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Organizational change and everyday health system resilience: Lessons from Cape Town, South Africa

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  • Gilson, Lucy
  • Ellokor, Soraya
  • Lehmann, Uta
  • Brady, Leanne

Abstract

This paper reports a study from Cape Town, South Africa, that tested an existing framework of everyday health system resilience (EHSR) in examining how a local health system responded to the chronic stress of large-scale organizational change. Over two years (2017–18), through cycles of action-learning involving local managers and researchers, the authorial team tracked the stress experienced, the response strategies implemented and their consequences. The paper considers how a set of micro-governance interventions and mid-level leadership practices supported responses to stress whilst nurturing organizational resilience capacities. Data collection involved observation, in-depth interviews and analysis of meeting minutes and secondary data. Data analysis included iterative synthesis and validation processes. The paper offers five sets of insights that add to the limited empirical health system resilience literature: 1) resilience is a process not an end-state; 2) resilience strategies are deployed in combination rather than linearly, after each other; 3) three sets of organizational resilience capacities work together to support collective problem-solving and action entailed in EHSR; 4) these capacities can be nurtured by mid-level managers’ leadership practices and simple adaptations of routine organizational processes, such as meetings; 5) central level actions must nurture EHSR by enabling the leadership practices and micro-governance processes entailed in everyday decision-making.

Suggested Citation

  • Gilson, Lucy & Ellokor, Soraya & Lehmann, Uta & Brady, Leanne, 2020. "Organizational change and everyday health system resilience: Lessons from Cape Town, South Africa," Social Science & Medicine, Elsevier, vol. 266(C).
  • Handle: RePEc:eee:socmed:v:266:y:2020:i:c:s0277953620306262
    DOI: 10.1016/j.socscimed.2020.113407
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    References listed on IDEAS

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    1. Alameddine, M. & Fouad, Fouad M. & Diaconu, K. & Jamal, Z. & Lough, G. & Witter, S. & Ager, A., 2019. "Resilience capacities of health systems: Accommodating the needs of Palestinian refugees from Syria," Social Science & Medicine, Elsevier, vol. 220(C), pages 22-30.
    2. Currie, Graeme & Dingwall, Robert & Kitchener, Martin & Waring, Justin, 2012. "Let’s dance: Organization studies, medical sociology and health policy," Social Science & Medicine, Elsevier, vol. 74(3), pages 273-280.
    3. Stephanie Duchek, 2020. "Organizational resilience: a capability-based conceptualization," Business Research, Springer;German Academic Association for Business Research, vol. 13(1), pages 215-246, April.
    4. Linda Rouleau, 2005. "Micro‐Practices of Strategic Sensemaking and Sensegiving: How Middle Managers Interpret and Sell Change Every Day," Journal of Management Studies, Wiley Blackwell, vol. 42(7), pages 1413-1441, November.
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    Cited by:

    1. Paschoalotto, Marco Antonio Catussi & Lazzari, Eduardo Alves & Rocha, Rudi & Massuda, Adriano & Castro, Marcia C., 2023. "Health systems resilience: is it time to revisit resilience after COVID-19?," Social Science & Medicine, Elsevier, vol. 320(C).
    2. Beth Engelbrecht & Lucy Gilson & Pierre Barker & Krish Vallabhjee & Gareth Kantor & Mike Budden & Anita Parbhoo & Uta Lehmann, 2021. "Prioritizing people and rapid learning in times of crisis: A virtual learning initiative to support health workers during the COVID‐19 pandemic," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(S1), pages 168-173, May.
    3. Fleming, Pádraic & O'Donoghue, Catherine & Almirall-Sanchez, Arianna & Mockler, David & Keegan, Conor & Cylus, Jon & Sagan, Anna & Thomas, Steve, 2022. "Metrics and indicators used to assess health system resilience in response to shocks to health systems in high income countries—A systematic review," Health Policy, Elsevier, vol. 126(12), pages 1195-1205.

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