claims, administrators, and in the downstream part involving actors in healthcare delivery such as doctors, nurses, hospitals, and patients, it becomes essential to understand which coordination strategies prove most effective to ensure the most efficient delivery of services to the end patient. Moreover, the development of a digital infrastructure within the healthcare supply chain facilitates the real-time collection of data, fostering situational awareness and a proactive response to disruptive events. Despite the growing literature on the healthcare supply chain (Scala & Lindsay, 2021; Spieske et al., 2022; Zamiela et al., 2022), there is still room for understanding how the digital technology could influence resilience healthcare supply chain and what the related (either positive or negative) effects might be. Finally, a key aspect that emerges from the literature review concerns the need for collaborative and cooperative participation between hospitals (Ito & Aruga, 2022; Koch et al., 2022; Shahverdi et al., 2020). Further research is needed to investigate how healthcare organisations should be reorganised, individually and collectively.

The findings of this study are consistent with and validate previous frameworks that contain potential explanatory factors of resilience dimensions. Technology, for example, and the ability to establish effective internal and external integration are features present in Barasa et al. (2018). Blanchet et al. (2017) recognises the importance of knowledge as the ability to acquire, integrate, and evaluate many sources of information and competencies, as well as the ability to manage diverse interdependencies.

This review identifies lack of experimental studies in comparison to observational research. This aligns with recognition that resilience is not open to direct measurement or intervention (Ellis et al., 2019). The lack of measurable indices suggests that there is still a gap between the concepts related to resilience and the following operationalisation in the context of the healthcare system and its organisations (Biddle et al., 2020). An aspect closely connected to the theme of healthcare service delivery and, consequently, a more resilient hospital system, is its increasing focus on the patient. As mentioned earlier, technological supports push in this direction, but it is not sufficient. Patient involvement is necessary in all stages of the supply chain, especially in the development of medical devices, to facilitate, support, and encourage usage not only by healthcare professionals but also by the patients themselves (Jiang et al., 2022). It would be worthy to investigate how empowering patients to identify the challenges and co-design the best solutions.

The future research perspective in this field is to enrich resilience operationalisation debates with new theoretical models and empirical studies. Analytical modelling approaches such as simulation, decision analysis, multi-criteria decision analysis, among others, and quantitative empirical research are relevant methods to understand in depth and consequently strengthen health resilience. With a more general-purpose key, the findings suggest that the following directions for future research should obtain a complete picture of resilience. This means that all the qualitative research emerged from this review must be integrated with quantitative research. It could be valuable to investigate with empirical studies the relationship between these resources and capabilities, figured out by this review, and resilience dimensions, catching, with cross-longitudinal studies, differences between hospitals.

7. Conclusions

Healthcare organisations and particularly hospitals have been severely affected by the pandemic that has undermined their primary goal of providing patient care. Such a crisis has put hospital resilience, namely, its ability to remain fully operational prior to, during, and following the disruption, at the centre of interest for researchers and practitioners. The findings of this study offer significant contributions to healthcare management researchers in advancing the current comprehension of hospital resilience. The SLR resulted in profiling the existing studies and identifying not only which resources and capabilities could foster hospital resilience, but also which of these organisational characteristics are associated with specific dimensions of hospital resilience.

Our research provides valuable insights to managers of service operations within hospitals highlighting those resources and capabilities to which managers should pay close attention to yield improvement in hospital resilience. A research approach based on resources and capabilities facilitates a greater comprehension of organisational dynamics and the development of structured and replicable resilience research (Alameddine et al., 2019).

For an overall advantage in resilience performance, managers should promote integration in all its three forms, internal, external, and supply chain. Specifically, the findings of the study reveal that external integration has a greater impact on the four dimensions of resilience, anticipate, adapt, respond, recover, only having little impact on the ability to learn. To this end, managers must ensure that all activities of collaboration, cooperation, and coordination are implemented. Managers, thus, should cultivate relationships with external members, such as other healthcare facilities, local entities, and develop collaborative networking. Moreover, internal integration is a prerequisite for the successful implementation of external integration. In this regard, internal integration appears to have a significant impact on the four dimensions of resilience of adapt, respond, recover, and learn while having a lesser effect on the ability to anticipate. To this end, managers must ensure that activities of coordination, collaboration, and proper communication are properly implemented in the workplace within and across hospital departments. Lastly, the lessons learned from this review reveal that the integration of healthcare supply chains can facilitate the development of hospital response ability. Given the scarcity of resources resulting from the pandemic, managers must allocate resources judiciously in order to build a supply chain integration infrastructure that yields the greatest possible benefits.

In terms of organisational capabilities, particularly useful for the ability to anticipate and adapt, the study recommends that managers make concerted efforts to implement or redeploy appropriate management measures and develop various organisational aspects ranging from formal and informal procedures and routines to new or changed tasks and roles. Also, they need to implement or redeploy appropriate management measures to boost adaptability in challenging situations and forging a closer link between services, staff, and patients. Hospitals are also suggested considering their resources and capabilities simultaneously. Utilising the skills and experience of medical and administrative technical personnel, for instance, promotes the growth and the implementation of diverse capabilities, such as internal, external, and supply chain integration.

Despite using a recognised and scientifically rigorous research technique, the study presents certain limitations. The literature review sample was confined to a predefined set of inclusion-exclusion criteria. This means our final included body of knowledge has excluded book chapters, conference proceedings, non-peer reviewed articles and non-English articles. Incorporating more works might have resulted in extra relevant works and new insights. Similarly, the keywords used in the database search and the selection filters used in the literature search could have resulted in the omission of potentially relevant articles. Finally, while our literature analysis aims to collect findings from the past 4 years, our final included body of knowledge may have excluded significant publications on this topic, published prior to 2019. In this study, we employed the theoretical lens of RBV to examine the influence of resources and capabilities on hospital resilience. However, it is crucial to note that this perspective has a limitation known as “context insensitivity”, neglecting contingencies that may impact this influence. To address this, in future studies, we will adopt the theoretical perspective of the Contingent Resource-Based View to delve deeper into environmental and organisational factors, aiming for a more comprehensive understanding of hospital resilience.

