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ABSTRACTThe analysis of hospital resilience is essential in understanding how health services prepared for and responded to sudden shocks and unexpected challenges in the COVID-19 health crisis. This study aimed to analyze the resilience of a referral hospital in the state of Pernambuco, Brazil, in the context of the COVID-19 pandemic. The main theoretical approach based on resilience is the system’s capacity to maintain essential functions and to absorb, adapt, and transform in the face of unprecedented or unexpected changes. A single case study approach was used to identify the strengths and weaknesses of this response capacity. Data triangulation was employed. Data were collected from April (beginning of case discharges) to October 2020 (decrease in the moving average of cases in 2020). A content analysis was then conducted. Data were analyzed in relation to context, effects, strategies, and impacts in facing the disruptions caused by the pandemic. The results indicated the occurrence of four configurations mostly favorable to hospital resilience during the study period. Among the main strengths were: injection of financial resources; implementation of new hospital protocols; formation of a support network; equipping and continuing education of professionals; and proactive leadership. Weaknesses found in the analysis included: initial insufficiency of personal protective equipment and confirmatory tests; difficulties in restructuring work schedules; increasing illness among professionals; stress generated by constant changes and work overload; sense of discrimination for being a health professional; lack of knowledge about the clinical management of the disease; and the reduction of non-COVID assistance services.

ABSTRACTHealth crises, such as the COVID-19 pandemic, challenge health systems in demonstrating resilience—the ability to cope with change, manage challenges, and adapt in order to retain their effectiveness. Understanding how such challenges affect and produce reactions in those involved in this response is extremely important. This study evaluated resilience in three referral hospitals in the city of Recife, Pernambuco, Brazil—one public, one private, and one philanthropic hospital—by examining the coping activities adopted by the nursing staff working on the COVID-19 frontline. A multiple case study was carried out, using a qualitative approach, triangulating data from direct observations, document analysis, and interviews with 21 nursing professionals working in management and care provision. Data were collected from April to October 2020. The interviews were transcribed and analyzed based on the resilience categories defined by Blanchet (2017): absorption capacity, adaptive capacity, and transformative capacity. Four themes were considered relevant to the objectives of this study: institutional support, access to personal protective equipment (PPE), work relationships, and fear and mental health. Adaptive capacity was demonstrated concerning the four themes analyzed, absorption capacity was demonstrated in two themes, and no transformative capacity was identified. The study highlighted that the health crisis was challenging for all the hospitals studied, regardless of their legal-administrative status. No differences were observed among them in terms of resilience.