ABSTRACT
BACKGROUND Resilience has been identified as the ability to maintain the safety and the performance of healthcare systems and is aligned with the principles of anticipation, monitoring, adaptation, and learning. In early 2020, the COVID-19 pandemic challenged the resilience of US healthcare systems due to the lack of equipment, supply interruptions, and a shortage of personnel. The purpose of this qualitative research was to describe resilience in the healthcare team during the COVID-19 pandemic with the healthcare team situated as a singular cognizant entity defined by its collective identity, purpose, competence, and actions.METHODS We developed a descriptive model which considered the healthcare team as a unified cognizant entity. This model combined elements from the Patient Systems Engineering Initiative for Patient Safety (SEIPS) and the Advanced Team Decision Making (ADTM) models. Using a qualitative descriptive design and guided by our adapted model, we conducted individual interviews with healthcare team members across the United States. Data were analyzed using thematic analysis and extracted codes were organized within the adapted model framework. To ensure the rigor of our study, we utilized the input of an expert in qualitative researcher and maintained an audit trail throughout the analysis process. Additionally, we explored factors participants’ described that may have either hindered or enhanced the resilience potentials within the healthcare team.RESULTS Five themes were identified from the interviews with acute care professionals across the US (N = 22): working in a pressure cooker, consistent with working in a high stress environment; healthcare team cohesion, applying past lessons to present challenges, congruent with transferring past skills to current situations; knowledge gaps, and altruistic behaviors, aligned with sense of duty and personal responsibility to the team. Participants’ described how their ability to adapt to their environment was negatively impacted by uncertainty, inconsistent communication of information, and emotions of anxiety, fear, frustration, and stress. Cohesion with co-workers, transferability of skills, and altruistic behavior enhanced healthcare team performance.CONCLUSION Working within the extreme unprecedented circumstances of COVID-19 affected the ability of the healthcare team to anticipate and adapt to the rapidly changing environment. Both team cohesion and altruistic behavior promoted resilience. The adapted model was useful to describe the healthcare team as a singular cognizant entity. Our research contributes to a growing understanding of the importance of resilience in healthcare and provides a bridge between individual and organizational resilience.