Appendix 1. Search strategies for each database

SCOPUS: TITLE-ABS-KEY (resilien* AND (hospital OR healthcare OR “health care”) AND NOT (“psychology* resilience” OR “personal resilience” OR “mental health”)) AND (LIMIT-TO (DOCTYPE, “ar”)) AND (LIMIT-TO (LANGUAGE, “English”)). 

WoS: resilien* AND (hospital OR healthcare OR “health care”) NOT (“psychology* resilience” OR “personal resilience” OR “mental health”) (Topic) and 2022 or 2021 or 2020 or 2019 (Publication Years) and Article (Document Types) and English (Languages).

PubMed: ((hospital OR healthcare OR “health care”) AND resilien* NOT (“psychology* resilience” OR “personal resilience” OR “mental health”)) Filters: English, from 2019 – 2022.

Detailed: (((“hospital s”[All Fields] OR “hospitalisation”[All Fields] OR “hospitalization”[MeSH Terms] OR “hospitalization“[All Fields] OR “hospitalised”[All Fields] OR “hospitalising-[All Fields] OR “hospitality-[All Fields] OR “hospitalisations-[All Fields] OR “hospitalizations”[All Fields] OR “hospitalize”[All Fields] OR “hospitalized”[All Fields] OR “hospitalizing”[All Fields] OR “hospitals”[MeSH Terms] OR “hospitals”[All Fields] OR “hospital”[All Fields] OR (“delivery of health care”[MeSH Terms] OR (“delivery”[All Fields] AND “health”[All Fields] AND “care”[All Fields]) OR “delivery of health care”[All Fields] OR “healthcare”[All Fields] OR “healthcare s”[All Fields] OR “healthcares”[All Fields]) OR “health care”[All Fields]) AND “resilien*“[All Fields]) NOT (“psychology resilience”[All Fields] OR “personal resilience”[All Fields] OR ”mental health,[All Fields])) AND ((english[Filter]) AND (2019:2022[pdat])).

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Table A.1.

Resources-Capabilities-Resilience.

