Table 2

The capacities underpinning everyday resilience (drawing on ref.23)

Organisational capacitiesKilifi experiencesMitchell’s Plain experiences
Cognitive capacities, for example,
  • Purpose, core values

  • Constructive sensemaking to provide meaning

  • Blend of expertise, opportunism, creativity and decisiveness despite uncertainty

These encourage an organisation to frame conditions in ways that enable problem solving and action
SCHMT members demonstrate concern for and commitment to staff and community
Medical superintendent in hospital demonstrates openness in engagement with staff and supportiveness (box 1)
Mid-level managers demonstrate sense of purpose in trying out new processes and practices, role-model new approaches to staff
HAST managers demonstrate sense of purpose and decisiveness in their approach to their challenge; by role-modelling and language they signal respect for others and importance of communication and relationships (box 2)
Behavioural capacities, for example,
  • Learnt resourcefulness, ingenuity

  • Useful, practical habits, especially repetitive, over-learned routines

  • Sense of what an organisation believes and its core set of values

  • Taking actions and making investments before they are needed

These generate a set of potential strategic actions and behaviours that can be drawn upon in emerging situations
SCHMT adapts supervision practices in order to maintain support to PHC facility managers
New routines of inclusive decision-making in one hospital strengthen collective sense of duty and encourage innovative practice (and may enable response to future threats)
Mid-level managers introduce new practices in, for example, way meetings are run, that provide spaces for learning and developing shared values —and support future action
HAST managers adopt participatory approach, in working with staff to develop develop new principles of communication and engagement, that recognise importance of relationship-building to their work—and support future action
Contextual capacities, for example,
  • Psychological safety, the willingness to take personal risks

  • Social capital evolving from respectful interactions within an organisational community

  • Diffuse power and accountability within the organisation

  • Broad resource networks outside the organisation

These promote interpersonal connections and allow access to resource supplies that lead to the ability to act quickly under emerging, uncertain conditions
Individual managers demonstrate willingness to take risks and respect for others
SCHMT drew on resource networks to access funding for supervision and address cholera outbreak
Hospital superintendent engages people respectfully, spreads responsibility for decision-making and generates strengthened sense of collective duty
Individual managers demonstrate willingness to take risks by trying out new approaches
Mid-level and HAST interventions founded on respectful interactions and recognise diffused power and responsibility
Mid-level and HAST managers draw on research team in developing new approaches
  • HAST, HIV/AIDS/sexually transmitted infections/tuberculosis; SCHMT, Sub-County Health Management Team.