Resilience testing in action: piloting the health system resilience testing tool with a pandemic scenario in Finland

Background: System-wide approaches to measure, prepare for and manage the next acute shock are needed. We document the application of the health system resilience testing tool to a hypothetical pandemic scenario in Finland. Methods: The resilience testing tool promoted pre-crisis identification of resilience gaps and was built on the Health Systems Performance Assessment Framework and the Shock Cycle Framework. It included guidance on building a shock scenario, conducting a semi-structured resilience testing dialogue with health system stakeholders, and evaluating resilience. A hypothetical scenario of a pandemic affecting predominantly children was addressed in a semi-structured, mixed-methods resilience test in Finland. The resilience test brought together national experts and other stakeholders to identify the health system weaknesses exposed by the scenario. Results: The resilience testing tool enabled the preparation for the high-level dialogue that identified actionable systemic weaknesses that undermine resilience. The identified weaknesses in the Finnish health system included: a lack of clarity of the process and value-basis of decision-making; sustaining trust towards and between authorities; multi-sectoral collaboration; safeguarding the health workforce; and developing a comprehensive knowledge base. Conclusions: The main benefit of the resilience testing methodology is the ability to bring key actors together to exchange different perspectives on how a health system functions during a crisis. The discussions at the high-level dialogue revealed the need for a mechanism, such as a resilience testing tool, to elucidate the range of practical challenges and how to potentially address them. The discussions also captured themes that are not routinely identified in existing performance assessment mechanisms, such as ethical considerations, values, and political determinants of the health system response. The Finnish pilot study was used to update the structure and facilitation of the resilience testing tool. Further suggested improvements for resilience testing include greater clarification for participants on the scenario, an increased emphasis on recovery and learning, and a greater representation of stakeholders from the community.