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Surge capacity—the ability to acquire additional workers and resources during unexpected increases in service demand—is often perceived as a luxury. However, the COVID-19 pandemic necessitated an urgent expansion of surge capacity within health systems globally. Health systems in Bangladesh, Nepal, and Sri Lanka managed to scale up their capacities despite severely limited budgets. This study employs a mixed-methods approach, integrating qualitative interviews with quantitative data analysis, to propose a comprehensive framework for understanding Human Resources for Health (HRH) surge capacity from 2018 to 2021, termed ARRAS: Anticipate, Recruit, Retain, Adapt, Sustain. We present national-level data to demonstrate how each country was able to maintain their per capita health care workforce during the crisis. Interviews with key informants from each country reinforce the ARRAS framework. Quantitative data revealed ongoing increases in doctors and nurses pre- and post-pandemic, but no country could rapidly expand its health workforce during the crisis. Qualitative findings highlighted critical strategies such as pre-crisis planning, financial incentives, telemedicine, and re-skilling the workforce. Despite adaptive measures, challenges included inadequate funding, poor data systems, and coordination issues. This study underscores the necessity for robust, long-term strategies to enhance surge capacity and better prepare health systems for future crises.

Professional health associations increasingly serve as vital transnational actors in responding to global public health emergencies and shaping health system resilience. Their cross-border collaboration becomes especially critical in conflict-affected settings, where local infrastructure is overwhelmed, and international expertise, advocacy, and solidarity can bridge urgent gaps. In Ukraine, the intersection of war, health system disruption, and infectious disease threats has underscored the role of organizations such as the All-Ukrainian Association of Public Health Specialists (UPHA), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the American Society for Microbiology (ASM), and the American Public Health Association (APHA). These associations contribute technical assistance, policy guidance, and emergency response and cultivate a shared professional culture and knowledge base that transcends national borders. While the role of professional health associations in routine healthcare delivery and advocacy has been previously explored in the literature, few publications have addressed their mobilization during acute crises—particularly in lower-resource or conflict settings. This comment responds to that gap by examining how professional associations act as platforms for coordinated response, capacity building, and health diplomacy during complex emergencies, with a specific focus on addressing infectious diseases in Ukraine. It draws on desk reviews, organizational reports, and authors’ insights to inform how these associations support infection prevention, biosafety, antimicrobial resistance surveillance, and the development of a resilient public health workforce—issues of global relevance that demand collaborative solutions.

Introduction Healthcare organizations experience difficult challenges as a result of nursing staff turnover. This is because it not only interrupts continuity of service but also its financial implications. Aim The purpose of the study was to find out the effects of work engagement on nurses' intentions to leave their jobs while considering resilience as a mediating factor. Methods The study used a descriptive-analytical design using a survey questionnaire on nurses working in different healthcare settings. The Utrecht Work Engagement Scale, the Brief Resilience Scale, and the Turnover Intention Scale were among the validated scales that were employed. The hypothesized relations were tested using descriptive and mediation analyses at a significance of <0.05. Results Though the turnover intention ( n  = 3.83 ± 1.42) and the level of work engagement ( n  = 4.03 ± 1.32) among nurses were high, their level of resilience of nurses was average ( n  = 2.48, SD: 0.63). Resilience had a negative association with turnover intention ( β  =  − 0.5699, p  < .0001), and there was also a significant negative association between work engagement and turnover intentions among nurses with resilience mediating the relationship ( β  = -0.0367, p  < .05). Conclusion Disengaged nurses are more likely to leave their jobs. Moreover, resilience acts as a mechanism through which work engagement influences turnover intentions. The study emphasizes the need to encourage work engagement among nurses to lessen intentions to leave the profession. Among factors that can improve work engagement and resilience to reduce turnover include conducting regular engagement assessments, fostering positive workplace cultures, employing flexible scheduling practices, and offering resources for personal and professional development.

