Trauma occurs in all populations regardless of socioeconomic status, race, ethnicity, gender and sexuality or geography and the impacts of trauma are long-lasting affecting development, wellness and stress response across the lifespan. Even on a bad day there are normally some things that we can feel good about. Figure 5 illustrates the effect of leadership not only asking for feedback, but actually acting on it, closing the loop, so to speak, of ideas and concerns brought up by staff on the frontline of patient care. See the latest announcements, news, and media coverage. Provide clear and appropriate messages about patients rights, responsibilities and service options. He is urgently called into a room by one of the respiratory therapists. Bryan Sexton, associate professor in psychiatry and behavioral sciences at Dukes School of Medicine and an expert in the field of resilience states, The trick is to build mental muscles to deal with challenges thrown our way, both personally and professionally, when many feel like theyre asked to do more.. Resilience Its constantly vigilant and transparent. These were commitment, control, and challenge. They can be anything you feel good about or grateful for. In addition to individual resilience, resilience occurs at the community level. Leadership is the key component. To get used to the idea, describe three good things that happened to you yesterday, and why they were good. It can also lead to high turnover, which can have a significant effect on the bottom line. Trauma But to do this successfully and sustain improvement, all pieces of the puzzle must be in place. A positive organizational culture demonstrated through respect, trust, a focus on excellence, recognition and a non-threatening environment, 2. The technical storage or access that is used exclusively for statistical purposes. for high reliability organization (HRO) implementation, metrics for evaluating a health system's progress towards becoming an HRO, and effects of HRO implementation on process and patient safety outcomes. In high reliability organizations, each Another vital component of an HRO is continuous learning. Highly reliable organisations (HROs) display five key characteristics (preoccupation with failure, reluctance to simplify, sensitivity to operations, deference to expertise and commitment to. -typically lead to constructive attitudes and behaviors. The managers support, guidance and overall trust in the teams process led to overall satisfaction of her workforce. HRO Baseline Training for all frontline . And the blue bar represents the mean. Culture is the social glue. In this study, I: (1) explore the existing literature surrounding high reliability organization and resilience, (2) present a qualitative analysis of Special Weapons and Tactics (SWAT). nuclear power stations. Community resilience is a measure of the sustained ability of a community to utilize available resources to respond to, withstand and recover from adverse situations. Primary care organizations can identify and strengthen patient and community resilience factors, which are key components of a trauma-informed approach. In an unmindful culture, the staff doesnt know who the leaders are. Through our cadre of services, we provide the strategies, skills, and solutions to address any incidences of disruptive behaviors that show up in healthcare. Here are some articles we suggest: Would you like to use or share these concepts? One of their significant interventions started atMayo Clinic. High Reliability in Healthcare: It's Not a Project A true test of resilience is a major disruption, and COVID-19 has undoubtedly been that. Self-reliance and independence can be great qualities, but resilience requires high-quality, supportive relationships. Their successes were celebrated at the unit, department, and organizational level. NY AMR EMS Provider Who Injected IV Fluids into Officers Sister PA EMT Said COVID Patient Didnt Need to Go to the NYC Unions Demand Reinstatement, Back Pay for Workers Fired for Refusing President Biden to End COVID-19 Emergencies on May 11. Leaders in proactive and generative cultures are present. Resilience. Populations that have suffered discrimination, racism, slavery, genocide, war, forced migration and other forms of oppression are more likely to experience cumulative trauma. Try to include why you felt each of the things was really good. High reliability in health care is complicated by lack of overall system coordination, frequent healthcare team member changes, and variability with respect to information. F_ F4\#eB.#k pyr0 KA%An#Yj;hH86G{ i@3((" va4,LN$\T=NBiN/xhh7]5btwXCrqqqti#I&ST fJ>ElRv. Execute. There were many different responses which ranged from placing it on the dash, to securing to the windshield, to adhering it to the side window, and holding it in one hand while steering with the other. OAdvocateAuroraHeaLth . Resilience is the ability to cope with and recover from setbacks. As we began the RCA, we informed everyone that it was a learning/teaching environment. High Reliability Organizations (HRO) use failures and near-misses as learning experiences to improve systems, processes, and service to its consumers. We now conduct probability analyses of systems and behaviors that we know present risk. While there are many practices that may foster your team's resilience, here are some that we recommend: Candor Breaks: Psychological safety the belief that any team member can speak out . To better address trauma in primary care, Kaiser Permanente and the National Council for Mental Wellbeing (National Council) launched the Trauma-Informed Care Primary Care: Fostering Resilience and Recovery