Healthcare Organizational Resilience: A Systematic Review and Integrative Framework of Factors, Capabilities, Outcomes, and Context

Abstract Background Healthcare organizational resilience remains inconsistently defined and measured, with organizational factors, capabilities, and outcomes frequently conflated. Objective To examine definitions and operationalizations, synthesize organizational factors, resilience capabilities, outcomes, and context, and develop an evidence-informed integrative framework. Methods We conducted a systematic review following PRISMA 2020. We searched MEDLINE, PsycINFO, Web of Science, and Scopus from inception to 11 May 2026 for empirical studies examining healthcare organizations as resilient entities. We synthesized qualitative, quantitative, and mixed-methods evidence using a convergent integrated approach informed by Joanna Briggs Institute guidance. Inductively coded findings were classified by analytical role. Results Forty-seven reports representing 45 studies (25 qualitative, 15 quantitative, five mixed-methods) across multiple countries were included; 31 examined COVID-19 or pandemic conditions, and most concerned hospitals. Operationalizations included direct measures, frameworks, qualitative inference, service proxies, and expert ratings. Six factor domains concerned leadership and governance; workforce and culture; information, communication, and digital technologies; preparedness and coordination; material, financial, and infrastructural resources; and external relationships and policy support. Five capabilities comprised anticipation and preparation, absorption, adaptation and reconfiguration, restoration and recovery, and learning and transformation. Four outcome groups were service continuity, safety and quality, recovery, and organizational viability. Immediate continuity sometimes depended on workforce overextension, deferred care, temporary support, or resource depletion. The framework distinguishes factors, capabilities, outcomes, and contextual conditions. Conclusions Resilience assessment should extend beyond preparedness plans and immediate continuity to safety, workforce well-being, recovery, and longer-term viability. The hypothesis-generating framework requires prospective testing across healthcare settings and disruptions.