Social Infrastructure and Organizational Resilience - A Theoretical Model

Abstract Background Considering resilience as a necessity for health care organisations (HCOs), many researchers argue that fluidity is a must and that organisational structures (formal and informal) hinder the adaptability and resilience of health care organisations. Contrary to this statement, my thesis posits that fundamental adaptive processes leading to new equilibria depend on a stable core that persists amidst change, enabling and catalysing these transformations. Methods The phenomenon of resilience within healthcare organisations is examined through the lens of sociological systems theory. Rooted in Talcott Parsons’ assertion that social systems, including healthcare organisations, must perform four basic functions (Adaptation, Goal Achievement, Integration, Latency: AGIL) to survive and function, our research uses the deductive method to derive the necessary structural social components required to cope with external demands. Results The application of the methods yields four complex basic structures rooted in the social structure of healthcare organisations: adaptive structures (flexible structures & resource generating structures), goal achievement structures (governance enabling collective goal setting, decision making and persistence), integrative structures (social capital and social networks) and sustainability structures (socialisation structure, knowledge base, organisational culture). Conclusions As the core of stability, this ‘four-component social infrastructure’ is essential for facilitating higher-order forms of resilience, such as new equilibria. In its absence, healthcare organisations would flounder during change, posing risks to the resilience of these HCOs. Thus, structure is indeed inherent in the chaos of resilience activities. In other words, there is order in the chaos of resilience, and it is essential. Key messages • Fundamental adaptive processes leading to new equilibria depend on a stable core that persists amidst change, enabling and catalysing these transformations. • There is order and structure in the chaos of resilience.