News and Events

New Publication

Dr Liz Farsaci led paper was published in the journal of Health Policy in May 2024, entitled ‘Understanding the legacies of shocks on health system performance: Exploring Ireland's management of recent crises and its implications for policy’.

Highlights from the article, which is based on some of our qualitative research, include:

  • Increased funding enabled Ireland to expand access to care during Covid-19.
  • Financial resources empowered leaders to purchase flexibility and adapt effectively to pandemic.
  • Policy makers can utilise shocks as opportunities to support health system resilience.
  • Health system leaders can use shocks as catalysts for implementing long-term reforms.
  • Financial constraints during austerity had significant negative impact on workforce, governance.

Link to Full Article Understanding the legacies of shocks on health system performance: Exploring Ireland's management of recent crises and its implications for policy - ScienceDirect

Upcoming Publication- Handbook of Health System Resilience

The RESTORE team is delighted to announce the upcoming publication of the Handbook of Health System Resilience published by Edward Elgar in September 2024. The Handbook of Health System Resilience presents cutting edge research from an international range of experts on crisis decision-making throughout healthcare. Chapter authors analyse the value of using ‘resilience’ as a theoretical framework, before delving into the durability of health systems in a variety of global case studies, including economic crises across Europe, conflicts in the Middle East, pandemics across the globe, and the climate crisis. Ultimately, the Handbook emphasises the importance of dealing with poor decision-making and austerity, the need to protect vulnerable groups, and the significance of capacity-building to deal with future crises.

Cover of Elgar handbook

EUPHA Health Workforce Research Conference

Dr Arianna Almirall-Sanchez attended and presented at the EUPHA Health Workforce Research Mid-Term Conference in Cluj-Napoca, Romania, 11-12th April. The conference title was ‘Investing in healthcare workforce governance: strengthen equity, inclusion and mental health & well-being’. Arianna presented on her work, with her presentation entitled ‘Construction and validation of a theoretical framework for measuring staff engagement in the Health Care System’.

Photo of Arianna Almirall-Sanchez at EUPHA

Collaboration with The University of California San Francisco

The University of California San Francisco invited RESTORE Research Fellow Liz Farsaci to be a module lead for their Delivering and Financing Health Systems module in Spring 2024, as part of their MSc in Global Health. Liz travelled to San Francisco January-February to lecture in person. RESTORE PhD student Arianna Almirall-Sanchez also travelled to UCSF to give a guest lecture with Liz. Arianna spoke about her PhD research on the health workforce in Ireland and her experiences working as a GP in the Cuban health system.

Photo of Liz Farsaci & Arianna Almirall-Sanchez in UCSF

European Public Health Conference

European Public Health conference logo

The RESTORE team were part of multiple presentations at the 16th European Public Health Conference, held at the Dublin Convention Centre, 8th to 11th November 2023. Prof. Steve Thomas was part of a pre-conference session on ‘Assessing COVID-19 response strategies: lessons, legacies and future preparedness’, with his presentation ‘Creating your Legacy in Shocking Times! Reflections on leveraging complex crises.’

Dr Liz Farsaci presented in the joint RESTORE and European Observatory on Health System and Policies session on ‘Rethinking Health System Resilience’. Liz presented her work from qualitative interviews with senior stakeholders, with her talk titled ‘Using Crises to Leverage Change and Build Resilience: Legacies and Learnings from Shocks’.

Dr Arianna Almirall-Sanchez and Catherine O’Donoghue both presented in a session on workforce. Arianna presented on her work with the HSE Your Opinion counts surveys data, with her talk titled ‘Barriers to resilience among healthcare staff in Ireland in the post-austerity period: A cross-sectional analysis.’ Catherine O’Donoghue talk was on nurse retention, titled ‘Exploring Job and Workplace Factors associated with Nurse Retention and Turnover in the Irish Healthcare System.’ 

Photo of Steve Thomas and Liz Farsaci at EPH

Prof Steve Thomas, Dr Liz Farsaci, Dr Ewout van Ginneken, Dr Astrid Eriksen, and Dr Louise Caffrey

Developing Global Thinking on Health System Resilience Workshop

The RESTORE team hosted 30 international health systems experts at Trinity College as part of a workshop aimed at Developing Global Thinking on Health System Resilience on 9-10 October. Participants presented on health system resilience and experiences of Covid-19 and other crises from around the world, which will be included in the Elgar Handbook on Health System Resilience, edited by Edward Kennedy Professor Steve Thomas, and due to be published in September 2024. 