Background Healthcare professionals are experiencing unprecedented levels of occupational stress and burnout. Higher stress and burnout in health professionals is linked with the delivery of poorer quality, less safe patient care across healthcare settings. In order to understand how we can better support healthcare professionals in the workplace, this study evaluated a tailored resilience coaching intervention comprising a workshop and one-to-one coaching session addressing the intrinsic challenges of healthcare work in health professionals and students. Methods The evaluation used an uncontrolled before-and-after design with four data-collection time points: baseline (T1); after the workshop (T2); after the coaching session (T3) and four-to-six weeks post-baseline (T4). Quantitative outcome measures were Confidence in Coping with Adverse Events (‘Confidence’), a Knowledge assessment (‘Knowledge’) and Resilience. At T4, qualitative interviews were also conducted with a subset of participants exploring participant experiences and perceptions of the intervention. Results We recruited 66 participants, retaining 62 (93.9%) at T2, 47 (71.2%) at T3, and 33 (50%) at T4. Compared with baseline, Confidence was significantly higher post-intervention: T2 (unadj. β =  2.43, 95% CI 2.08–2.79, d  = 1.55, p  < .001), T3 (unadj. β =  2.81, 95% CI 2.42–3.21, d  = 1.71, p  < .001) and T4 (unadj. β =  2.75, 95% CI 2.31–3.19, d  = 1.52, p  < .001). Knowledge increased significantly post-intervention (T2 unadj. β =  1.14, 95% CI 0.82–1.46, d  = 0.86, p  < .001). Compared with baseline, resilience was also higher post-intervention (T3 unadj. β =  2.77, 95% CI 1.82–3.73, d  = 0.90, p  < .001 and T4 unadj. β =  2.54, 95% CI 1.45–3.62, d  = 0.65, p  < .001). The qualitative findings identified four themes. The first addressed the ‘tension between mandatory and voluntary delivery’, suggesting that resilience is a mandatory skillset but it may not be effective to make the training a mandatory requirement. The second, the ‘importance of experience and reference points for learning’, suggested the intervention was more appropriate for qualified staff than students. The third suggested participants valued the ‘peer learning and engagement’ they gained in the interactive group workshop. The fourth, ‘opportunities to tailor learning’, suggested the coaching session was an opportunity to personalise the workshop material. Conclusions We found preliminary evidence that the intervention was well received and effective, but further research using a randomised controlled design will be necessary to confirm this.

Background Previous studies have advocated the benefits of resilience-based interventions for creating a healthy and sustainable workforce. However, resilience is defined and measured in diverse ways. Therefore, the aim of this systematic review is (1) to identify how resilience is defined within different workplace interventions, translated into intervention content, and measured in these interventions; and (2) to synthesize the effectiveness of these interventions. Methods A systematic literature search was conducted and included articles from 2013 – 2023. Twenty-four studies met the inclusion criteria, covering a total of 26 unique interventions. Definitions were categorized as: resilience as a trait, process, or outcome. Cohen’s D was calculated to depict the effect sizes within the intervention groups from pre-test to post-test and, when possible, from pre-test to 3-month follow-up. Results Included studies applied a wide range of definitions; most definitions fitted within the trait-orientation, conceptualizing resilience as an individual characteristic or ability, or the process-orientation, conceptualizing resilience as a dynamic process. No studies solely used the outcome-orientation, but some did combine elements of all three orientations. Various definitions, measures and intervention strategies were applied, however, almost half of the studies (46%) showed inconsistencies within these choices. Furthermore, findings show that most resilience-based interventions in the workplace have a positive impact. While educational workshops with a higher frequency and duration had medium to large effects, solely digital interventions had small effects, changing to small to medium when combined with non-digital elements. Conclusions Findings suggest that resilience-based can benefit employees by enhancing their psychological well-being. This, in turn, can lead to improved work-related outcomes such as productivity, thereby offering advantages to employers as well. This underscores the growing recognition that resilience should be viewed as a shared responsibility between the individual and the organization. Further advancement in the field of resilience-based interventions in the workplace calls for future research to focus on maintaining consistency when choosing a definition of resilience, developing intervention content, and choosing an outcome measure. Preregistration The search protocol was preregistered in the Open Science Framework, see Hollaar et al. (2023). https://doi.org/10.17605/OSF.IO/UKYF7 .

It is estimated that approximately one-fifth of nurses in the United States will leave the profession by 2027 due to stress and burnout caused by the COVID-19 pandemic. It is unknown how burnout, resilience, and post-traumatic stress changed during the first two years of the COVID-19 pandemic in frontline nurses. The primary aim of this study was to evaluate how resilience, burnout, and post-traumatic stress changed in hospital-based nurses from 2020 to 2022. Secondary objectives were to describe the relationships between them and test whether burnout and resilience mediated the relationship between pandemic stress and post-traumatic stress. This was a secondary analysis of a longitudinal cohort study of hospital nurses who participated in the COVID-19 Study and Registry of Healthcare and Support Personnel (CHAMPS) Registry. Changes in resilience, burnout, and post-traumatic stress (PTS) were evaluated using repeated measures ANOVA. Path analysis was conducted using multiple regressions to identify whether burnout and resilience acted as mediators between pandemic stress and post-traumatic stress. Thirty-two participants were included in all four waves of the longitudinal study, with a range of 32 to 740 participants across all time points. Changes in PTS were significant, while changes in burnout and resilience were not. Eighty-nine participants were available for the regression models used to answer the secondary objectives. Burnout mediated the relationship between pandemic stress and post-traumatic stress, but resilience did not. In addition, adequate protective equipment was found to be a predictor of lower pandemic stress. Post-traumatic stress peaked in 2020 during lockdown in the United States and decreased significantly by 2022. Resilience and burnout did not change between 2020 and 2022. The results of this study can guide healthcare organizations in providing frontline healthcare workers with mental health resources, especially at the outset of a pandemic.

