Resilience in local Finnish health systems: how are leaders' approaches to change manifested in organisational crisis responses?

purposeLocal 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.

findingsResilience 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.