Photo of meeting attendees


Health Management Institute of Ireland’s Annual Conference

Steve Thomas gave a keynote presentation at the Health Management Institute of Ireland’s annual conference held at the Royal Dublin Society on 25th October. His talk was entitled “The State of Healthcare in Ireland through System Shocks: The Legacy for the Workforce”. He highlighted that while shocks could initially motivate a workforce their long-run legacy was to produce high turnover, leadership loss, increased workload and burnout. Nevertheless, while shocks destabilised a health system they also opened up an opportunity for transformation.

Photo of Steve Thomas at HMI conference

On 1st June Steve Thomas presented at the international MedTech Forum 2023 in the Dublin Conference Centre as the sole speaker in the parallel session “MedTech innovation: Addressing healthcare system inefficiencies and health workforce constraints”. His presentation was entitled: “ Towards permacrisis: Shock legacy, workforce constraints and patient impact.”  Key themes were then discussed by a panel, which he joined, and with the audience of 65 industry participants from 50 different organisations.

Slide from MedTech presentation


Dr Padraic Fleming was awarded the best European paper award at the 2023 European Health Management Association annual conference held in Rome, Italy. The paper “A realist review of the international literature demonstrating how governance and decision-making during the 2008 financial crisis impacted health workforce resilience for COVID-19 and future health system shocks” is based on an article published in the International Journal of Health Policy and Management. The paper is available here:

Slide from EHMA conference

Dr Padraic Fleming participated in the 6th Annual Conference on Public Policy, which took place in Toronto Metropolitan University from June 27th to 29th. Dr Fleming presented a paper during the methodological panel: “Using realist evaluation, synthesis and research in public policy practice”. The paper: “A realist review of the international literature to understand how legacies from the 2008 financial crisis impacted health system resilience for COVID-19 and future health system shocks” presented the real-world application of realist synthesis to inform policy and practice in relation to health system resilience. The presentation was based on an article published in the International Journal of Health Policy and Management, available here:

Slide from conference in Toronto

Steve Thomas attended the WHO Barcelona Forum on Financial Protection in Europe, 14–16 June 2023 which featured the launch of the UHC Watch network and in-depth discussions across European countries on the dissemination of financial protection data to help policy engagement and reform. Steve joined a panel discussion on rationing and entitlements reflecting on the evolution and current situation in Ireland and necessary next steps to advance a Universal Health Care Agenda.   

Photo of attendees at WHO Barcelona Forum on Financial Protection in Europe

On 12-13 June, Dr Liz Farsaci presented at the European Health Policy Group’s Spring 2023 meeting in Milan, Italy. The conference was organised by the Centre for Research on Health and Social Care Management at Bocconi University. Dr Farsaci presented a paper entitled “Using Health Crises as Catalysts for Change: Legacies and resilience amidst health system shocks”. The paper includes qualitative findings from the RESTORE project.

Slide from European Health Group Policy Rome June 23


On May 25th Steve Thomas and Catherine O’Donoghue presented “Highlights from the PRESTO report: An analysis of resilience and sustainability in the Irish health system with particular focus on the COVID-19 era” as part of the HSE Research Webinar Series. They were joined by Padraic Fleming for a broad-ranging and insightful Q&A session with participants. Key messages related to the fact that Ireland responded quite well to the COVID-19 pandemic with vastly increased funds, system flexibility and generally good Governance leading to low excess mortality.  However Pre-COVID preparedness of the Irish healthcare system was not ideal: limited bed capacity, demoralised staff, lack of specific pandemic planning, alongside IT deficiencies and no universalism.   

Slide from presentation on PRESTO report

The RESTORE project launches a new report on Covid-19

The impact of Covid-19 on the Irish health system, the Government’s response to the pandemic and the ways in which the HSE can prepare for the next crisis are highlighted in a report launched by the RESTORE team on 29 March at Trinity College Dublin.

International speakers from the London School of Economics join leading researchers from Trinity’s Centre for Health Policy and Management, School of Medicine to launch the report, entitled The PRESTO Report: An analysis of resilience and sustainability in the Irish health system.

The PRESTO report suggests that Covid-19 provided a profound stress test for the Irish health system. Going into the pandemic, the Irish system had low capacity, with very long waiting lists for acute and community care. The pandemic itself then created unprecedented demands on services and the workforce, placing huge strain on a system already under pressure. However, the PRESTO report also shows that the Covid-10 pandemic provided opportunities to bring in reforms outlined in Sláintecare ahead of schedule. These included free healthcare for Covid testing and diagnostics, as well as new pathways of care in the community and online.

The report also highlights the central role the healthcare workforce plays in the delivery of services, and the important role of engagement and communication in staff retention.

