Development of a resilience assessment tool for cardiac care pathways in Europe: A mixed-methods study

Objectives

To develop a resilience assessment tool for cardiac care pathways, informed by stakeholder insights on the impact of COVID-19, emerging innovations, and recommendations to enhance resilience.

Design

Mixed-methods study comprising three phases: 1) survey among European cardiac care providers; 2) five multi-stakeholder focus groups; 3) collaborative tool development. Quantitative data were analysed using descriptive statistics, and qualitative data were analysed thematically.

Setting

The survey targeted cardiology professionals from the 27 EU Member States and Ukraine who worked during the COVID-19 pandemic. Focus group participants were purposefully sampled to represent clinical, organisational, and policy perspectives.

Participants

A total of 177 survey respondents and 40 informants in focus groups.

Results

Six key resilience dimensions of cardiac care pathways were identified: workforce, organisation of care delivery, governance and trust, communication and cooperation, medical devices and products, and data collection and use. Staff shortages and infrastructure capacity were key challenges during the pandemic. The most frequent measures were the reallocation of health staff (75%; n=133) and repurposing infrastructures (38%; n=32). Participants discussed the six resilience dimensions around a total of 17 sub-dimensions and 39 recommended actions to enhance resilience were identified. The resulting resilience assessment tool included four components: 1) mapping a context-specific cardiac care pathway; 2) stakeholder identification critical to participate in collective self-assessment; 3) a preparedness checklist generating a visual heat map; and 4) a resource toolkit.

Conclusions

The resilience assessment tool offers step-by-step guidance to strengthening cardiac care pathways across six key resilience dimensions, supported by actionable recommendations. The tool enables the identification of context-specific vulnerabilities and improvement priorities, thereby supporting healthcare professionals and policymakers in enhancing preparedness and ensuring care continuity before, during, and after crises. Its implementation is currently being piloted in European hospitals to evaluate and refine its practical applicability.

ARTICLE SUMMARY

Strengths and limitations of this study

• This study draws on the lessons from COVID-19, informed by stakeholder insights, to fill the gap of systematic tools tailored to enhance the resilience of cardiac care pathways.

• A sequential mixed-methods approach aimed to foster cross-country learning and the identification of key challenges and strategies to enhance cardiac care resilience.

• Despite a low survey response rate, the combination of survey data with insights from focus groups and a co-creation process, supported the development of a context-specific resilience assessment tool for cardiac care pathways.

• The continuous involvement from the RESIL-Card Consortium and Advisory Board ensured the tool’s relevance and usability, to support policymakers and healthcare professionals in identifying and prioritising context-specific vulnerabilities in cardiac care.

• While the tool is specifically tailored to cardiac care, future research could test and adapt these findings to other clinical areas and geographies.