how healthcare is delivered, will change the demands placed on specific health infrastructure, putting some areas under severe pressure while others become obsolete. The rate of technological change is

predicted to take a quantum leap forward in what has been termed the second machine age. The impacts of this are already being felt with an ever increasing ability for self-diagnosis and self- medication. Future technologies such as AI, nanotechnology, AGVs and robots, personalised medicine, telesurgery, and genetic and stem cell therapies, have the potential to fundamentally change medicine and healthcare with a direct impact on the form, function and capacity of health infrastructure. This impact will include outpatient and community care services. It is likely more products will need

to be designed to be recycled from the outset. This circular economy approach is liable to impact healthcare waste disposal, with a greater need for waste treatment on site and a greater cost for waste disposal off site.

Prioritising areas for action By applying the measures of resilience demand and resilience capacity to the knowledge gained through the systems analysis, the areas of greatest concern are easily identified, and indicators for which strategies should be employed to mitigate them can be identified. Measures to reduce vulnerability, which are already in place, should be assessed in terms of resilience capacity and future scenario modelling, to show where the future need is greatest and action should be focused.

Engage and governance The key to successfully improving resilience is people. Resilience building should be viewed as a change programme that engages and brings together a broad

Embracing the principles of resilience and building them into our health care systems can help future proof and protect this critical infrastructure

set of stakeholders, including those whose needs can be expressed, assessed and incorporated into future strategies. This approach needs to be coordinated through clear vision setting, effective leadership, clear mandates for action throughout the organisation, and testing and review cycles, to ensure the resilience that needs to be built into the systems as they evolve is fit for purpose and in line with organisational needs in the future.

Strategy Strategies for solving resilience issues should balance risk against cost, to ensure they are both affordable and deliverable. Sustainability is vital, as any resilience solution must be able to stand the test of time. Strategies should also be coordinated and integrated into the fabric of the relevant healthcare systems, in coordination with their operating environment, so that they can adapt and respond to a broad range of future scenarios, including the unknown.

Implementation and integration Resilience is not about producing a glossy strategy document, but effecting long- lasting change to assure the future of an organisation. We understand that implementing these strategies is the last and most important step, but also the most difficult to accomplish. The secret of success lies in good, open governance, that demonstrates to stakeholders the value of the path taken by proving it will benefit everyone. Consistent and effective governance with a clear vision also has the power to change a culture,

a common barrier to change and one of the most common sources of failure. Although implementation and

integration is listed as the last step, it is the last step in a reiterative cycle, a cycle that needs to gather speed as the rate of change in the environment within which the organisation operates accelerates.

Conclusion Healthcare infrastructure takes a great deal of time and effort to deliver. A conservative estimate suggests it takes ten years to deliver a hospital, but this is within an environment that is rapidly changing, and that speed of change is accelerating. Embracing the principles of resilience and building them into our health care systems can help future proof and protect this critical infrastructure so that it remains fit for purpose now and into the future. Applying the principles and tools of resilience can help provide the data needed to build business cases for change and monitor the effectiveness of change implementation, as well as improving the healthcare systems ability to respond to shocks and stress factors as they develop and impact. But more than this, the culture of resilience makes change more accepted and less resisted, opening the door for the tempo of change to match that of the VUCA environment.

Reference 1 NHS England, Our Vision and Values. (October, 2016). Retrieved from our-vision-and-purpose/


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