The PRESTO report is the result of a collaboration between researchers from the Centre’s RESTORE team and the global Partnership for Health System Sustainability and Resilience (PHSSR). The aim of the project is to ensure the Irish health system is able to continually provide services, while also being able to prepare for, adapt to, learn, transform and recover from shocks and accumulated stresses. The Trinity research team examined the Irish system, but the international partnership carried out this study in 20 countries around the world.

The Partnership for Health System Sustainability and Resilience (PHSSR) is a global collaboration between academic, non-governmental, life sciences, healthcare and business organisations. The PHSSR and its partners seek to work with local academics, governments, policymakers and other stakeholders like providers and payors to build knowledge and guide action through research reports that offer evidence-informed policy recommendations to improve healthcare system sustainability and resilience.

Trinity is the only Irish academic institution involved in this collaboration but other stakeholders from the Department of Health, Department of Finance, Health Service Executive (HSE), Irish College of General Practitioners (ICGP), Economic Social and Research Institute (ERSI), Tampere University (Finland), and Personal and Public Involvement (PPI) representatives are involved in an advisory capacity. This research is funded through the HRB-funded RESTORE project, which is led by Prof Steve Thomas, Edward Kennedy Chair of Health Policy and Management, Director of Health Policy and Engagement for the School of Medicine.

See the PRESTO report and the executive summary here: PRESTO Ireland Report (PDF 7.86MB) PRESTO Ireland Summary (PDF 1.30MB)

Presto report cover

Transforming Health System Resilience into Health Reform 2nd annual workshop of the RESTORE project HRB Research Leader Award 2020 9:30am -1pm, 29th March 2023, Tangent, Trinity Business School

Click image below for full agenda.

Restore conference agenda


Oireachtas Health Committee

1st March 2023: Prof Sara Burke, Prof Steve Thomas and Dr Bridget Johnston were invited to present to the Oireachtas Health Committee on the progress of Sláintecare. Their opening statement highlighted the slow progress towards Sláintecare but how the government’s response to COVID-19 had revitalised the reform programme. The subsequent discussions focussed on next steps for Sláintecare and bottlenecks to its implementation. The session got media coverage in the Irish Times, The Irish Examiner and RTE.

Photo from Oireachtas health committee

BBC Scotland

Steve Thomas was interviewed by BBC Scotland as part of a package to assess what learning there might be for Scotland from the design of the Irish health systems and its Sláintecare reform programme. The package was broadcast on the BBC Scotland evening news, 7th March 2023, and BBC Scotland radio.

Photo of Prof Steve Thomas

International Foundation for Integrated Care - Ireland

Slide from IFIC 23 conference

Steve Thomas was invited to present the opening key note address “What are the system building blocks for successful Sláintecare implementation?”, at the All-Ireland Conference on Integrated Care (AICIC23) “People-centred Integrated Care: The right care, in the right place, at the right time” at UCD on Thursday, 23 March. The conference was co-hosted by IFIC Ireland and the International Foundation for Integrated Care (IFIC), in association with the Health Service Executive (HSE Ireland)Health and Social Care Northern Ireland (HSC NI) and Sláintecare. A recording of the presentation can be seen at the following link (plenary session 1, minutes 16:20-33:43)

Slide from AICIC 23 conference

SPHeRE Network 9th Annual Conference

Dr. Arianna Almirall Sanchez presented a paper at the SPHeRE Network 9th Annual Conference. The presentation “Barriers to resilience among healthcare staff in Ireland in the post-austerity period: A cross-sectional analysis” introduced findings regarding the organisational and individual dimensions of healthcare staff engagement in Ireland and drew a number of  key messages 1) Improving the communication strategies in the health organisations is the best approach for guaranteeing the retention of the Irish health staff 2) It’s necessary to enhance the opportunities of training and Career Progression within Irish and foreign trained doctors 3) Health organisations should offer more information on the available services for coping with discrimination and bullying to their staff because both psychological state variables were highly correlated with the disengagement of the health staff in the country.

Arianna Almirall-Sanchez at SPHeRE conference

Catherine O’Donoghue presented at the SPHeRE Network 9th Annual Conference. The presentation “Exploring Job and Workplace Factors associated with Nurse Retention and Turnover in the Irish Healthcare System” reported on initial findings from analysis of the HSE Your Opinion Counts surveys from 2016 and 2018, as well as reporting the HSE turnover figures from 2019-2022. Nurse categories analysed included staff nurses, nurse managers, public health nurses, specialist nurses and student nurses. Turnover figures show a worrying trend, with an increase of turnover in 2022, compared to 2019-2021, across all nurse categories. The 2018 survey question on intention to leave did appear to correlate with the actual turnover figures. ‘Feeling Valued and Recognised by your Organisation’ and Satisfaction with ‘Opportunities for Career Progression’ were among the top factors associated with intention to stay. Stress Levels were found to be less important, as both those who intended to Stay and who intended to Leave had similar levels of reported stress. Changing workplace cultures to more supportive environments where staff feel valued and recognised may increase staff retention.

