Elderly care across Europe is under increasing pressure. Healthcare workers are experiencing high workloads, emotional strain and staff shortages. At the same time, informal caregivers are expected to take on more responsibility for the daily care of their loved ones. As these pressures grow, the need for resilient systems that can sustain the quality of care, maintain workforce stability and support the mental wellbeing of healthcare workers and informal caregivers grows too.
A new systematic review conducted by the Support4Resilience team synthesizes 134 empirical studies to provide a comprehensive overview of the key factors shaping resilience at organizational level among healthcare workers and informal caregivers in elderly care. Importantly, the review also highlights the pivotal role of leadership in strengthening these resilience dimensions.
Bridging the Gap
Elderly care depends on healthcare workers, as well as on informal caregivers supporting their loved ones. Supporting individual resilience, including mental wellbeing, is crucial to achieving resilience in health systems, yet research has often treated these two aspects separately. This review bridges that gap by examining:
- Individual resilience
- Organizational resilience
- The influence of leadership
As outlined below, the results offer a clearer picture of the factors influencing resilience in elderly care and how leaders can actively support it.
Individual Resilience in Healthcare Workers
Studies show that healthcare workers draw resilience from a combination of:
- Intrinsic attributes and personal relationships: Factors include optimism, self-efficacy, and humor. Some workers use religion, spirituality, or self-compassion to manage stress. Support from family and friends provides an essential external resource for individual resilience.
- Psychological safety and peer support: Workers need a safe space to share concerns and emotions. Peer support helps staff clarify difficult tasks and ventilate. Interacting with co-workers makes it easier to clarify aspects of the work that staff are struggling with.
- Well-organized team work: Effective team structures are a key source of resilience. Workers report that not having a team to rely on is a source of stress.
- Management support: Reliable, supportive and motivating leadership reduces emotional exhaustion.
- Opportunities for professional growth and career fulfilment: Training and learning increase confidence. This makes it easier for staff to adjust to new roles or overcome challenges.
- Having balanced job demands, including work-life balance: An adequate work-life balance and manageable workloads support physical and mental health.
These factors suggest that resilience is a combination of internal traits and external conditions. Personal attributes provide a necessary foundation. However, these attributes require a supportive working environment to remain effective. Leadership and opportunities for growth provide a sense of purpose. When these elements come together, healthcare workers are better able to manage the pressures of care.
Individual Resilience in Informal Caregivers
Resilience in informal caregivers depends on several internal and external factors. Studies show that the factors that strengthen caregiver resilience include:
- Personal attributes and management strategies: Caregivers use active problem-solving techniques and set personal boundaries. Self-care through leisure activities and daily routines helps them to continue in their role.
- Feeling of control and competence in the caregiving role: Feeling competent in caregiving tasks is an important factor in building resilience. Being able to navigate the healthcare system effectively improves a caregiver’s ability to manage demands.
- Access to private and professional support: Professional support groups can reduce isolation and improve well-being. Respite care gives families a sense of shared responsibility.
- Access to practical guidance and training: Professional help enables individuals to assess and accept their situation. As care complexity grows, training to increase technical skills becomes a necessary resource.
- Appropriate coordination and continuity between care providers: A good relationship with formal care teams, like nurses, is important. Proper coordination between different care providers reduces the overall burden.
Organizational Resilience
Organizational resilience depends on the capacity of the system to maintain care during both routine operations and crises. The review highlights several factors, including:
- Technology and tools to streamline work processes: Innovation and new technologies enhance efficiency and service accessibility. Many digital tools emerged during the COVID-19 pandemic to facilitate remote work and streamline tasks.
- Safe staffing levels and manageable workloads: Stability requires adequate funding and consistent staffing levels. To maintain care delivery during challenging times, organizations require high retention rates and backup staffing plans.
- Adaptive capacity: This involves the ability of staff to adapt to changes and stretch the scope of their professional roles. It includes flexibility, improvisation, and embracing new ways of working to overcome challenges.
- Stable and competent leadership: Strong leadership involvement and low manager turnover support organizational stability. Leaders must be able to prioritize tasks and manage resource shortages effectively.
- Adequate cooperation within and across healthcare services: Clear communication and information sharing are necessary for coordination. Effective teamwork and interdisciplinary cooperation with external providers ensure cohesive care.
- Supportive cultures that prioritize learning: Training and professional education opportunities strengthen the organization. Peer-to-peer and collaborative learning communities foster a supportive environment.
Leaders as Intermediaries
According to the findings, leaders play a central role as mediators between individual and organizational resilience
Effective leaders:
- Strengthen relational trust and foster open communication: Leaders who show compassion and remain accessible create spaces for reflection and discussion. Demonstrating respect allows employees to assume a higher level of autonomy.
- Drive structural and strategic improvements: Supporting staff involves ensuring timely distribution of information and facilitating teamwork. Involving workers in decision-making gives them a sense of control over workplace strategies.
- Safeguard workers’ wellbeing: Prioritizing workers’ health and meeting their psychological needs strengthens their professional identity. When workers feel valued, they are better able to adapt to challenges as they arise.
- Manage appropriate resource and task allocation: Leaders regulate job demands through appropriate resource and task allocation. Securing adequate staffing and resources is necessary to reduce stress and fear among the staff.
- Recognize and support informal caregivers: Leaders play a role in recognizing and supporting informal caregivers within the care system.
Reciprocal relationship
Overall, the findings highlight the reciprocal relationship between individual and organizational.
A resilient worker benefits from a resilient organization; a resilient organization depends on resilient individuals. Leadership is a mechanism that aligns the two – not only through structural and strategic measures, but also by strengthening the relational dimension of leadership. However, despite the well-recognized importance of informal caregivers in elderly care, very little existing research addresses how leaders can support them, revealing a critical gap in the literature.
Dive Deeper
This blog post only summarizes the main findings of our systematic review. To explore the data in depth:
Written by: Malin Knutsen Glette, from the University of Stavanger