Resilience Dimensions	Capabilities	Exploited Resources	Authors
Ability to anticipate	External Integration (Collaboration with HIT designer)	Information sharing	(Barrett, 2022)
	Visibility; Technological capability	Blockchain, AI, Machine learning; cryptosystem, fog-computing, radio-frequency identification (RFID), cloud technologies	(Agrahari et al., 2022; Awan et al., 2021; Domadiya & Rao 2021; Ejaz et al., 2021; Guo et al., 2021; Hirano et al., 2020; Jan et al., 2021; Joyce et al., 2021; Li, 2022; Lotfi et al., 2022; Musamih et al., 2022; Pamucar et al., 2022; Pu et al., 2022; Rehman and Ali, 2022; Shakil, 2020; Singh and Chaurasiya, 2022; Taimoor and Rehman, 2022; Ullah et al., 2020; Chiu et al., 2021; Garg et al. 2020; Islam et al., 2021; Mayer et al., 2021; T. de Oliveira et al., 2021; Xu et al., 2020; Garcia-Perez et al., 2022; Garg et al., 2022; Hundal et al., 2021b; Jagatheesaperumal et al., 2022; Jeet et al., 2022; Nimmy et al., 2022; Wazid et al., 2022; Joyce et al., 2021; Singh and Chaurasiya, 2022; Abraham et al., 2019; Guo et al., 2021; Marulli et al., 2022; Patrone et al., 2020; Sim et al., 2022)
		Digital Health Technology for monitoring	(Marques da Rosa et al., 2021; McLeod et al., 2019; Milch et al., 2021; Rubbio et al., 2019; Tortorella et al., 2021; Tortorella et al., 2022)
	Situation Awarenses; Visibility; Robustness	Quality culture (Lean Six Sigma tools, Incident Report System, Forecasting model for drug inventory); Staff competencies (prevent drug shortage)	(Alemsan et al., 2022; Hundal et al., 2021a–b; Hussain et al., 2022; Kuiper et al., 2022; Lotfi et al., 2022; Papalexi et al., 2021; Ferorelli et al., 2020; Moss et al., 2021)
	Organizational Capability (Establishing protocols and guidelines)	Information sharing; Managerial competences	(Fiske et al., 2021; Hassan and Hussam, 2020; Hines and Reid, 2021; Kihlström et al., 2022; Angelopoulou and Panagopoulou, 2022)
Ability to Adapt	Technological capability; Flexibility; Internal integration (communication and coordination among staff members); Visibility; External integration (communication with patients; supply chain integration).	Digitalisation of health care setting; Remote care technology (e-health apps, telemedicine, wireless devices)	(Agrahari et al., 2022; Austin et al., 2022; Bhaskar et al., 2020a; Bhaskar et al., 2020b; Chowdhury et al., 2021; Furstenau et al., 2022; Lyng et al., 2021; Marques da Rosa et al., 2021; McLeod et al., 2019; Milch et al., 2021; Ölcer et al., 2021; Plagg et al., 2021; Rehman and Ali, 2022; Rusinko, 2020; Shaw et al., 2022; Singh and Chaurasiya, 2022; Tonetto et al., 2021; Tortorella et al., 2021; Tortorella et al., 2022; VanderWerf et al., 2022; Wiig et al., 2022; Winkelmann et al., 2022; Behrens et al., 2022; Dichter et al., 2022; Zamiela et al., 2022; Chiu et al., 2021; Lyng et al., 2021; Malik et al., 2021; Minka et al., 2021; Shah et al., 2020; Suresh et al., 2021; Till and McGivern, 2021; Zhang and Qi, 2021; Zhang et al., 2020; Garcia-Perez et al., 2022; Xu et al., 2022; Ziser et al., 2022; Jordan et al., 2022; Kaleta et al., 2022)
	Redundancy (In-house production; backup, increase capacity (staff, bed, equipment))	Managerial competences; clinical nurses experience;	(Behrens et al., 2022; Lim et al., 2020; Spieske et al., 2022; Ladak et al., 2021; Chiu et al., 2021)
	Organisational Capability (improving operational routines and procedures); Internal Integration (coordination among staff, non-hierarchical governance).	Information sharing; Digital Technology; Medical and managerial skills; Leadership	(Bessis et al., 2022; Borek et al., 2022; Casiraghi et al., 2020; de La Garza & Lot, 2022; Dichter et al., 2022; Donelli et al., 2022; Gifford et al., 2022; Hines and Reid, 2021; Hybinette et al., 2021; Lim et al., 2020; Liu et al., 2020; Lyng, et al., 2022a; Lyng et al., 2022b; Moitinho de Almeida et al., 2021; Phattharapornjaroen et al., 2022; Ravaghi et al., 2022; Ree et al., 2022; Sacoor et al., 2022; Sawyer et al., 2022; Shahverdi et al., 2022; Tremblay et al., 2022; Trucco et al., 2022; Minka et al., 2021; Reyes et al., 2021; Shah et al., 2021; Suresh et al., 2021; Till and McGivern, 2020; Uhl-Bien et al., 2020; Veerapen and McKeown, 2021; Wei et al. 2019; Croghan et al., 2022; Fagerdal et al., 2022; Fernandes et al., 2022; Förster et al., 2022; Grailey et al., 2022; Hodgins et al., 2022; Khalil et al., 2022; Litke et al., 2022; Łukasik and Porębska, 2022; Sanford et al., 2022; Wong et al., 2022; Ziser et al., 2022; Lloyd-Smith, 2020 Pandit et al., 2021; Pomare et al., 2022;)
Ability to Respond	External Integration (supply chain integration, lateral trans-shipment, coordination and collaboration with stakeholders; collaboration with local authority and agencies)	Information sharing; Skills-expertise of the physicians-procurement department	(Ali and Kannan, 2022; Chowdhury et al., 2021; Cimellaro et al., 2019; Harland et al., 2021; Hines and Reid, 2021; Juvet et al., 2021; Lim et al., 2020; Pamucar et al., 2022; Phattharapornjaroen et al., 2022; Ravaghi et al., 2022; Scala and Lindsay, 2021; Sigala et al., 2022; Spieske et al., 2022; Zamiela et al., 2022; Lyng et al., 2021(c); Veerapen and McKeown, 2021; Khuntia et al., 2022;)
	External Integration (networking; coalitions, consortia; collaboration, collaborative place-based networking)	Digital technologies; Information sharing; Skills-expertise of the physicians-procurement department	(Baxter and Casady, 2020; Bohnett et al., 2022; Ceferino et al., 2020; Chen et al., 2022a; Chen et al., 2022b; Cimellaro et al., 2018; de La Garza & Lot, 2022; Donelli et al., 2022; Hassan and Hussam, 2020; Ito and Aruga, 2022; Kihlström et al., 2022; Kagwanja et al., 2020; Mandel-Ricci and Belfi, 2022; Shahverdi et al., 2020; Winkelmann et al.,2022; Hannan et al., 2021; Förster et al., 2022; Jiang et al., 2022; Snowdown and Wright, 2022; Wang et al., 2022; Aldrighetti et al., 2022; Friday et al., 2021; Capolongo et al., 2020; Kazemi Matin et al., 2021; Koch et al., 2022; Pandit et al., 2022; Mervyn et al., 2019;)
Ability to Recover	External integration (Long-term collaborations with the local authority; supply chain integration)	Information sharing; Skills-expertise of top managers	(Bhaskar et al., 2020a; Harland et al., 2021; Ito and Aruga, 2022; Kihlström et al., 2022; Scala and Lindsay, 2021; Spieske et al., 2022; Wiig et al., 2021; Bozorgmehr et al., 2022; Hossain et al., 2022; Khuntia et al., 2022)
Ability to Learn	Internal integration (collaborative learning)	Psychoeducational programme; Curses and training; Information sharing	(Appelbom et al., 2021; Ballantyne and Achour, 2022; Casiraghi et al., 2020; Fiske et al., 2021; Huey and Palaganas, 2020; Juvet et al., 2021; Kihlström et al., 2022; Lim et al., 2020; Sabateen et al., 2022; Turan, 2021; Sawyerr and Harrison, 2022; Wiig et al., 2021; Johnson et al., 2020; Spiva et al., 2020; Croghan et al., 2022; Haraldseid-Driftland et al., 2022; Lowry et al., 2022; Franco and Christie, 2021; Jordan et al., 2022)

Table A.2.

Detailed overview of resilience dimensions, resources, capabilities of retrieved papers.