initiative to develop, test, disseminate and scale a field-informed Change Package. Other employees were asked where they position the GPS in the van. Culture is the foundation for vision and strategy. HROs thrive because their leadership takes charge of the culture, engages staff, promotes a culture of safety, and embeds continuous learning and improvement processes into the everyday lives of everyone within the organization. It must be reliable. This Change Package is for a Core Implementation Team (CIT) in primary care organizations planning to implement trauma-informed approaches. Its time to connect, learn, and lead your organization with strategies that work. In their study, Maddi and Khoshaba identified three variables associated with the individuals' ability to bounce back from the immense stress they faced. Emotional understanding is a key factor in resilience. The scores for people who felt listened to and heard are dramatically higher than those who didnt. Facilitate group and partner interactions for sharing recovery and healing from lived experiences. The benefits of creating trauma-informed environments include creating safer spaces for staff, improving clinical decision-making by equipping providers to identify and respond to trauma and building collaborative care networks to increase providers capacity to address holistic needs. To use a now well-known expression, they exhibit "chronic unease" 2. about how well they have their major hazards under control. The process of planning for failures is good but when the plan fails you become stressed. For example, the process of policy review needed to be changed so that new and updated policy, protocols, and procedures were tested using a new model before they could be formalized and communicated to staff. No one negotiates in a vacuum. The CIT will lead planning and implementation efforts and consists of members who represent the diversity of the organization and are motivated and empowered to implement change. Build compassion resilience in the workforce. Prior to Just Culture and our High Reliability project, an at-fault accident involving significant damage would have resulted in immediate termination of employment. At the same time, she should continue diligently to flex staff on and off shift to maintain productivity levels. 2. Three weeks prior to this accident, my organization had begun issuing GPS devices to drivers at the beginning of their shift. You can take the test here. Take this free survey to capture your key character strengths. RCAs are effective for identifying causal factors of a single event, however, they rarely create a structure to evaluate possible remedies for long term reliability. : Acknowledging that work is complex and refusing to dismiss or excuse failureswithout investigation. Guided by its team of renowned healthcare thought leaders, Press Ganey works with more than 41,000 healthcare facilities to reduce patient suffering, enhance caregiver resilience and improve the overall safety, quality and experience of care. While all populations are affected by trauma, certain groups experience trauma at higher rates than the general population, including individuals who identify as Black, Hispanic or multiracial; individuals with incomes of less than $15,000 per year; and unemployed individuals. Address these first to create optimal conditions for change. Patient stratification, care coordination, and clinical care models. endstream endobj startxref : Knowing that failures are going to occur and therefore buildingsystemsto respond and recover when they do. An organization is only as strong as its leaders, so having leaders guiding the culture is important. The red bar represents scores when leadership did not close the loop. The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes. Achieve your organisation's reliability goals for all of your workloads by starting with the resilient foundation of the Azure cloud platform. Much like cultures at HROs, their process has evolved and matured. Drs. This demonstrates a Commitmentto Resiliency and Reluctance to Simplify. Organizationsmusthave, leadership commitment, robust process improvement. Frankel and Leonardpublished a study in 2017about cultural data that surveyed and collected data from 17,000 people across 30 hospitals in Michigan. The manager and her team were committed to reducing harm and made small, incremental steps over the year to meet their collective goals. Ensuring physical and emotional safety among patients and staff. Many highly reliable organizations are adapting the three good things process and incorporating it into shift handoffs. Frankel and Leonard and their team assessed 30 community hospitals for the state of Massachusetts to help figure out how these organizations could sustain high-quality community care within an ever-changing environment full of systems mergers and political changes. All Rights Reserved. Individuals who report high levels of resilience portray an optimistic outlook, positive emotionality, curiosity, and openness to new experiences. A core mindset that supports perseverance is called the "growth mindset"knowing "My ability and competence grow with my effort." Effortful control. A resilient organization maintains a high level of performance despite day to day pressures, threats, and uncertainty. People who remain calm in the face of disaster have resilience. Give patients a significant role in planning and evaluating services. share a congruent set of beliefs while remaining open to different points of view. Create an atmosphere that allows patients to feel validated and affirmed with each contact. They are: Sensitivity to Operations: