Karreinen Soila, Janhonen Kristiina, Kihlström Laura, Paananen Henna, Viita-Aho Marjaana, Tynkkynen Liina-Kaisa
Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.
Welfare State Research, Finnish Institute for Health and Welfare, Helsinki, Finland.
J Health Organ Manag. 2024 Dec 17;39(9):1-15. doi: 10.1108/JHOM-06-2024-0257.
Local health systems form the basis for health system resilience. Leaders' standpoints are crucial in advancing resilience capacities and change. This study analysed how local health system leaders' approaches to change reflect health system resilience capacities. Furthermore, we explored what triggers and hinders change during a crisis.
DESIGN/METHODOLOGY/APPROACH: The data consist of purposively sampled interviews with 14 local Finnish health system leaders during the COVID-19 pandemic. Using abductive content analysis, examples of resisting, absorbing, adapting and transforming were identified. Contextual triggers and hindrances for the initiation of change processes were analysed to support understanding of health system resilience capacities at the local level.
Resilience capacities were manifested by doing standard things faster (absorption), engaging in collaborative reflections (adaptation) and reforming organisational boundaries and services (transforming). "Resisting" leaned on varied levels of reflection, with mixed responses. Triggers and hindrances varied situationally and highlighted the roles of a changing operational environment, existing practices and the social dimension (e.g. building a shared understanding).
ORIGINALITY/VALUE: Leaders' standpoints and their approaches to change are rarely the focus of attention in system-centred conceptualisations of health system resilience. Leaders' awareness of their approaches to change can affect organisational responses and health system resilience. This should be more clearly acknowledged in theoretical frameworks, leadership training, preparedness planning and crisis governance. Health system resilience capacities form intertwined, nonlinear processes that are reshaped throughout a crisis. Analysis of resistance can enrich the understanding of local-level processes.
地方卫生系统是卫生系统恢复力的基础。领导者的立场对于提升恢复力能力和推动变革至关重要。本研究分析了地方卫生系统领导者的变革方式如何反映卫生系统的恢复力能力。此外，我们还探讨了危机期间引发和阻碍变革的因素。
设计/方法/途径：数据包括在新冠疫情期间对14位芬兰地方卫生系统领导者进行的有目的抽样访谈。运用归纳式内容分析法，确定了抵制、吸收、适应和转型的实例。分析了变革过程启动的背景触发因素和阻碍因素，以支持对地方层面卫生系统恢复力能力的理解。
恢复力能力表现为更快地做常规之事（吸收）、进行协作反思（适应）以及改革组织边界和服务（转型）。“抵制”基于不同程度的反思，反应不一。触发因素和阻碍因素因情况而异，突出了不断变化的运营环境、现有做法和社会层面（如建立共同理解）的作用。
原创性/价值：在以系统为中心的卫生系统恢复力概念化中，领导者的立场及其变革方式很少成为关注焦点。领导者对其变革方式的认识会影响组织反应和卫生系统恢复力。这一点在理论框架、领导力培训、备灾规划和危机治理中应得到更明确的承认。卫生系统恢复力能力形成相互交织的非线性过程，在整个危机过程中不断重塑。对抵制的分析可以丰富对地方层面过程的理解。