Authors	Year	Resilience Dimension	Resources	Capabilities	Methodology	Specific methodology/technique/method applied
Appelbom et al.	2021	Learn	Training for hospital leaders on how to manage crisis, transfer of new knowledge; teamwork, interpersonal skills, effective educational interventions		Empirical	Case study
Awan et al.	2021	Anticipate	Digital technologies (cybersecurity)		Quantitative	Mathematical model and simulation
Baxter & Casady	2020	RespondRecover		Externa integration (Public-private partnership: institutional cooperation, long term infrastructure contracts, short-medium and long term projects)	Researchers’ perspectives	Commentary
Bhaskar et al.	2020b	Adapt	Digital technologies (Telemedicine, communication infrastructure)	Technological capability	Researchers’ perspectives	Commentary/viewpoint
Casiraghi et al.	2020	Adapt Learn	Skills of medical and nursing staff Training for staff	Organizational capability (after cancelling elective surgeries, re-employment of medical and nursing staff in covid wards); External integration (Formal national and intrahospital protocols)	Empirical	Case study
Chowdhury et al.	2021	AdaptRespond Recover	Digital technologies (3-D printing technology, artificial intelligence and mobile service operation)	Organizational capability (redefinition of roles and tasks; scaling capacity) External integration (partnership)	Review	Systematic literature review
Cimellaro et al.	2019	Respond	Information sharing, emergency training and drills	Internal integration (coordination within and across departments)	Empirical	Survey, factor analysis for ranking
Domadiya & Rao	2021	Anticipate	Digital technologies (Data mining central service)		Quantitative	Mathematical model and simulation
Ejaz et al.	2021	Anticipate	Digital technologies (cybersecurity: combination of edge computing and blockchain)		Quantitative	Mathematical model and simulation
Fiske et al.	2021	Anticipate	Educational training (for students on stress management, trauma-informed care, develop resilience skills)	Internal integration (collaborate with other disciplines to provide care)	Empirical	Case study (educational course)
Guo et al.	2021	Anticipate	Digital technologies (cryptosystem and fog-based communication architecture)		Quantitative	Mathematical model and simulation
Hines & Reid	2021	AnticipateRespond	Skills and competence of nurses, physicians, doctors and technician (expert team)	Organizational capability (Establishing protocols and guidelines); External integration (collaboration with local authority, agencies)	Empirical	Case study (survey, interviews, secondary data)
Hirano et al.	2020	Anticipate	Digital technologies (cybersecurity)		Empirical	Case study
Huey and Palaganas	2020	Learn	Training for hospital leaders (on how to manage crisis, transfer of new knowledge); teamwork, interpersonal skills, effective educational interventions		Review	Review synthesis
Hundal et al.	2021(a)	Anticipate	Quality culture (Lean six sigma programs and practices)		Empirical	Interviews + new model
Hybinette et al.	2021	Adapt	Information sharing	Internal integration (coordination among managers such as clinical coordinators, head nurses, physicians); organizational capability (reorganising tasks, defining clearly new role)	Empirical	Case study (observation)
Jan et al.	2022	Anticipate	Digital technologies (cybersecurity)		Quantitative	Mathematical model
Juvet et al.	2021	AdaptRespond	Skills of extra qualified personnel; Information sharing	Organizational capability (Reorganisation of tasks, services and spaces; staff increases and reassignments; new rules and protocols); Internal and external integration (interdisciplinary collaboration and collaboration with families)	Empirical	Longitudinal study
Kagwanja et al.	2020	Adapt		Organizational capability (Reorganisation of tasks, services and spaces; staff increases and reassignments; new rules and protocols); Collaboration (external integration)	Empirical	Learning site: interviews, observations, secondary data
Marques da Rosa et al.	2021	Anticipate Adapt	Digital technologies (Telemedicine, Digital non-invasive care)	External integration (project for design of digital collaborativeplatforms)	Empirical	Case study (survey, interviews)
McLeod et al.	2019	Anticipate Adapt	Pharmacist competence in using electronic prescribing and medication administration (epa) systems;	Technological capability	Empirical	Case study (observation, interviews)
Milch et al.	2021	Anticipate Adapt	Digital technologies (telemedicine)		Review	Literature review
Ölcer et al.	2021	Adapt	Digital technologies (Web site for sharing information, Telemedicine)		Empirical	Case study (qualitative document analysis, qualitative content analysis)
Plagg et al.	2021	Adapt		External integration with primary care specialist (helpful in identifing outbreaks in a timely manner and take immediate action to avoid going to hospital)	Researchers’ perspectives	Perspective/opinion piece/commentary/ viewpoint
Ree et al.	2021	Adapt	Managerial skills	Organizational capability (Prioritizing and allocation of resources); internal integration (interdisciplinary collaboration); external integration (networks or collaboration with external actors)	Empirical	Longitudinal case study
Rubbio et al.	2019	Anticipate Adapt	Digital technologies (electronic medical records, digital platforms)	Internal integration (multidisciplinary collaboration) Flexibility	Empirical	Case study (on hospital ward, semi structured interviews)
Rusinko	2020	Adapt	Digital technologies (telemedicine, communication infrastructure; Additive manufacturing)		Empirical	Case study
Sacoor et al.	2020	Adapt	Medical skills (incorporating dentists in the emergency workforce)		Researchers’ perspectives	Commentary/ viewpoint
Scala & Lindsay	2021	Respond		External integration (local authority, suppliers)	Empirical	Exploratory case study
Shahverdi et al.	2020			External integration (coordination with other hospitals for patient transfer, coalition policy)	Quantitative	Simulation of hospital interconnections, shared resources.
Tonetto et al.	2021	Adapt	Digital technologies (ICT’s for remote consultation, digital platforms, digital non-invasive devices; interconnected medical emergency support)	Internal and external information integration (collaborative sharing)	Empirical	Exploratory case study
Turan	2021	Learn	Psychoeducational training for intensive care workers		Empirical	Case study