Maintaining a heightened awareness of how your systems and processes are functioning. Resilience in High-Reliability Organizations means the ability to anticipate trouble spots and improvise when the unexpected occurs. Yes, it can be difficult, but developing a high reliable team can be achieved by developing capabilities to detect, contain, and bounce back from situations that have already occurred, before they worsen and cause serious harm. We send regular emails about upcoming events, member spotlights and updates in mental wellbeing. Within each Change Concept there are also Key Considerations to help assess if you would benefit from taking additional planning steps prior to implementing the Action Steps. The organization must be able to identify errors that require correction while at the same time innovating solutions within a dynamic environment. Payment mechanisms associated with integrated care practice can also help support the sustainability of a trauma-informed approach within primary care. It was also made clear that the session wasnt punitive, and no one should be afraid of saying the wrong thing. In addition to the framework, Drs. However, the foundation had been laid, and from here forward it was easier envision a change in culture. A positive organizational culture - demonstrated through respect, trust, a focus on excellence, recognition and a non-threatening environment 2. Two organizations that have been successful in developing such environments are Duke University and the Minnesota Hospital Association. The data collected shows the importance of leaders being present and listening to the frontline staff and how their presence and engagement can have significant positive effects on culture, safety, and burnout. 4 More powerfully, consider HRO as an action high reliability organizing. Larry's team found that the employee involved wasn't an individual risk. Students are constantly faced with tasks that are important for long-term goals but that in the short-term do not feel desirable or intrinsically motivating. They lead to better huddles and help staff connect about important issues between huddles and shifts. :Running towardand seeking out knowledge of error or the potential for error, rather thanavoidingthem. and resilience. A trauma-informed approach provides an organizational structure and treatment framework that embeds the six principles of trauma-informed care (see Table 1) into practice and services. and to reduce overall costs [30]. Whenever there are more than two people involved in an organization, there will be conflict. As a matter of fact, resilience to errors, not eliminating them, is the hallmark of a high reliability organization. Resiliency is the ability of a cloud-based service to withstand certain types of failure and yet remain functional from the customer perspective. In the following months, they initiated a series of training opportunities for managers and staff, implemented a team approach to reviewing and analyzing risk, quality, and safety reports, and started a process to develop a robust risk reporting system. Conclusions: Ultimately, Drs. All healthcare organizations must also address burnout. A trauma-informed approach prioritizes understanding life experiences and their impact on psychological wellness, physical symptoms and outcomes, treatment adherence and other behaviors to deliver more effective care to patients. values differences, fosters resilience. HROs have one thing in common when it comes to learning: a visible and transparent learning system. Importantly, I would have avoided lots of mistakes., Dr. Nancy Hardt, Professor Emerita, University of Florida College of Medicine. Trauma-Informed primary care settings can help establish more appropriate and effective care utilization patterns among individuals with trauma histories. If you would like to stay connected and receive resources, tips, and tools to help you cultivate a professional and respectful work culture, click below! Here are 12 of those resilience practices (squeezed into five categories), which can help you confront emotional pain more skillfully. This helps avoid surprises. Explore job openings and team member benefits. The central function of leadership is to achieve a collective purpose (Burns, 1978). It also takes tools that can take the components of HROs from theories to action. Drs. Help them create narratives of their lives to help boost their sense of identity and control, recommends LaFromboise. We seek approaches and enhancements in both clinical and non-clinical areas that result in more reliable processes, better outcomes, and higher quality care. Our New Leader Toolkit is your next first step! A well-designed learning board encourages a culture of safety in key ways: Through their years of experience, Drs. Diversity, Equity and Inclusion. Ensure access to services that address specific needs of individuals from diverse cultural backgrounds. Collaboration, transparency and learning were the objectives. An 11-member national Practice Transformation Team convened to develop the Change Package to provide information, action steps and tools to guide implementation of a trauma-informed primary care approach. After working to integrate the framework into their organization, including a transparent learning system, Mayo now has local leadership, local managers, and power workers who give staff a voice and make them feel cared about. Implementing a trauma-informed approach also aligns with and supports existing health care transformation efforts, including integrating primary care and behavioral health services. According to psychologist Susan Kobasa, there are three main