Summary

Interest in health care resilience began in the mid-1940s, but it took approximately two decades for researchers to realize its importance. By the early 2000s, the body of knowledge reached a level of maturity, with details of international case studies about the performance of health facilities and systems in responding to multiple hazards and also guidance and regulations to secure the minimum level of resilience of health systems. However, the failure of health systems to respond effectively to COVID-19 indicates that preparedness was not adequate and that there is a gap between this body of knowledge and practice. This gap is driven by many factors but mostly the Lost in Translation (LiT) Effect. The LiT Effect occurs when the application of guidelines is done in a mechanical, “paper filing” manner, without understanding their goal and the knowledge behind them. There are many contributors to the LiT Effect, including appropriate knowledge of disaster resilience, an individual’s workload and motivation and capability to acquire new knowledge, let alone the difference between agendas and organizational priorities. Some of these have been investigated and concluded that more work is needed to translate strategic evidence at operational levels. This will enhance the further learning of professionals and enable them to develop adequate plans.

The way disaster resilience is approached is one of the key issues of health care vulnerability. Health systems struggle with the large number of day-to-day challenges. Disaster resilience is low on decision-makers’ lists of priorities, specifically when risks are moderate or low, because it is viewed as a burden instead of an obligation, a moral and a legal requirement. The analogy of the human body, specifically the immune system, can help us understand how health care facilities’ internal systems operate. Immunity is integrated throughout the body; it detects and manages most external hazards such as bacteria and viruses without affecting daily activities. The immunity of the human body is comparable to the resilience of health care facilities and health systems and perhaps should operate in a similar way. Resilience needs to be embedded in the daily operations of health systems and facilities. The Jigsaw Concept is a simplified approach to enhance understanding of the complexity of health care facilities and systems without overlooking details. It applies structured thinking to reduce the LiT Effect by identifying the components of health care facilities and systems, their interconnectivity and interdependency, and predicting and mitigating the impact of the failure of each of these on the overall functionality in a continuous and integrated way. This functionality depends on six internal interconnected components, namely building integrity, lifeline systems, equipment, supplies, workforce, and management and governance to regulate the way all these operate. Externally, it depends on interdependent components such as suppliers and infrastructure (e.g., transportation, power, water, internet, and gas networks). Failure of one of these could cause direct or indirect failure of the continuity of health care service. Each of these components plays a unique role in the system, similar to pieces of a jigsaw puzzle that must be assembled in a specific way to provide a clear picture and clarity is affected when one piece is missing. Advanced and smart technologies might play a role in dealing with this compounded complexity; however, many questions must be answered before this technology is applied, including questions regarding ethics and ownership of used and generated data.