Resilience and complex adaptive systems: A perspective on healthcare



ecological approach, contextual framework, organization, governance, networks


Purpose. The term “healthcare system resilience” is becoming topical in policy planning documents around the world, increasingly in the context of the COVID-19 pandemic. This research aimed to explore the role of the contextual framework in the research on resilience and prevailing aspects of the healthcare system’s resilience.

Design / methodology / approach. The research hypothesised on the increasing relevance of the concept of resilience in the healthcare system as demonstrated by scientific literature; on determining elements that characterise the interrelationship between the domains of the healthcare system and the concept of resilience; and on the role of the contextual framework in creating an awareness of the concept of resilience in the healthcare system. The hypotheses were verified by the literature review on the PubMed, Web of Science, and Scopus databases.

Findings. The concept of resilience was introduced to the healthcare system literature from the ecological sciences through an increased understanding of the healthcare system as a complex adaptive system (CAS). The perception of the nature of the healthcare  system in the context of a CAS, viewing it as a complex, dynamic part of the socio-economic system, operating in circumstances of high  uncertainty, provides additional opportunities for understanding the healthcare system’s functioning, governance and decision-making.

Originality / value. This study identified a research gap in the practical implementation of the CAS approach in the healthcare system on the highest level of governance. A CAS contains a multitude of characteristics and elements that could assist in attaining a more nuanced understanding of healthcare system resilience. Significantly, the inherent characteristics of a CAS, such as flexibility and an adaptive nature, which seem to undermine the stability of the system, actually create the core of this system’s resilience, and these aspects merit increased attention. Further research could be devoted to the investigation of healthcare system resilience in the context of healthcare system reforms.