Resilient Health Systems
In 2021, the South East London Integrated Care System (SEL ICS) commissioned King’s Health Partners Women and Children's Health (KHP WCH) to deliver the "Resilient Health Systems" (RHS) as part of iterative approach to healthcare system design and implementation to facilitate evidence-based decision-making in the health system.
Using a range of evaluation research methods, the project aims to generate and synthesise evidence to guide SEL ICS decision-making. This approach will identify the services, programmes, and policies that enhance the resilience capacities of the health system and, in so doing, allow decision-makers to make evidence-based choices about whether to start, stop, or scale-up innovations.
The RHS project is divided into three phases:
- Scoping: meetings with policymakers and healthcare professionals engaged with healthcare delivery in south east London to further refine the project parameters. [Completed]
- Co-design: working with key stakeholders to co-design the methods for learning and dissemination and identify priority areas for evaluation. Validating a conceptual framework used for mapping resilience capacities. [Completed]
- Implementation: mapping the resilience capacities of the south east London health system using qualitative and quantitative research methods. Rapid evaluation projects will generate evidence-based health service and policy recommendations. [Ongoing]
Project team
The project is being delivered by a team of researchers based at King's Health Partners Women and Children's Health
- Dr Ingrid Wolfe (Principal Researcher), King’s College London
- Dr Ibidun Fakoya (Research Fellow), King’s College London
Funders: South East London Integrated Care System
Research to date: Implementation Phase
Findings from the scoping and co-design phase of the RHS project indicated that in south east London, the health and social care systems’ ability to bounce back from shocks or absorb ongoing stressors remains precarious. The implementation phase of the RHS project focuses on mapping the resilience capacities of the SEL healthcare system. This phase has been underpinned by the conceptual framework developed during the co-design phase of the project. To date, the RHS project has undertaken:
Evidence-finding focus group discussions:
Aim: understand where, how & why innovations in response to COVID-19 were introduced and understand the resilience capacities of the SEL health system.
Data collection: Five focus groups discussions (FGD) were held with approximately 31 purposively sampled participants. The focus groups covered five of the six domains in the conceptual framework: governance, services, resources, technology, and analytics. It was not possible to conduct a focus group for the finance domain. Participants were given ‘shock’ and ‘stress’ scenarios and asked to discuss the health system’s response. The data was analysed in relation to the resilience capacities outlined in the conceptual framework. This work was presented at the Health Services Research UK conference in July 2023.
Evaluations:
Aim: understand where, how and why innovations in response to COVID-19 were introduced and understand the resilience capacities of the SEL health system.
The project team refined and tested the FGD findings by conducting rapid service evaluations of innovative changes to healthcare provision. The evaluated interventions were selected using pre-defined criteria agreed by the RHS project steering committee.
Resilience indicator workshops:
At the King’s Health Partners conference, a workshop was held to start prioritising a set of indicators for health system resilience. The workshop was attended by key informants in KHP and the SEL healthcare system. This is the first step towards a co-designed/produced Resilience Capacity Assessment.
System resilience recommendations
Using the data collected from the focus groups, evaluations, and workshops, the team created a set of recommendations around system resilience, these were presented at the resilience indicator workshop and to the project steering committee and will be developed during the project extension.
Current work
The implementation phase currently has three workstreams.
Workstream 1: Developing Resilience Capacity Assessment
A Resilience Capacity Assessment will systematically map and exploring the resilience capacities of any given health or social care system. In the long term, this should lead to stakeholders routinely undertaking such analyses while planning and delivering services. Additionally, in the medium term, the RHS project is expected to lead to the further spread of evidence-based decision-making, with stakeholders across SEL using robust methods to make choices about whether to start, stop or scale-up innovations.
Workstream 2: Refining the Resilience Framework
The framework developed during the co-design phase of the project represents the complex relationships between various interlinked concepts that influence health system resilience. Data from health and policy evaluations will be used to refine the framework so it can be used to design or evaluate interventions to improve system resilience.
Workstream 3: Disseminating Findings
Throughout the project the team will disseminate the findings of the Resilient Health Systems project.
- Policy briefs for decision-makers at a sub-regional and place level.
- Academic papers to contribute to the evidence base.
- A community of Interest to ensure that stakeholders in SEL have the tools, skills and language to make evidence-based or evidence-informed decisions about whether to start, stop or scale up innovations that strengthen health system resilience.