A systems response to managing stresses

We live in a world that the US Army War College has dubbed VUCA – volatile, uncertain, complex and ambiguous. Unprecedented technological change is seeing us all become increasingly interconnected and dependent on technology for every aspect of our professional and private lives.

This change is occurring against the backdrop of climate change, and amid the social stress of a population that is ageing, growing and moving. Understanding our healthcare systems;

how we determine, create and protect their value; identify where they are vulnerable to short-term disruption and long-term change, and how we can build their resilience and assure their fitness for the future is essential. To be fit to meet current needs, as

well as being prepared for the future, our healthcare systems and infrastructure need to continually adapt and change to reflect the changes, shocks and stresses within wider society. The speed of change within our society is accelerating. It is driven by rapid advances in knowledge and technology, ever greater interconnectivity, and other factors such as urbanisation, population growth, climate change and globalisation. This need for change and adaptation is happening in and driven by a VUCA environment. Our healthcare systems are becoming ever more complex and as a result, planning, implementing and integrating change into these systems is becoming more challenging and is progressively taking longer. This evolution creates the potential for a gap to open between accelerating change and the ability of our healthcare to keep up. Indeed, the only hope is for our healthcare systems to become ever more resilient. It needs to have the will and ability to

anticipate, endure, respond, adapt and thrive within this disruptive and changing environment. While the necessary adaptive capacity also needs to be built within the structures and culture of healthcare systems. The concept of resilience is still

evolving, and the terminology is becoming more commonly used in a wide range of contexts as a useful means for defining policy, communicating a state of being or for suggesting successful paths through a VUCA environment. Personal resilience has become synonymous with self-help approaches, as well as mental health therapies. Organisational resilience is now the subject of a British Standard (BS 65000), and community resilience has been the subject of public policy

Our urban environments are incredibly complex, but the more we understand them, the better our strategic decision- making will be

Richard Look

Richard Look is an associate resilience consultant at Burro Happold. He has first-hand experience of every aspect of

resilience – from preparing communities, to developing hazard mitigation, to the coordination of numerous emergency

responses and recovery operations. He has worked at every level of government developing policy, implementing strategy and running critical operations managing projects and creating business cases for resilience building.


making for many years. City resilience is also the subject of a developing British Standard, as well as programmes from organisations such as the UN International Strategy for Disaster Risk Reduction and the Rockefeller Foundation. The broad themes running through all this understanding around resilience are holistic systems, situational awareness, hazard and change awareness, adaptive capacity, planning, preparation, protection, reflecting, learning, and adapting. For this article, resilience is defined

in very broad terms, as: “The will and ability to anticipate,

endure, respond, adapt and thrive within a disruptive and changing environment.” This definition implies the capacity of

an entity to understand the operational environment and the impingent vulnerabilities and to be able to reduce those vulnerabilities and prepare for disruptions so that it can endure shocks and stresses and recover from them while adapting to, and growing from, the disruptive experience. Within this context, the ability to adapt also implies the ability to reflect and learn. As resilience develops, the ability to prevent or mitigate shocks and stresses is developed, and the ability to respond to those shocks which are unpredictable or unavoidable is improved. Effective resilience can also develop a greater capacity to bounce back from a crisis, to learn from it, achieve revitalisation, and turn a shock or stress into an opportunity, using perceived failures as the springboard for future success from a more robust, better- informed footing.

Building resilience While it is difficult to predict the social, economic and geopolitical impact of these stresses to our urban and healthcare systems, BuroHappold has developed six principles of resilience that can help us respond to potential future challenges. These principles allow us to


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