What makes health systems resilient against infectious disease outbreaks and natural hazards? Results from a scoping review

Nuzzo, Jennifer B.; Meyer, Diane; Snyder, Michael; Ravi, Sanjana J.; Lapascu, Ana; Souleles, Jon; Andrada, Carolina I.; Bishai, David

Core Health Service Capabilities: A resilient health system sustains baseline levels of routine healthcare delivery during a public health emergency [28] [29] [30] [31] [32] [33] [34] [35] . Barriers to Healthcare Access: A resilient health system dismantles barriers to healthcare access so that the public accesses care during emergencies [36, 37] . Maintaining Critical Infrastructure and Transportation: A resilient health system develops plans to weather interruptions in critical infrastructure and transportation [24, 25, [38] [39] [40] [41] [42] [43] [44] [45] [46] [47] [48] [49] [50] . Timely and Flexible Access to Emergency/Crisis Financing: A resilient health system has timely, flexible access to financing so that it can better prepare for and respond to public health emergencies [24, 29, 36, 37, [39] [40] [41] [51] [52] [53] [54] [55] [56] [57] [58] [59] . Leadership and Command Structure: A resilient health system has a clear and flexible command structure that has been established prior to an event and is exercised frequently [24, 29, 57, [60] [61] [62] [63] [64] [65] . Collaboration, Coordination, and Partnerships: A resilient health system collaborates and coordinates with partners within and outside of the health system [2, 29, 39, 45, 57, 66, 67] . Communication: A resilient health system has clear channels of communication between health system actors and other sectors, risk communication protocols, and robust engagement with patient populations [60, 68] . Flexible Plans and Management Structures: A resilient health system has flexible plans and management structures to cope with rapidly evolving circumstances [1, [69] [70] [71] . Legal Preparations: A resilient health system has made legal preparations to address challenges that may emerge during a crisis [1, 45, 49, 59, 62, 72, 73] . Surge Capacity: A resilient health system is able to call on human and capital resources to "surge" the level of care during public health emergencies [36, 74] . Altered Standards of Care: A resilient health system has adaptable response plans to guide them in allocating scarce resources and healthcare services [23, 75] . Health Workforce: A resilient health system has an adequate, trained, and willing work force [4, 22, 36, 40, 45, 53, 54, 76, 77] . Medical Supplies and Equipment: A resilient health system has access to medical supplies and equipment, including personal protective equipment, antivirals, and ventilators, during a crisis [40, 53, [78] [79] [80] . Infection Prevention and Control (IPC): A resilient health system has implemented strong IPC measures, including staff training, standardized protocols, a dedicated IPC focal point, and dedicated treatment units [4, 22, 39, 47, 51, 54, [81] [82] [83] [84] [85] [86] . Commitment to Quality Improvement: A resilient health system requires a commitment to continuous quality improvement that promotes excellence and garners the trust of the community [15, 27, 39, 54, 69, 87, 88] . Plans for Post-Event Recovery: Resilient health systems have plans for post-event recovery that address a broad range of issues [24-26, 34, 40, 59, 73, 89-93] .