Table 2 Integrated Resilience Attributes Framework analysis [20] of the managerial and organizational characteristics that contributed (+) or limited (-) resilience over time throughout the health system

Anticipating

(+) Learning collaborations with internal actors, clinical training centers, universities and international contacts

(-) Lack of preparedness for a viral pandemic

(-) Acute shortages (PPE, equipment, staff, capacity)

(-) Difficult to anticipate pandemic volume

Monitoring

(+) Resource management

Responding

(+) Infection control routines

(-) Fear of lack of resources

(-) Unfamiliarity with new products

(-) Continued presence of Covid-19

(-) Medical challenges

(-) Increased care needs, especially with older patients

(-) Displacement of other care needs

(+) Resource management

(+) Restrict visitation

(+) Staff shared a common purpose and goals

(+) Staff attitudes

(+) Interprofessional collaboration

(+) Individuals’ desire to do good

(+) Task shifting and facility repurposing

(+) Improved patient capacity

(+) Support for equipment, staffing, planning (e.g. repurpose and redirect support to hospitals, collaboration with government agencies)

(+) Communication and relational capacity

(+) New PMs and routines

(+) Restructure flows and operations

(+) Focused, needs based competency training

(+) Competency exchange

(+) Down-prioritize non-essential education

(+) Manage psychological factors

(-) Historical organizational divides

(-) Just-in-time supply model

(-) Transition from normal to crisis, and then back

(-) Communication challenges

(-) Conflicting and changing directives and guidelines

(+) Governance methods and decision-making

(-) Inflexible digital infrastructure

(-) Suboptimal crisis leadership

(-) Patient flow logistics including hand-offs

Learning

(-) Brittleness

(+) Become agile through fast iterations and quick mobilization with short decision pathways

(+) Integrate organizational change

(+) System-wide collaboration

(+) Share learnings

(+) Pandemic response planning

(+) Find balance between bureaucratic control and decentralized professional bureaucracies