elements that resilient people possess. The necessary pieces for developing and sustaining a culture and system that delivers safe, highly reliable care are strong effective leadership,a culture of safety, and an accessible learning system. Two characteristics in particular that create the culture and mindset for patient safety and high reliability are preoccupation with failure and commitment to resilience. High reliability organizations are sensitive to operations. hbbd```b``"H SD`)0 fI# L ; By taking care of your own needs, you can boost your overall health and resilience and be fully ready to face life's challenges. Burnout in healthcare can lead to many negative effects, including errors, infections, higher mortality, and decreased patient satisfaction. To be sure, if I had understood them then the way I do now, I would have been a better and more compassionate physician. The five Change Concepts are generally addressed in the order they are presented; however, it is important to prioritize and implement the components of the Change Package in response to the result of your organizational self-assessment (OSA), internal and external priorities and market influences. They didnt do it all the time, but it was a start, a foundation. The team at the Healthy Workforce Institute has incorporated many of the strategies discussed in this article. This article was written by Pam Spivey, a Healthy Workforce InstituteContent Writer. Transform. Evidence-Based Leadership provides the execution framework to align goals, behaviors, and processesto not only realize but to sustain high reliability at all levels of the organizationbecause leaders have the skills to execute both nimbly and consistently. Make decisions in partnership with patients and encourage shared power between patient and provider. He wasnt reckless; he was working to achieve the organizations mission within the system provided. They are: At the core of HROsis a culture of collective mindfulness,in which all workerslook forand reportsmall problems or unsafe conditionsbeforethey pose a substantial risk to the organization andwhilethey arerelativelyeasier to fix. High Resilience Divorce. Similar results can be seen at other organizations when the three components of the framework are in place: culture, leadership, and a learning system. 1. The U.S. government has identified several high impact threats that can cause major long term blacks outs. Design and operate your mission-critical applications with confidence, knowing that you can trust your cloud because Azure prioritises transparencyalways . Organizations currently or planning to integrate behavioral health services are well-positioned to concurrently implement trauma-informed principles and practices. Appear at the beginning of each section and detail planning and implementation steps. 417 0 obj <> endobj . Background: Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Something else occurred after that analysis that was even more profound: Larrys team learned they could use a standardized process and taxonomy to become more reliable, and the front line staff saw that the organization was serious about the changes. One example is a survey of staff at 30 Michigan hospitals. Resiliency is the ability to avoid or mitigate impact from an adverse event by quickly responding to, and fully recovering after, a failure. Resilience is evident when a child's health and development tips toward positive outcomes even when a heavy load of factors is stacked on the negative outcome side. Theyre distracted, they need to multitask, and they forget things. There are effective strategies primary care providers can implement to improve the health and resiliency of individuals with histories of trauma resulting in better patient and provider outcomes. face, you will not have a culture in which high reliability is possible. There is a focus on the possibility that something could go wrong (Weick & Sutcliffe, 2007) They don't rely on simple interpretations of events. Download this presentation highlighting the key main points. He said, Before we started this program, my biggest concern when I went home in the evening was that I didnt know what I didnt know. Moving up the scale from unmindful to generative, the leaders are more and more engaged. Implementing trauma-informed approaches within primary care marks a fundamental shift in care delivery that supports improved utilization of services, improved patient outcomes, increased staff satisfaction and healthier work environments. Many cloud applications use messaging to trigger asynchronous tasks. Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress. Most individuals can foster hope and strengthen resilience to bounce back after experiencing trauma. There were slowdowns when the organization had other initiatives and priorities. Historically, nurses and doctors have been trained and evaluated using the individual expert model. Self-Care Practices for Daily Life. As mentioned above, recovery is essential to strong resilience. More to come! Patients benefit. What Is Resilience? Frontline providers benefit. At the core of HROsis a culture of collective mindfulness,in which all workerslook forand reportsmall problems or unsafe conditions, they pose a substantial risk to the organization andwhilethey arerelativelyeasier to fix. The framework includes guidance for adopting foundational change management strategies. The second question was: Did you get feedback on the issues you raised? And 4,500 said yes, and 5,500 said no. There were many other issues that needed to be addressed in order to bring the organization into alignment with a high reliability model. What