Ullah et al.	2020	Anticipate	Digital technologies (cybersecurity)		Quantitative	Mathematical model+simulation
Wiig et al.	2021	RecoverLearn	Digital technologies (digital platform) communication skills of regulators and hospital managers	Internal and external integration (reflective spaces, dialogic practice for gaining understanding about the organization)	Researchers’ perspectives	Commentary/viewpoint
Agrahari et al.	2022	Anticipate	Digital technologies (cybersecurity)		Quantitative	Mathematical model
Alemsan et al.	2022	Anticipate	Quality culture (Lean principles)		Review	Scoping review
Ali and Kannan	2022	Adapt	Digital technologies (Iot, big data, blockchain, Ai)		Review	Topic modelling
Austin et al.	2022	Adapt	Digital technologies (computerised clinical support systems, telecommunication, health medical records)	Technological capability External integration (distal specialist consultation, and integrated patient-centred care)	Empirical	Cwa modelling+case study
Ballantyne and Achour	2022	Adapt	Nurses skills leaders competencies	Organizational capability (Reorganisation of tasks, services and spaces; staff increases and reassignments; new rules and protocols)	Empirical	Case study (interview)
Barrett	2022	Anticipate		External integration with suppliers and HIT designer	Empirical	Case study (interview)
Behrens et al.	2022	AdaptRespond	Backup suppliers	Organizational capability (Reorganisation of tasks, services and spaces; staff increases and reassignments; new rules and protocols); Increasing capacity of staff	Researchers’ perspectives	Conceptual
Bessis et al.	2022	Adapt		Organizational capability (Reorganisation of tasks, services and spaces; staff increases and reassignments; new rules and protocols);	Empirical	Case study (description)
Bhaskar et al.	2020a	Adapt	Digital technologies (telemedicine, communication infrastructure)	External integration	Researchers’ perspectives	Commentary based on case-based approach literature review, website, media sources
Bohnett et al.	2022	Respond		External integration (inter-organizational collaboration)	Empirical	Case study (survey+monte carlo simulation)
Borek et al.	2022	Adapt		Organizational capability (shifting responsibilities and redeployment)	Empirical	Longitudinal case study (interview)
Ceferino et al.	2022	Respond		Organizational capability (reorganisation of tasks, services and spaces; staff increases and reassignments; new rules and protocols); External integration (collaboration between groups of interdependent hospitals, social networks, coordination)	Quantitative	Simulation of earthquakes response at national level
Chen et al.	2022(a)	Adapt Respond		External integration (hospital networking, cooperation between hospitals through the ambulance deviation)	Quantitative	Mathematical model, case study (comparative study between different strategies)
Chen et al.	2022(b)	Adapt	Digital technologies (telemedicine)skills of the NCIS GO service (multidisciplinary team comprising geriatricians, oncologists, advanced nurse practitioner, nurses, carecoordinators, pharmacists, medical social workers, physiotherapists, occupational therapists, and dietitians)		Empirical	Case study
de La Garza and Lot	2022	Adapt Respond	Knowledge, competencies and expertise of hospital crisis unit made up by critical care, surgery, medicine, administrative skills, epidemiologist, surgeons, infectologists, virlogists information sharing and communication	Internal and external integration (coordination mechanisms, working groups) Organizational capability (reconfigurations of roles and tasks, change protocols, simplification of administrative procedure)	Empirical	Interview
Dichter et al.	2022	Adapt	Interpersonal skills	Internal integration	Researchers’ perspectives	Perspective/opinion piece/commmentary/viewpoint
Donelli et al.	2022			Organizational capability (reorganization of roles, rules and tasks)	Empirical	Case study
Furstenau et al.	2022	Adapt	Digital technologies	External integration	Empirical	Multiple case study
Gifford et al.	2022	Adapt	Skills of crisis team crisis unit (board members, departmental managers (e.g., hr, capacity planning) and medical leaders); digital technologies	Organizational capability (scaling capacity, increasing ICU and emergency care capacity; change of destination of use about spaces); redeployment of staff; expansion of role (after short training)	Empirical	Exploratory case study
Harland et al.	2021	Respond	Skills and competencies of managers and administrative staff (to identify new suppliers); Digital technologies	External information integration (coordination with suppliers)	Empirical	Interview
Hassan and Mahmoud	2020	Anticipate Respond	Skills and competencies of managers and administrative staff	Organizational capability (reorganisation of tasks, services and spaces; staff increases and reassignments; new rules and protocols); External integration (collaboration through interdependent hospital groups, redistribution of patients and reduction of waiting times)	Quantitative	Definition of functionality model and simulation in a case study
Hussain et al.	2022	Anticipate	Quality culture (lean tools for eliminatingredundant activities and designing useful interventions for achieving operationalresilience through better responsiveness)		Empirical	Case study (interview and observation)
Ito and Aruga	2022	Respond		External integration (healthcare coalition)	Researchers’ perspectives	Conceptual
Kihlström et al.	2022	AnticipateRecover Learn	Information sharing Educational program (how to stay updated) Training	External integration (networks of cooperation local and regional level for identifying creative solutions together, for ensuring access to PPE, setting up covid testing infrastructure)	Empirical	Case study
Kuiper et al.	2022	Anticipate	Quality culture (Lean 6 sigma programs and practices)		Researchers’ perspectives	Commentary/viewpoint (abductive reasoning)
Li	2022	Anticipate	Digital technologies (cybersecurity Blockchain)		Quantitative	Mathematical model
Lim et al.	2020	Anticipate Adapt Learn	Backup, emergency stockpiles Managerial and medical skills Training and drills for staff	Organizational capability for technical response plan (reorganisation of tasks, services and spaces; staff increases and reassignments; new rules and protocols); Internal integration (interdisciplinary communication) External integration with authority or emergency agencies and public	Empirical	Survey for data collecting and regression analysis
