Organisational resilience in healthcare is important if hospitals are to recover effectively from unexpected events, such as infection outbreaks and manage successfully the continuous pressure from hospital associated infections. Yet studies of resilience in hospital organisations are rare and organisational resilience theory is insufficiently developed. The aim of this thesis is to examine organisational resilience in UK acute hospitals, through a case study and empirical analysis. The objectives are to investigate what is known about the concept, associated factors and application of organisational resilience to hospitals, to explore theoretically and empirically the two contexts for organisational resilience (expected conditions and unexpected events) and finally to design and test a tool to measure organisational resilience in the context of an unexpected event.
A multi-methods approach was adopted to examine organisational resilience. A literature and systematic review were carried out to establish the evidence-base for organisational resilience. These reviews informed two health care studies of organisational resilience; a micro and meso-level case study exploring an unexpected infection outbreak and a macro-level study assessing the system response to infections as continuous stressors on routine practice. The case study informed the design and testing of an organisational resilience questionnaire.
The key contributions to the literature were: firstly a novel multidisciplinary resilience questionnaire from which a framework of organisational resilience constructs was developed; secondly, a modest theoretical contribution of an intermediate resilience category within a framework that identifies levels of resilient practice and associated sensemaking characteristics; and thirdly, a positive example of ICT-enabled national surveillance programmes that increased hospitals’ resilience to infection through the enrolment of clinical leaders in self-surveillance.
In conclusion, this research has generated novel, empirically-derived theoretical developments to this field of study that facilitate the measurement, application and improved conceptualisation of organisational resilience.