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Background <p>Resilient healthcare, defined as the capacity of a health system to maintain operations throughout changes and disruptions, has become instrumental in reshaping safety paradigms. There has been little focus on identifying practices that enable and hinder resilient performance within healthcare teams. This study examines the adaptability of different types of teams in Australian hospitals to categorise misalignments and the adaptations used to enable resilient care delivery.</p> Methods <p>The study involved observations (75&#xa0;hours) and interviews (<i>n</i> = 46) with staff from two Australian metropolitan hospitals. Four types of healthcare teams were studied at each hospital, based on the adaptive teamwork approach: Structural (e.g., aged care ward); Hybrid (e.g., emergency department); Responsive (e.g., intensive care); and Coordinating (e.g., bed management). Data collection was conducted between March and November 2023. Thematic analysis of transcripts involved a dual approach combining inductive and deductive coding, through the lens of the Concepts for Applying Resilience Engineering (CARE) model 2.0.</p> Results <p>This study identified 632 instances of misalignments and 387 instances of adaptations across eight teams in the two participating hospitals. Misalignments were classified into nine types: (1) <i>equipment</i>, (2) <i>staffing</i>, (3) <i>communication</i>, (4) <i>space</i>, (5) <i>process/procedures</i>, (6) <i>workflow interruption</i>, (7) <i>leadership</i>, (8) <i>external stressors</i>, and (9) <i>team/organisational culture</i>. Adaptations were categorised into five types: (1) <i>extra-role performance</i>, (2) <i>resource redistribution (staff/equipment)</i>, (3) <i>process/procedure change</i>, (4) <i>prioritising</i>, and (5) <i>COVID-19</i>. <i>Staffing</i> was the most common misalignment and <i>staff redistribution</i>, <i>supportive leadership</i>, <i>extra role performance</i> and <i>prioritising</i> were the most frequent adaptations. Teams with longer histories of working together demonstrated positive team cultures and were able to adapt and respond fluidly and nimbly to emerging misalignments. Supportive leadership facilitated adaptability and were able to authorise flexible solutions. The massive disruption of COVID-19 demonstrated all teams’ adaptability but left a legacy of sometimes intractable misalignments.</p> Conclusions <p>The findings highlight the importance of flexible and contextually relevant adaptive strategies in ensuring effective clinical care delivery within hospitals. Results have important implications for how healthcare systems are structured (e.g., greater connectivity and flexibility in staffing) and how resources can be shared and managed.</p>

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Resilience in healthcare teams: a qualitative study of misalignments and adaptations across hospital teams in Australia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月30日

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  • Janet C. Long,
  • Tanja Schroeder,
  • Kate Churruca,
  • Maree Saba,
  • Samantha Spanos,
  • Elle Leask,
  • William de Montemas,
  • John Shephard,
  • Natalie Sequeira,
  • Siri Wiig,
  • Jeffrey Braithwaite,
  • Louise A. Ellis

摘要

Background

Resilient healthcare, defined as the capacity of a health system to maintain operations throughout changes and disruptions, has become instrumental in reshaping safety paradigms. There has been little focus on identifying practices that enable and hinder resilient performance within healthcare teams. This study examines the adaptability of different types of teams in Australian hospitals to categorise misalignments and the adaptations used to enable resilient care delivery.

Methods

The study involved observations (75 hours) and interviews (n = 46) with staff from two Australian metropolitan hospitals. Four types of healthcare teams were studied at each hospital, based on the adaptive teamwork approach: Structural (e.g., aged care ward); Hybrid (e.g., emergency department); Responsive (e.g., intensive care); and Coordinating (e.g., bed management). Data collection was conducted between March and November 2023. Thematic analysis of transcripts involved a dual approach combining inductive and deductive coding, through the lens of the Concepts for Applying Resilience Engineering (CARE) model 2.0.

Results

This study identified 632 instances of misalignments and 387 instances of adaptations across eight teams in the two participating hospitals. Misalignments were classified into nine types: (1) equipment, (2) staffing, (3) communication, (4) space, (5) process/procedures, (6) workflow interruption, (7) leadership, (8) external stressors, and (9) team/organisational culture. Adaptations were categorised into five types: (1) extra-role performance, (2) resource redistribution (staff/equipment), (3) process/procedure change, (4) prioritising, and (5) COVID-19. Staffing was the most common misalignment and staff redistribution, supportive leadership, extra role performance and prioritising were the most frequent adaptations. Teams with longer histories of working together demonstrated positive team cultures and were able to adapt and respond fluidly and nimbly to emerging misalignments. Supportive leadership facilitated adaptability and were able to authorise flexible solutions. The massive disruption of COVID-19 demonstrated all teams’ adaptability but left a legacy of sometimes intractable misalignments.

Conclusions

The findings highlight the importance of flexible and contextually relevant adaptive strategies in ensuring effective clinical care delivery within hospitals. Results have important implications for how healthcare systems are structured (e.g., greater connectivity and flexibility in staffing) and how resources can be shared and managed.