Liu et al.	2020	Adapt Respond	Nurse-physician skills to communicate, trust,information sharing.	Internal and external integration	Empirical	Case study (interview)
Lotfi et al.	2022	Anticipate	Digital technologies (blockchain technology for VMI to manage the medicine inventory) Information sharing	External integration (communication between suppliers and resellers)	Quantitative	Mathematical model
Lyng et al.	2022a	Adapt		Organizational capability (reframing practices, adjustment as short term adaptation; re-prioritizing resources)	Researchers’ perspectives	Conceptual
Lyng et al.	2022b	Adapt	Skills and competencies of healthcare operators (as mediators between hospitals and community, transferring knowledge between departments) Information sharingDigital Technologies	Internal and external integration (multidisciplinary coordination and between hospitals and community)	Researchers’ perspectives	Conceptual
MacKinnon et al.	2022	Adapt	Managerial skills (preparing areas) Interpersonal skills (teamworking, support for decision making about patients)	Internal integration (multidisciplinary coordination)organizational capability (scaling capacity)	Empirical	Case study (interview)
Mandel-Ricci and Belfi	2022	Adapt Respond		External integration (cooperation between hospitals, routine coordination meetings with governors ‘office)	Empirical	Case study
Moitinho de Almeida et al.	2021	Adapt	Educational training (psychological support) Interpersonal skills	Internal integration (staff meeting) Organizational capability (reorganisation of tasks, services and spaces; staff increases and reassignments; new rules and protocols)	Empirical	Case study, interview
Musamih et al.	2022	Anticipate	Digital technologies (cybersecurity through NFT: transparency and security of products in the healthcare supply chain, with benefits such as verification of product propriety, transferability, authenticity, and blocking of new entry flows)		Quantitative	Mathematical model
Ortiz-Barrios et al.	2022	Anticipate	Backup, Emergency equipment, training and drills	Internal integration (multidisciplinary communication)	Quantitative	Analytical model
Pamucar et al.	2022	Anticipate	Digital technologies for Healthcare supply chain using fuzzy rough numbers (FRN)		Quantitative	Mathematical model+case study
Papalexi et al.	2021	Anticipate	Quality culture (Lean principles)		Empirical	Multi group regression
Phattharapornjaroen et al.	2022	Adapt		Internal and external integration; organizational capability (reorganisation of tasks, services and spaces; staff increases and reassignments; new rules and protocols)	Researchers’ perspectives	Conceptual
Pu et al.	2022	Anticipate	Digital technologies (cybersecurity)		Quantitative	Mathematical model
Ravaghi et al.	2022	Anticipate Adapt Respond	Experience of multi-sectorial and multi-speciality emergency operating centres (teaching role); Skills and experience of hospital directors, members of hospitals management teams Information sharingdigital technologies	External integration (multisectoral collaboration involving private sector, educational institutions, military, national and international NGOs); organizational capability (increasing capacity, staff, increasing spaces, reorganization of resources)Internal integration (meeting)	Empirical	Descriptive analysis
Rehman and Ali	2022	Anticipate Adapt	Digital technologies (augmented reality, blockchain, iot, tatus and identification,radio-frequency identification (RFID), cybersecurity and business intelligence in the supply chains for timely sharing of data and information)		Quantitative	Mathematical model+multi-criteria decision-making (mcdm)techniques for analysis.
Sabateen et al.	2022	Adapt Respond	Skills of procurement department in increasing backup of PPE, Skills of multidisciplinary response committee (comprised of Chief Executive and Operations Officers (CEO, COO), Medical Director, infectious disease specialists, members of the infection control committee, pharmacy/supply services, front-liners, and support services like cleaners)	Internal integration (daily briefing); organizational capability (reorganizing spaces and tasks)	Empirical	Case study
Sawyerr and Harrison	2022	Learn	Training and educationinterpersonal skills	Internal integration	Empirical	Case study (implementation of psychoeducational program)
Shakil	2020	Anticipate	Cloud technologies for privacy and security		Quantitative	Mathematical model + simulation biometric security, experiment to validate the authentication
Shaw et al.	2022	Adapt	Virtual assistance of rpavirtual	Internal and external integration (interprofessional collaboration and team working)	Empirical	Case study
Sigala et al.	2022	Respond	Skills of procurement departmentincreasing in-house production (PPE, disinfectants),digital platform	External integration (coordination with other hospitals, pharmacies and laboratories, central warehouse)	Empirical	Review, interview, modelling
Singh and Chaurasiya	2022	Anticipate	Digital technologies (cybersecurity)		Quantitative	Mathematical model
Spieske et al.	2022	Respond	Skills of procurement department increasing in-house production (PPE, disinfectants),digital platform	External integration (coordination with other hospitals, pharmacies and laboratories, central warehouse)	Empirical	Multiple case study
Taimoor and Rehman	2022	Anticipate Adapt	Digital technologies (healthcare 5.0)		Researchers’ perspectives	Commentary/viewpoint
Tortorella et al.	2021	AnticipateAdapt	Digital technologies (Telemedicine, wireless devices; information and communication technologies (such as platform) for collaborative sharing)	Technological capability; Internal and external integration (with patients)	Empirical	Exploratory survey, hierarchical clustering
Tortorella et al.	2022	Anticipate, Adapt	Digital technologies (digital platform, ERP, ICT, RFID, Interconnected and real-time electronic medical record of patients, Augmented reality as clinical decision support, Remote diagnosis through mobile applications, Wireless body area network)		Empirical	Multiple case study
Tremblay et al.	2022	Respond		External integration (on-site collaboration with clinicians, managers, policymakers, people)	Empirical	Multiple case study
Trucco et al.	2022	Adapt	Skills of dedicated team of specialists	Organizational capability (Reorganization of resources)	Quantitative	Discrete event simulation