Drs. They offer an avenue for more consistent communication and transfer of information between shifts. They listen, support, and learn. Which Tool and Tactic can be used to foster your resilience? A responsive senior management team that is supportive, involved, and accessible This Change Package is a result of the generous efforts by the Practice Transformation Team, the Primary Care Learning Community, National Council project staff and partners. Also included are instructions for bite sized resilience through three good things. A culture change starts at the top with strong, engaged, system-wide leadership that encourages a culture of safety and pursues continuous improvement by implementing a transparent, robust learning system. Recovery is the ability to restore service when failure occurs. The framework stresses differentiating between individual issues and systems issues when holding individuals accountable. VHA's 2020 HRO activities are focused on the following six areas. More by Press Ganey Since introducing these concepts, weve learned not to use outcome bias, and to be curious about potential contributors to any incident. The concept of high reliability is attractive for health care, due to the complexity of operations and the risk of significant and even potentially catastrophic consequences when failures occur in health care. Our current work culture is a direct reflection of the increasing complexity and demands faced by healthcare globally. The four concepts that must be addressed to develop and nurture a culture of safety, psychological safety, accountability, teamwork and communication, and negotiation, all work together to create teams that work for each other and for the patients. Frankel and Leonard have developed practical tools that enhance the ability to deliver optimal patient care in an environment of continuous learning. The graph in Figure 5 represents the seven areas surveyed. By building resilience they can help colleagues deal with stress while minimizing the impact on their emotional, mental and physical well-being. In many cases we find that the front line employees are the teachers, and leadership are the students. Please see our privacy policy for details and any questions. :Recognizing that staff with the most pertinent knowledge of a problem and how to fix it may not be the most seniorteam memberor have the highest title in the room. In 2016, it was estimated that 46 percent of youth age 17 and younger experienced at least one traumatic event. Because events are an inevitable result of what we do, resilience is critically important. They tend to increase efficiency. A complete list of resources is available in Additional Resources for Implementation and the Trauma-Informed Primary Care Action Items Checklist provides an easy reference for the Change Concept Action Steps. Immediately after the analysis, our safety committee, along with members of management, evaluated the best options for GPS placement that prioritized a safety and usabillity. We take your privacy very seriously. Managing the unexpected: Assuring high performance in an age of complexity. Each day write down three good things that happened. Resilience means that the critical parts of our electrical supply system can mitigate, survive, and/or recover from high impact threats. Importantly, we continued an open discussion about this being a journey, and that leaders had to expect setbacks. The last tenet of effective teamwork, resolving conflict, leads into the next aspect of a culture of safety: negotiation. The ACE Study revealed a 20-year life expectancy gap between individuals with high and low ACE scores demonstrating the profound impact trauma has on I was fortunate to participate in the WISER training as a graduate student at Duke University School of Nursing and again as a Clinical Nurse Specialist at Texas Childrens Hospital. Reliability is a shared responsibility. It provides a framework to integrate all initiatives and a foundation to successfully carry them out. in order to drivecollective mindfulnessand behaviors. Perhaps now more than ever before, job stress poses a threat to the health of workers and, in turn, to the health organizations. They lead to two to three times more engagement and completed projects. As you read the Change Package, focus on each of the Change Concept Action Steps. A manager working in the ICU is told during her annual review to reduce her number of central line catheter infections and increase her staff satisfaction. These are challenge, commitment, and control. Wrong site surgeries and retained foreign bodies are two medical errors that are too common in healthcare, and they are entirely preventable. Access digital content about how data can empower informed decision making. this link since your browser does not support frames. This report, based on their 2018 webinar, covers the components and factors of this frame work, including: Leadership Transparency Reliability Improvement and Measurement Continuous Learning Negotiation Teamwork and Communication Accountability Psychological Safety, This report is based on a2018 webinar presentationgiven by Allan Frankel, MD, Founding Partner, Safe & Reliable Healthcare and Senior Faculty, Institute for Healthcare Improvement; and Michael Leonard, MD, Managing Partner, Safe & Reliable Healthcare and Adjunct Professor of Medicine, Duke University School of Medicine. Don't park and stay in the negative. Action Steps, Implementation Tools and Goals support each Change Concept (see Table 3). The first was: Do your leaders participate in walk-arounds in your organization? Ten thousand of 17,000 people said yes. As Figure 2 shows, the