How can innovation promote resilience in the Long-Term Care system? An analysis of LTC workforce innovation examples through a systemic resilience lens

Internationally Long-Term Care (LTC) systems are under pressure, due to rising demands and concerns for financial sustainability. LTC heavily relies on its workforce, but in many countries there are significant staff shortages, primarily attributed to poor working conditions and welfare spending constraints. In England, public policies have long considered innovation as key to address critical social issues, including the care workforce crisis. In this context, numerous stakeholders have developed innovations involving the LTC workforce, indicative of system resilience. Ungar (2018) defines resilience as the capacity of a system to adapt and reorganise itself under adverse conditions, sustaining its successful functioning, and identifies five processes underpinning systemic resilience: persistence (maintenance of stable functioning despite the threat of change); resistance (active use of resources to face external or internal stressors); recovery (capacity to bounce back); adaptation (process of incremental adjustment and learning new ways of functioning); and transformation (radical change to creating something new and better). This paper will examine four examples of LTC workforce innovations, and critically assess the utility of ‘systemic resilience’ as a lens to understand the processes through which LTC workforce innovation may foster sustainability in a key welfare sector.

Data were collected through interviews and documentary review to formulate four case studies. These innovations were selected through a bibliographic indicator, online document search, a review of care awards, and a multi-stakeholder consultation. They focused on training, diversity approaches, promoting care work and new job profiles. Contextual challenges, innovation aims and promoters, and processes through which innovation fostered resilience were analysed.

Initial findings suggest that workforce innovations produced resilience primarily through persistence and adaptation mechanisms. The first entailed leveraging existing human and organisational resources. The second involved system readjustments to new needs by means of collaborative practices, sector alignment to emerging norms, and piloting new roles and working models. Resistance processes, were financially weak, and primarily fuelled by the mobilisation of stakeholders’ expertise, accumulated over time. Recovery processes appeared almost absent, due to inconsistent institutional support and inter-systemic cooperation. Workforce innovations hardly produced system transformations, because of their time-limited and local dimension; and implementation beyond the testing phase appeared challenging. Finally, the LTC sector resilience appeared to be created through ‘assemblages’, in which stakeholders developed creative processes using a variety of tools.

Systemic resilience appeared a useful lens to examine how LTC workforce innovations support care sector sustainability. Innovation operated through processes and resources emerging at the local level, preserving the stability of the care system and interdependent spheres. In one way, innovations challenged previous conventions of care. In another way, they were bricolage, making resourceful use of whatever was available, regardless of their original purpose. To promote resilience, we argue, innovations should consider the complexity of the problems and foster solutions which permit the system to learn, adapt, and occasionally transform, without producing turbulence elsewhere. We would also highlight the intrinsic limits of resilience to address complex issues such as the workforce crisis, which needs strategic choices promoting change in different systems, and with different speeds.