Vanderwerf et al.	2022	Adapt Respond	Digital technologies (telemedicine)managerial and medical skills	Internal and external integration	Researchers’ perspectives	Commentary/viewpoint
Winkelmann et al.	2022	AdaptRespond	Experience of final year medical and nursing students, inactive professionals to return to work Managerial skills	Organizational capability (increasing capacity (with other spaces, mobilising final year medical and nursing students, inactive professionals to return to work) External integration with regional cross-border collaborations (redistribution of patients)	Researchers’ perspectives	Commentary/viewpoint
Zamiela et al.	2022	Adapt	Digital technologies	External integration	Researchers’ perspectives	Conceptual
Chiu et al.	2021	AnticipateAdapt	Digital technologies (telemedicine) residents’ competencies (to expand the available staff)		Empirical	Single case study (survey+descriptive findings)
Ferorelli et al.	2020	Anticipate	Quality culture (incident reporting system)		Empirical	Case study
Garg et al.	2020	Anticipate	Digital technologies (cybersecurity)		Quantitative	Analytical model
Hannan et al.	2021	Respond		External integration (Communication with external pharmacies)	Researchers’ opinions	Commentary
Islam et al.	2021	Anticipate	Digital technologies (cybersecurity through fog/edge computing)		Quantitative	Analytical model
Johnson et al.	2020	Learn	Training and drills for staff		Empirical	Case study
Lyng et al.	2021	Adapt Respond	Digital technologies (telemedicine, platform) nursing homes experience	External collaboration (patients and families)	Empirical	Case study (exploratory)
Malik et al.	2021	AnticipateAdapt	Digital technologies (Health information system)		Empirical	Case study (cross-sectional study)
Mayer et al.	2021	Anticipate	Digital technologies (Fog/edge computing, internet of things)		Quantitative	Mathematical model and simulation
Minka et al.	2021	Adapt Learn	Backup, emergency stockpilesDigital technologies (telemedicine)managerial and medical skills training and drills for staff	Organizational capability technical response plan (reorganisation of tasks, services and spaces; staff increases and reassignments; new rules and protocols); Internal integration (interdepartmental communication)external integration with authority or emergency agencies and public.	Empirical	Case study (descriptive observational study)
Moss et al.	2021	Anticipate	Staff experience (prevent drug shortage)		Researchers’ opinions	Commentary
Reyes et al.	2021	Adapt	Nurse-physician skills to communicate, trust. Information sharing.	Internal integration	Researchers’ opinions	Commentary
Shah et al.	2021	Adapt	Digital technologies (digital platform)hospital’s improvement team	Internal integration	Empirical	Case study (observation)
Spiva et al.	2020	Learn	Training and education,interpersonal skills	Internal integration	Empirical	Case study (observation)
Suresh et al.	2021	Adapt	Extra qualified personnel, information sharing	Organizational capability (reorganisation of tasks, services and spaces; staff increases and reassignments; new rules and protocols); internal and external integration interdisciplinary collaboration and collaboration with families	Review	Total interpretive structural modelling (tism)
T. de Oliveira et al.	2021	Anticipate	Digital technologies (cybersecurity)		Quantitative	Mathematical model and simulation
Till and McGivern	2020	Adapt	Information sharing	Internal integration (leadership)	Empirical	Case study (interview)
Uhl-Bien et al.	2020	Adapt	Information sharing,skills of nurses	Internal integration (leadership)	Researchers’ opinions	Commentary
Veerapen and McKeown	2021	Adapt Respond	Competences of final year medical and nursing students, inactive professionals (return to work)	Organizational capability (reorganisation of tasks, services and spaces; staff increases and reassignments; new rules and protocols); internal and external integration	Empirical	Case study (interview)
Wei et al.	2019	Adapt		Internal integration among staff members	Empirical	Interview
Xu et al.	2020	Anticipate	Digital technologies (cybersecurity with ntru lattice)		Quantitative	Analytical model
Zhang & Qi	2021	Adapt	Digital technologies (ITC)		Empirical	Regression to test hypotheses
Zhang et al.	2020	Anticipate Adapt	Digital technologies (healthcare 5.0 and digital twin)		Quantitative	Mathematical model and simulation
Angelopoulou and Panagopoulou	2022	Anticipate	Implementation of psychoeducational program		Review	Systematic literature review and meta-analysis
Bozorgmehr et al.	2022	Recover	Information sharing	External integration (governmental authority)	Researchers’ opinions	Commentary
Croghan et al.	2022	Adapt Learn	Nurse and physicians skills psychoeducational program	Internal integration	Empirical	Survey+multiple linear regression
Fagerdal et al.	2022	Adapt	Nurse-physician skills, communication, trust. Information sharing.	Internal integration	Empirical	Case study
Fernandes et al.	2022	Adapt	Nurse-physician skills, interpersonal skills (trust), Information sharing.	Internal integration; organizational capability (Reorganisation of tasks, services and spaces; staff increases and reassignments; new rules and protocols)	Researchers’ opinions	Commentary
Forsgren et al.	2022	Respond	Information sharing; interpersonal skills, managerial skills	External integration (local authority)	Review	Scoping review
Förster et al.	2022	Adapt	Information sharing, interpersonal skills, hospital manager’s skills	Internal and external integration (networking)	Empirical	Interview
Garcia-Perez et al.	2022	Anticipate Adapt	Digital technologies (cybersecurity) digital skills		Empirical	Survey+multiple linear regression
Garg et al.	2022	Anticipate	Digital technologies (cybersecurity)		Quantitative	Mathematical model
Grailey et al.	2022	Adapt	Manager’s skills	Internal integration	Empirical	Interview
Haraldseid-Driftland et al.	2022	Learn	Interpersonal skills	Internal integration (collaborative learning)	Review	Literature review
Hodgins et al.	2022	Adapt	Interpersonal skills	Internal integration (non-hierarchical governance)	Empirical	Case study
Hossain et al.	2022	Recover	Hospital manager’s skills	External integration (stakeholder coordination private non-private players; integration with pharmacies)	Quantitative	Grey clustering method
Hundal et al. (b)	2021	Anticipate (Risk Mitigation)	Digital technologies (big data analysis)quality culture (lean six sigma: failure mode and effects analysis)	Organizational capability (resource reconfiguration)	Review	Content analysis
