Resilience is a highly desirable quality, even though the term is at risk of becoming a cliché. It describes the ability of individuals and organisations to maintain, or regain, their required level of functioning despite significant stressors.

The two elements of resilience, maintaining and regaining function, are beautifully illustrated by the Maori proverb: ‘do not die like an octopus. Die like a hammerhead shark’.

The hammerhead shark has fierce determination and will maintain its defensive efforts to the bitter end. It is tough. The octopus, on the other hand, adapts to its environment, then quickly regains its original structure when danger passes.

Octopi have fantastic flexibility – their beaks are the only part they cannot contort. They have been filmed squeezing through spaces barely the width of a coin. They are also highly intelligent, as illustrated by the adventures of Inky the octopus who successfully escaped from a New Zealand aquarium in 2016 in a puff of magical black ink.

The analogy of the octopus and hammerhead shark applies to resilience in healthcare. However, we must guard against the seductive overtures of superhero rhetoric and recognise the sham of commodified, ‘fake’ resilience.

There are five important ways in which fake resilience is different from true resilience. They are:

• Recognition and respect for resilience
• The distribution of responsibilities and resources
• The degree of reflection and reconfiguration
• How resilience is rewarded and recovered
• The nature of relationships

Recognition and respect

Healthcare organisations and leaders that truly value resilience only rely on it when it is truly necessary. They can discern when their team members draw on their resilience to meet challenges, acknowledge the contributions, and strive to quickly resolve the stressors.

A truly resilient healthcare system treats resilience with respect. Senior leaders understand that it requires much effort, sacrifice, and often comes at a personal cost for individuals and systems. Just because team members are resilient, and able to cope with additional stress, does not mean this precious resource should routinely be exploited. Resilience must not be relied on to meet organizational KPIs, but kept in reserve for exceptional events, like the COVID-19 pandemic.

The proponents of fake resilience purposefully conflate resilience with outcomes. According to them, positive outcomes are associated with strong resilience, while individuals or organisations who are unable to overcome a challenge is deficient in resilience. In fact, even the most resilient individual or organization must eventually succumb before an overwhelming and relentless onslaught of stressors.

Responsibilities and resources

A truly resilient healthcare system takes responsibility for its staff and systems by allocating sufficient resources and providing training and support. Resilience is not an accidental byproduct, nor a platitude of mindfulness and positive thoughts. Instead, resilience becomes a conscious pursuit through exercise and rehearsals, and it is actively restored once the stressors have been dealt with.

Reflection and reconfiguration

The third way to different true resilience from fake resilience, is to examine the response once the stressors have been dealt with. Leaders and organisations that value true resilience learn from events and implement changes that will help them better respond in future. They are not simply content to regain their previous functioning but aspire to grow through and from adversity and achieve higher levels of functioning and more robust structures.

In Tuesday’s with Morrie we read: ‘Give love, receive love and grow from the painful memories of yesterday. No one emerges from a battle unchanged – it is the battles that define who we are.’ True resilience means learning from the past and improving despite adversity.

Reward and recovery

Senior leaders and organisations that truly value resilience recognizes, rewards, and restores it. After the devastating earthquakes in Christchurch, New Zealand, on 22 February 2010, the following reflections were offered: ‘Earthquakes are inevitable in New Zealand, but earthquake disasters are not. We should be aiming to invest in measures that ensure buildings and infrastructure are stronger, not just to prevent loss of life, but to enable them to function as soon as possible after the ground had stopped shaking.’

The authors observe that the cost of enhancing resilience is a fraction of the economic and social costs of a decade of demolition and rebuilding. When this principle is applied to healthcare, it becomes self-evident why staff ‘need to be given time, space and resources to recover, which might include adequate breaks and time off following intense periods’.

Relationships

In Tuesday’s with Morrie, the professor offers this observation during the final days of his life: ‘the fact is, there is no foundation, no secure ground, upon which people may stand today if it isn’t the family. If you don’t have the support and love and caring and concern that you get from a family, you don’t have much at all.’

This sentiment is beautifully expressed by the Maori answer to the question about the most important thing in the world: ‘It is the people, it is the people, it is the people’.

As we pause and reflect on how far we have come on the COVID-19 pandemic journey, and as we prepare for the next steps on the way, let us also take a few moments to recognize and celebrate true resilience!

Alternative animal analogies for resilience

• In some cultures, the humble ox represents positivity, resilience, honesty, hard work, determination, and a spirit of perseverance.
• The Cheetah is not just revered for its speed, but also its agility. Without agility, it would not be able to manage the risk of speed.
• Contrary to popular belief, the amazing ostrich does not hide its head in the sand. It lies its head flat on the ground to eat gravel that aids its digestion.