Resilience Capability and Capacity in Unexpected Crises: Experiences and Lessons Learned in a Healthcare Organisation during the COVID-19 Pandemic

Aim. The current article aims to gain insight into (a) what characterises organisational resilience during an unexpected crisis such as COVID-19 and (b) how organisations respond to developments in their environments. Background. In times of societal crises, such as the COVID-19 pandemic, the resilience of the healthcare organisation is tested. Method. This research is based on a case study in a university hospital and a county hospital in Sweden using surveys with both structured and open answers. Results. The result shows ambiguity and "polarised” experiences, emphasising flexibility vs. structure, clear hierarchical information vs. spaces for peer learning through dialogue, and focus on acute care vs. determination to continue with core operations. Conclusion. The article concludes that the pandemic resulted in paradoxes, tensions, and new experiences in organisational processes and interactions. These create opportunities for learning not only during crises but also for improving nursing management in both acute and planned care. Three relations are important in building organisational resilience in crises: resilience capability, resilience capacity, and sustainable resilience practices. Implications for Nursing Management. Organisational resilience under extraordinary circumstances, such as a pandemic, as well as enhancing the previous literature on nursing management that offer a more individually oriented perspective.

Reduction of early surgical site and other care related infections in 3553 hip fracture patients: lessons learned from the 5-year Safe Hands project.

BACKGROUND: Surgical site infection (SSI) after acute hip fracture surgery is a devastating complication associated with increased suffering and mortality. The aim of the study was to investigate early SSI, sepsis, pneumonia and urinary tract infections over five years, before and after the implementation of the Safe Hands project. METHODS: This was a single-centre observational study with a 5-year longitudinal design, investigating the effects of an infection-prevention intervention targeting the clinical care pathway of individuals with acute hip fracture. Statistical analyses were based on routinely collected patient outcome data comprising 3553 patients. The study conforms to the criteria of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). RESULTS: The incidence of early SSIs decreased from 2.5% in years 1-2 to 1.1% in years 4-5. Similar results were observed for sepsis (2.7% to 1.3%) and urinary tract infections (14.2% to 4.2%). The multivariable regression results suggest that, for every observed year, the odds of early SSIs decreased. Male gender, procedure time, sepsis and preoperative skin damage increased the odds significantly. CONCLUSIONS: Our preventive bundle, based on partnership between researchers, managers and clinicians and a strong commitment to change from the involved professions, appear to be effective in reducing the frequency of potentially devastating SSIs and other hospital acquired infections after hip fracture surgery. The use of external and internal facilitators was crucial to enable individual and organisational learning and overcoming barriers to improvements. TRIAL REGISTRATION: Clinical Trials.gov ID: NCT02983136 Registered 6 December 2016-Retrospectively registered.