Table 1.

Overview of aims, methods, concepts used and dimensions of resilience addressed by quantitative research papers (n = 15)

Author	Year	Country	Research objective	Key findings	Study design and data source	Operationalization of resilience	Conceptual framework used	Management capacity dimensions	Resilience outcome dimensions
Assessing national-level health system resilience in context of a specific crisis
Fukuma et al.	2017	Japan	To assess population-level health indicator changes following the Great East Japan Earthquake and discuss redesign to enhance health systems' responsiveness and resilience	Age-adjusted all-cause mortality and some disease specific mortality rates rose more in affected prefectures than the average national rates. Disaster revealed strengths and deficiencies in responsiveness and resilience of health system	Case study using routine data sources	Population indicators, Health system indicators, Health outcome indicators	N/A	N/A	Absorptive
Watts et al.	2018	Global	To track a series of indicators of progress, publishing an annual ‘health check’, from now until 2030, on the state of the climate, progress made in meeting global commitments under the Paris Agreement, and adapting and mitigating to climate change	The public, and the health systems they depend upon, are ill-prepared to manage the health impacts of climate change	National survey completed by 101 national ministries of health	Six Indicators developed as part of the Lancet Countdown initiative	Several UN frameworks used	Knowledge Uncertainties	Adaptive
Assessing health service delivery in context of a specific crisis
Radcliff et al.	2018	USA	To present ‘measures of ambulatory care recovery and resilience that rely on routine appointment records’	‘Most clinics in affected areas achieved appointment completion percentages that matched or exceeded prestorm levels within 2 weeks of the storm’.	Administative data from Veterans Affairs clinics	Percentage of completed appointments before and after a disaster	N/A	N/A	Absorptive
Simonetti et al.	2018	USA	‘To understand the impacts of emergency situations on blood availability and the resiliency of the US blood supply system’.	‘The absence of blood shortage in both emergency scenarios highlighted the resilience of the inter-regional system to meet the potential associated blood demand’.	Modelling study using administrative data on blood collections and utilization	Blood stocks available at regional and national level	N/A	N/A	Absorptive
Sochas et al.	2017	Sierra Leone	To quantify the extent of the drop in utilization of essential reproductive, maternal and neonatal health services in Sierra Leone during the Ebola outbreak and to model the implication of the decrease in utilization in terms of excess maternal and neonatal deaths	Use of essential reproductive health services decreased as a result of Ebola. This decrease translates to 3600 additional maternal, neonatal and stillbirth deaths in 2014–15 meaning the indirect mortality effects of the crisis may be as important as direct mortality.	Modelling study using routine utilization data to compare projected utilization without crisis to real utilization	Antenatal health services utilization data	N/A	N/A	Absorptive
Taking a community resilience perspective
Andrew et al.	2016	Thailand	To test the impact of two competing hypotheses - bonding and bridging- on enhancing organisational resiliency during the Thailand floods of 2011	Resilience was found to be associated with bridging effect, rural location and private and NGO status rather than public sector organizations	Structured interviews with key informants	Four items on the robustness, resourcefulness, redundancy and rapidity of the organization during the crisis	Framework to assess seismic resilience of communities (Bruneau et al. 2003)	Interdependence	Absorptive
Cohen et al.	2019	Israel	To explore the relationship between the public’s confidence in the availability of healthcare services during and following emergencies, and community resilience	‘Confidence in continuity of health services during a state of emergency was found to be positively correlated with community resilience’	Household survey	Conjoint Community Resilience Assessment Measurement (CCRAM) tool	CCRAM model (Leykin et al. 2013)	Uncertainties Interdependence Legitimacy	N/A
Health workforce issues
Falegnami et al.	2018	Italy	‘To assess the anaesthesia professionals' organizational resilient performance with respect to different daily work conditions’.	The questionnaire shows the potential to assess proxy measures of resilience, despite being complex and time‐consuming.	Survey of anaesthesiologists	Resilience Assessment Grid, adapted using analytic hierarchy process method	Four cornerstones of resilience (Hollnagel et al. 2006)	Knowledge Uncertainties	N/A
Infrastructure and Thermal Resilience
Iddon et al.	2015	UK	To assess the influence of hospital ward design on resilience to health waves and develop model for predicting inside temperatures	Nightingale wards showed remarkable resilience to hot weather. Distributed lag models are a promising method for forecasting inside temperatures	Distributed lag models developed from measured temperatures	Temperature maintenance	N/A	N/A	Absorption
Lomas et al.	2012	United Kingdom	To estimate the resilience of a representative building type, the ‘Nightingale wards’	Nightingale wards demonstrate relative resilience. Modest refurbishment such as insulation, shading, improved natural ventilation and removal of suspended ceilings increase resilience.	Descriptive statistics and calibrated dynamic thermal model developed from measured temperatures	Temperature maintenance	N/A	N/A	Absorption Adaptation
Short et al.	2015	UK	To model temperature for Rosie Maternity Hospital in Cambridge and develop and compare adaptive interventions	The existing building is unable to shed heat so that recommended maximum internal temperatures are reached in relatively mild external conditions. Adaptations to the building will be required to maintain resilience to increasing temperatures.	Multizone thermal dynamic model developed from measured temperatures	Temperature maintenance	N/A	N/A	Absorption Adaptation
Development of preparedness checklists and assessment tools
Dobalian et al.	2016	USA	To develop a hospital preparedness tool for six domains or ‘mission areas’	Tool serves as comprehensive assessment for hospital preparedness	Structured assessment of 140 Veteran Affair Hospitals, two-stage confirmatory factor analysis	Six critical mission areas: programme management, incident management, safety and security, resiliency and continuity, medical surge, support to external requirements	N/A	Uncertainties Intrdependence	N/A
Goncalves et al.	2019	Spain	To adapt and validate the short-form version of the Benchmark Resilience Tool into Spanish language and to explore its relationship with safety climate	The instrument fulfils the psychometric criteria to evaluate resilience in healthcare and nuclear organizations in Spain	Survey of workers in the healthcare and nuclear energy sectors	Short-form version of the Benchmark Resilience Tool (BRT-13B)	Four Cornerstones of Resilience (Hollnagel et al. 2006)	Knowledge Uncertainties Interdependence	Absorption
Zhong et al.	2014a	China	To validate a framework of key indicators of hospital resilience	Identification of a four-factor structure of hospital resilience: Emergency medical response capability, disaster management mechanisms, hospital infrastructural safety and disaster resources with good internal consistency	Survey among 41 tertiary hospitals in China; factor analysis	Eight key domains: hospital safety standard and procedures, emergency command, communication and cooperation system, disaster plan, disaster resource stockpile and logistics management, emergency staff capability, emergency services and surge capability, training and drills, and recovery and adaptation strategies	Four criteria of disaster resilience (robustness, resourcefulness, redundancy and rapidness) (Zhong et al. 2014b)	Uncertainties	N/A
Zhong et al.	2015	China	To develop a framework of key indicators of hospital resilience	Framework identified a comprehensive set of indicators for hospital resilience, 60 of 75 proposed measures reached consensus.	Modified Delphi consultation of experts; Likert scale evaluation of proposed measures