Jagatheesaperumal et al.	2022	Anticipating Adapt	Digital technologies (5G remote surgery, 5G enabled iot services: more reliable and trustworthy services among medical services, machine learning algorithms; iot pill bottle)		Researchers’ opinions	Commentary
Jeet et al.	2022	Anticipate	Digital technologies (cybersecurity)		Quantitative	Mathematical model and simulation
Jiang et al.	2022	Respond	Interpersonal skills	External integration (community, families)	Empirical	Survey for data collecting and descriptive analysis
Khalil et al.	2022	AnticipateAdapt	Backup,information sharing,expert team	Internal integration (communication and collaboration in decision making)	Empirical	Focus group (grounded theory)
Khuntia et al.	2022	RespondRecover	Manager’s skills, skills of procurement department	External integration (supply chain stakeholders)	Empirical	Survey+regression analysis
Litke et al.	2022	Adapt	Interpersonal skills	Organizational capability (reorganisation of tasks services and spaces; staff increases and reassignments; new rules and protocols); internal integration	Empirical	Observations and interview
Lowry et al.	2022	Learn	Training for hospital leaders on how to manage crisis, transfer of new knowledge; teamwork, interpersonal skills, effective educational interventions		Empirical	Survey and descriptive findings
Łukasik andPorębska	2022	AdaptRespond		Organizational capability (reorganisation of tasks services and spaces)	Empirical	Scenarios
Nimmy et al.	2022	Anticipate	Digital technologies (cybersecurity)		Quantitative	Mathematical model and simulation
Sanford et al.	2022	Adapt	Training for staff	Organizational capability (reorganisation of tasks services and spaces); internal integration	Empirical	Observations and interview
Snowdown and Wright	2021	Respond	Skills of procurement department (diversifying suppliers); digital platform	External integration (coordination with other hospitals, pharmacies and laboratories, central warehouse, local manufacturer)	Empirical	Case study
Wang	2022	Respond	Digital technologies	External collaboration with local authority (institutional cooperation)	Researchers’ opinions	Commentary
Wazid et al.	2022	Anticipate	Digital technologies (cybersecurity through blockchain)		Quantitative	Mathematical model and simulation
Wong et al.	2022	Adapt	Interpersonal skills	Organizational capability (reorganisation of tasks services and spaces); internal integration	Empirical	Case study (cross-sectonal study)
Xu et al.	2022	Adapt	Digital technologies (e-health),digital skills		Empirical	Case study (cross-sectonal study)
Ziser et al.	2021	Adapt	Digital technologies, digital skills,pharmacist’s experience	Internal integration, organizational capability (defining new roles and tasks)	Empirical	Observations
Joyce et al.	2021	Anticipate	Digital technologies (cybersecurity),digital skills,digital education and training		Review	Literature review
Singh and Chaurasiya	2021	Anticipate	Digital technologies (cybersecurity)		Quantitative	Mathematical model and simulation
Abraham et al.	2019	Anticipate	Digital technologies (cybersecurity)		Quantitative	Mathematical model and simulation
Aldrighetti et al.	2022	Respond	Skills of procurement department	External integration (lateral transshipment, central logistics hub, collaboration with other hospitals)	Empirical	Case study (simulation model)
Franco and Christie	2022	Learn	Psychoeducational programnurse’s experience		Empirical	Observation
Friday et al.	2021	Respond		External integration (collaborative planning, forecasting and replenishment practices)	Review	Systematic literature review
Capolongo et al.	2020	AdaptRespond	Digital technologies (IT systems, smartphones, wearable devices, telemedicine)	External integration (hub and spoke model avoiding overflow of users in the hospitals)	Researchers’ opinions	Commentary
Guo et al.	2021	Anticipate	Digital technologies (cybersecurity)		Quantitative	Mathematical model and simulation
Jordan et al.	2022	Adapt Learn	Interpersonal skills, information sharingpsychoeducational support	Internal integration (interprofessional teamwork)external integration (with external pharmacists and care coordinators and patients)organizational capability (reconfiguration of tasks and roles)	Empirical	Interview
Kaleta et al.	2022	Adapt Respond	Digital technologies (telemedicine remote technologies)		Quantitative	Mathematical model and simulation
Kazemi Matin et al.	2021	AnticipateRespond	Skills of procurement department	External integration (hospitals, blood production centre, blood collection centre, blood distribution centre)	Quantitative	Mathematical model and simulation
Koch et al.	2022	Respond		External integration: Health-care coalitions (hccs)	Empirical	Interviews
Ladak et al.	2021	AdaptRespond	Skills and competence of clinical nurse specialists (create expert team)		Empirical	Interviews
Lloyd-Smith	2020	Adapt	Skills of crisis team included board members, departmental managers and medical leaders	Organizational capability (reorganisation of tasks, services and spaces; staff increases and reassignments; new rules and protocols); internal integration: interdisciplinary collaboration	Researchers’ opinions	Commentary
Marulli et al.	2022	Anticipate	Digital technologies (cybersecurity)		Quantitative	Simulation
Pandit et al.	2021	AdaptRespond	Skills and experience of physicians and hospital managers, skills of multidisciplinary response committee, and the medical director, the infectious disease specialists, members of the infection control committee	Internal integration (daily briefing) external integration (integrated care partnerships, universities, the independent sector and charities)	Researchers’ opinions	Commentary
Pomare et al.	2022	Adapt	Interpersonal skills, Information sharing	Internal integration (inter-departmental meeting)	Empirical	Longitudinal mixed methods case study
Mervyn et al.	2019	Respond	Managerial skills, interpersonal skills, information sharing	External integration (collaborative place-based networks, new inter-organizational partnership, collaboration-based healthcare network)	Empirical	Case study
Patrone et al.	2020	Anticipate	Quality culture (lean principles)		Quantitative	Scenarios
Sim et al.	2022	Anticipate	Digital technologies (cybersecurity through blockchain technology)		Researchers’ opinions	Commentary

Disclosure statement

No potential conflict of interest was reported by the author(s).