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Resilience in Healthcare (RiH): a longitudinal research programme protocol
  1. Karina Aase1,
  2. Veslemøy Guise1,
  3. Stephen Billett2,
  4. Stephen Johan Mikal Sollid1,3,
  5. Ove Njå4,
  6. Olav Røise1,5,
  7. Tanja Manser6,
  8. Janet E Anderson1,7,
  9. Siri Wiig1
  1. 1SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
  2. 2School of Education and Professional Studies, Griffith University, Nathan, Queensland, Australia
  3. 3Department for Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
  4. 4Faculty of Science and Technology, University of Stavanger, Stavanger, Norway
  5. 5Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
  6. 6School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
  7. 7Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
  1. Correspondence to Dr Karina Aase; karina.aase{at}


Introduction Over the past three decades, extensive research has been undertaken to understand the elements of what constitutes high quality in healthcare. Yet, much of this research has been conducted on individual elements and their specific challenges. Hence, goals other than understanding the complex of factors and elements that comprises quality in healthcare have been privileged. This lack of progress has led to the conclusion that existing approaches to research are not able to address the inherent complexity of healthcare systems as characterised by a significant degree of performance variability within and across system levels, and what makes them resilient. A shift is, therefore, necessary in such approaches. Resilience in Healthcare (RiH) adopts an approach comprising a comprehensive research programme that models the capacity of healthcare systems and stakeholders to adapt to changes, variations and/or disruptions: that is, resilience. As such, RiH offers a fresh approach capable of capturing and illuminating the complexity of healthcare and how high-quality care can be understood and advanced.

Methods and analysis Methodologically, to illuminate what constitutes quality in healthcare, it is necessary to go beyond single-site, case-based studies. Instead, there is a need to engage in multi-site, cross-national studies and engage in long-term multidisciplinary collaboration between national and international researchers interacting with multiple healthcare stakeholders. By adopting such processes, multiple partners and a multidisciplinary orientation, the 5-year RiH research programme aims to confront these challenges and accelerate current understandings about and approaches to researching healthcare quality.

The RiH research programme adopts a longitudinal collaborative interactive design to capture and illuminate resilience as part of healthcare quality in different healthcare settings in Norway and in five other countries. It combines a meta-analysis of detailed empirical research in Norway with cross-country comparison from Australia, Japan, Netherlands, Switzerland and the UK. Through establishing an RiH framework, the programme will identify processes with outcomes that aim to capture how high-quality healthcare provisions are achieved. A collaborative learning framework centred on engagement aims to systematically translate research findings into practice through co-construction processes with partners and stakeholders.

Ethics and dissemination The RiH research programme is approved by the Norwegian Centre for Research Data (No. 864334). The empirical projects selected for inclusion in this longitudinal research programme have been approved by the Norwegian Centre for Research Data or the Regional Committees for Medical and Health Research Ethics. The RiH research programme has an embedded publication and dissemination strategy focusing on the progressive sharing of scientific knowledge, information and results, and on engaging with the public, including relevant patient and stakeholder representatives. The findings will be disseminated through scientific articles, PhD dissertations, presentations at national and international conferences, and through social media, newsletters and the popular media.

  • quality in health care
  • health & safety
  • health policy
  • organisation of health services

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors KA designed the overall research proposal, drafted the original manuscript and contributed to revisions and additions to the manuscript. SW and VG contributed with substantial intellectual contents in the design of the research programme, drafted substantial parts of the original manuscript, and contributed to revision to the manuscript. SJMS, ON, OR, SB, TM and JEA contributed to the design of the research programme, drafted parts of the original manuscript and contributed to revisions to the manuscript. All authors approved the final version of the manuscript.

  • Funding The RiH research programme has received funding from the Research Council of Norway under the FRIPRO Toppforsk programme, grant agreement no 275367. The University of Stavanger, Norway, the Norwegian University of Science and Technology in Gjøvik, and the Norwegian Air Ambulance Foundation support the programme with in-kind funding.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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