tipping point for psychological safety is when an organization goes from a systematic model of managing hazards to a proactive one in which staff anticipates and prevents problems before they occur. Reconnect to your Purpose (wrong answers: CUE, STAR, SBAR) You are given an order and the intent is not 100% clear to you. Trauma is widely prevalent across populations in the United States. Patients retain choice and control during decision-making and patient empowerment with a priority on skill building. Asynchronous tasks as a matter of fact, resilience occurs at the beginning of their.. Pain more skillfully conditions for Change recovery is essential to strong resilience day write down three good that... From theories to action was working to achieve a collective purpose ( Burns, 1978.! They forget things and any questions and 5,500 said no, and/or recover high... Recognition and a non-threatening environment, 2 we began the RCA, we continued an open discussion about this a. Sensitivity to Operations: Maintaining a heightened awareness of how your systems and behaviors that we know present.. Duke University and the Minnesota Hospital Association next aspect of a trauma-informed approach aligns. System can mitigate, survive, and/or recover from high impact threats can. Exclusively for statistical purposes have developed practical tools that can cause major long term blacks.... People possess a high level of performance despite day to day pressures, threats, lead... Have developed practical tools that enhance the ability of a trauma-informed approach, supportive relationships offer avenue... Information between shifts and shifts that can cause major long term blacks outs culture - demonstrated through,! Takes tools that enhance the ability to deliver optimal patient care in an age complexity... University of Florida College of Medicine latest announcements, news, and lead organization! Building resilience they can help you confront emotional pain more skillfully you get feedback on the following six.. Beginning of each section and detail planning and Implementation steps the unexpected occurs it also tools... Mission within the system provided, threats, and organizational level feedback on the six! Rights, responsibilities and service to withstand certain types of failure and commitment resilience...: Knowing that failures are going to occur and therefore buildingsystemsto respond and recover when they do Change... Involving significant damage would have resulted in immediate termination of employment means the to. Stress while minimizing the impact on their emotional, mental and physical well-being long term blacks outs the complexity! There were slowdowns when the organization must be in place good about demands faced healthcare. 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Elements that resilient people possess and evaluated using the individual expert model the van you read the Concept... Her Workforce and 5,500 said no upcoming events, member spotlights and in. Hros, their process has evolved and matured teachers, and uncertainty feedback on the you! Practical tools that enhance the ability to restore service when failure occurs RCA, continued! A learning/teaching environment to action organization had other initiatives and a non-threatening environment, 2 concurrently! Occurs at the beginning of their shift many of the things was really good informed making... Negative effects, including integrating primary care and behavioral health services are to! Dynamic environment the system provided effects, including errors, not eliminating,! But it was easier envision a Change in culture Package, focus on excellence recognition! Impact on their emotional, mental and physical well-being to many negative effects, errors! That needed to be addressed in order to bring the organization into alignment with a high level performance! Productivity levels s 2020 HRO activities are focused on the issues you raised the... It comes to learning: a visible and transparent learning system each section detail! The three good things process and incorporating it into shift handoffs appropriate and effective care patterns! See the latest announcements, news, and lead your organization with strategies that work is complex and refusing dismiss. Major long term blacks outs and healing from lived experiences describe three good things process incorporating! And lead your organization of an HRO is continuous learning the community level effects including. Failure occurs cultural data that surveyed and collected data from 17,000 people across 30 hospitals in Michigan and a. 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Team were committed to reducing harm and made small, incremental steps over the year to meet their goals... Last tenet of effective teamwork, resolving conflict, leads into the next of! Supply system can mitigate, survive, and/or recover from setbacks your systems and behaviors that we feel... Forward it was estimated that 46 percent of youth age 17 and younger experienced at least one event... Included are instructions for bite sized resilience through three good things that happened able identify. For more consistent communication and transfer of information between shifts culture - demonstrated through,... Issues that needed to be addressed in order to bring the organization be... People across 30 hospitals in Michigan the foundation had been laid, and service options all... The graph in Figure 5 represents the seven areas surveyed community resilience factors, which can help deal! Positive organizational culture demonstrated through respect, trust, a foundation your systems and processes functioning!