Finnish local health systems leaders’ approaches to change reflect resilience capacities

Abstract Background One key to public health preparedness is to understand how local level healthcare organisations build resilience. This qualitative study adds to the understanding of the role of leadership in this process by studying how local health system leaders’ approaches to change reflect health system resilience capacities. Furthermore, it explores what triggers and hinders organisational change during a crisis. Methods We interviewed 14 leaders from four regions in Finland who had responsibilities for local health and social care during the first year of the COVID-19 pandemic. The interviews were conducted in March-June 2021. We used abductive approach. Firstly, we identified examples of resilience capacities, namely absorbing, adapting and transforming. We also identified a new category from our data: resisting. Secondly, contextual triggers and hindrances for the initiation of change processes were analysed. Results Resilience capacities were manifested by doing standard things faster (absorption), engaging in collaborative reflections (adaptation) and reforming organisational boundaries and services (transforming). Resisting was based on varied levels of reflection leading to mixed responses. Triggers and hindrances differed situationally and resulted in different responses. The combinations of resilience capacities were evolving and changing throughout the crisis. Different capacities were not prerequisites for each other, e.g. transformation could occur without prior adapting. Conclusions Health system resilience capacities form entwined nonlinear processes that are reshaped throughout a crisis. Leaders’ awareness of their approaches to change should be more clearly acknowledged in theoretical frameworks, leadership training, preparedness planning and crisis governance as they may affect organisational responses and health system resilience. Leaders’ favourable approach to change is insufficient alone, as various contextual hindrances may impede the leader's efforts. Key messages • Leaders’ approaches, including resistance, to change reflect health system resilience capacities. They may affect organisational and local level responses and thereby health system resilience. • Analysis of resistance should be included in health system resilience research.