During the COVID-19 pandemic, healthcare workers are fighting a lethal virus with acute shortages of Personal Protective Equipment (PPE). These unprecedented circumstances have amplified the sources of emotional distress and worker burnout. However, many healthcare organizations (HCOs) in the United States, have opted for a “stoic approach” to healthcare worker support, i.e., no additional support beyond federal and state policy protections for the licensing and liability of healthcare workers. In this scenario, a key public health concern is sustaining an adequate healthcare workforce, both by way of quantity (adequate numbers) and quality (maximizing clinician resilience to provide safe care to large volumes of patients under challenging conditions). Therefore, it is imperative for HCO leaders to recognize that a limited view of worker psychological safety, without due consideration for the broader emotional distress created by the pandemic, could have the effect of restricting organizational resilience and adversely impacting patient safety and staff retention during and beyond the pandemic. This paper uses the organizational resilience framework to discuss the potential impact of a stoic approach to healthcare worker support on patient safety and staff retention in a hospital intensive care unit (ICU) during COVID-19. The discussion in turn, helps to develop recommendations for HCOs to overcome these challenges.

The global mental health workforce is facing a severe crisis marked by burnout, secondary trauma, compassion fatigue, and workforce shortages, with disproportionate effects on marginalized communities. This paper introduces the Integrated Workforce Trauma and Resilience (IWTR) Model, a comprehensive framework to understand and address these interconnected challenges. This study employs a conceptual, documentary analysis approach to examine the challenges faced by mental health workers, particularly trauma, burnout, and workforce shortages. By synthesizing existing qualitative and quantitative studies, the research identifies recurring themes and provides recommendations for policy reform to improve workforce sustainability and equity. Using a thematic synthesis of 75 peer-reviewed articles, conceptual papers, and policy reports published between 2020 and 2025, alongside foundational theoretical works, the IWTR Model integrates five theoretical perspectives: trauma-informed care, Conservation of Resources Theory, Intersectionality Theory, the Job Demands–Resources Model, and Organizational Justice Theory. The analysis identifies three dimensions: the impact of trauma on mental health professionals, organizational and systemic factors influencing workforce retention, and strategies to build resilience through policy and education. The findings reveal how secondary trauma, burnout, and systemic inequities interact to undermine workforce stability and access to care. The IWTR Model emphasizes that individual-level interventions will be insufficient without addressing structural issues, such as workload inequities, lack of leadership diversity, and underfunding. This model offers a roadmap for systemic reforms to strengthen workforce resilience, improve retention, and advance global equity in mental health care systems.

Background Primary Health Care (PHC) systems are pivotal in delivering essential health services during crises, as demonstrated during the COVID-19 pandemic. With varied global strategies to reinforce PHC systems, this scoping review consolidates these efforts, identifying and categorizing key resilience-building strategies. Methods Adopting Arksey and O'Malley's scoping review framework, this study synthesized literature across five databases and Google Scholar, encompassing studies up to December 31st, 2022. We focused on English and Persian studies that addressed interventions to strengthen PHC amidst COVID-19. Data were analyzed through thematic framework analysis employing MAXQDA 10 software. Results Our review encapsulated 167 studies from 48 countries, revealing 194 interventions to strengthen PHC resilience, categorized into governance and leadership, financing, workforce, infrastructures, information systems, and service delivery. Notable strategies included telemedicine, workforce training, psychological support, and enhanced health information systems. The diversity of the interventions reflects a robust global response, emphasizing the adaptability of strategies across different health systems. Conclusions The study underscored the need for well-resourced, managed, and adaptable PHC systems, capable of maintaining continuity in health services during emergencies. The identified interventions suggested a roadmap for integrating resilience into PHC, essential for global health security. This collective knowledge offered a strategic framework to enhance PHC systems' readiness for future health challenges, contributing to the overall sustainability and effectiveness of global health systems.

Background: The health workforce is central to healthcare systems and population health, but marginal in comparative health policy. This study aims to highlight the crucial relevance of the health workforce and contribute comparative evidence to help improve the protection of healthcare workers and prevention of inequalities during a major public health crisis. Methods: Our integrated governance framework considers system, sector, organizational and socio-cultural dimensions of health workforce policy. The COVID-19 pandemic serves as the policy field and Brazil, Canada, Italy, and Germany as illustrative cases. We draw on secondary sources (literature, document analysis, public statistics, reports) and country expert information with a focus on the first COVID-19 waves until the summer of 2021. Results: Our comparative investigation illustrates the benefits of a multi-level governance approach beyond health system typologies. In the selected countries, we found similar problems and governance gaps concerning increased workplace stress, lack of mental health support, and gender and racial inequalities. Health policy across countries failed to adequately respond to the needs of HCWs, thus exacerbating inequalities during a major global health crisis. Conclusions: Comparative health workforce policy research may contribute new knowledge to improve health system resilience and population health during a crisis.