Catherine O'Donoghue at SPHeRE conference

HSE Research Webinar Series

Dr Padraic Fleming and Prof Steve Thomas presented at the second HSE Research Webinar Series, a joint collaboration between the Research & Development and Operations Planning, HSE in association with the Centre for Health Policy and Management, Trinity College Dublin.

The presentation “Workforce resilience and implications for health system reform - Learning from austerity and COVID-19” drew on a number of recently published articles that examined 1) how health workforce resilience has been measured in the past, 2) workforce trends in Ireland during and after the austerity period, and finally 3) how legacy issues from this period of austerity impacted health workforce resilience when facing into COVID-19 and lessons learned for building resilience into the future.

The event was recorded and can be accessed here:

Photo of slide from research webinar


In February 2023, Prof Steve Thomas and Prof Sara Burke presented at the two separate webinars in the Department of Health and the HSE. The Department of Health Policy Seminar Series is a staff-led project within the Policy, Strategy, and Integration Unit, that invites subject matter experts to share their experience and knowledge on best practice in policy development. The HSE Research Webinar Series is a joint collaboration between the Research & Development and Operations Planning, HSE in association with the Centre for Health Policy and Management, Trinity College Dublin.

The presentations “Assessing Ireland’s health system resilience during the first 18 months of COVID-19 – learning for health system reform” explored whether and how the Irish government's pandemic response contributed to health system reform and increased resilience including delivering universal healthcare.

The HSE event was recorded and can be accessed here:  

Photo of slide from research webinar

Photo of Steve Thomas at EPH Berlin

Prof Steve Thomas and Dr Padraic Fleming attended the 15th European Public Health Conference in Berlin in November. Together with research collaborators from the Finnish Institute for Health and Welfare, Tampere University Finland, and the University of Copenhagen, Prof Thomas presented RESTORE research during the workshop entitled: Strategies to build up health system resilience: Legacy of COVID-19 pandemic, with workshop overview available here. The abstract for the RESTORE contribution: “Strategies for developing preparedness and building legacy – learning from the experience of building Health System Resilience in Ireland” can be seen here

Screenshot of EHMA presentation

Prof Steve Thomas was invited to present at the European Health Managers Association (EHMA) webinar series in November entitled “Towards better health systems’ preparedness and response: existing gaps and solutions – Health management in action: Fostering health systems resilience”. Prof Thomas’ presentation “Living with Permacrisis: Health System Resilience into the next shock” focused on much of the RESTORE research, offering evidence-informed strategies and reflections as many countries face challenges associated with the next set of shocks namely: the cost-of-living crisis, migration issues and war. The full presentation and slides are available here: Towards a better EU health preparedness and response: gaps and solutions - EHMA

PHSSR summit slide

Dr Padraic Fleming was invited to contribute to the PHSSR Global Summit in November, a 2-day virtual event where key findings from 13 countries involved in the Partnership for Health System Sustainability and Resilience (PHSSR) were presented and discussed. Chaired by Prof Alistair McGuire of London School of Economics, Dr Fleming presented recent finding from the RESTORE project during the closing session of the event – Assessing and measuring sustainability and resilience of health systems. The presentation included reflections based on the systematic review examining metrics and indicators used to assess health system resilience in high-income countries, as well as key recommendations for building health system resilience, based on the realist review examining longer-term legacy issues associated with the 2008 financial crisis. Links to these publications can be found here.

The presentation from the Global Summit can be viewed here:

Photo of Padraic Fleming presenting at Foundations conference

On December 7th, Dr Padraic Fleming participated in the Foundations seminar, which took place in Tangent TCD, with over 100 attendees from academic, health and policy disciplines. The seminar showcased research from the Centre for Health Policy and Management Team, and in particular, Dr Fleming presented workforce trends from 2008-2021, reflecting on implications for health system reform and workforce recovery in the context of health system shocks. The presentation also outlined findings from the recently published realist review, focusing on supports and mitigation measures to protect workforce resilience. A copy of the presentations from the day can be found here (Foundations seminar slides) and associated RESTORE publications can be found here.

Professor Steve Thomas was invited to an international workshop on “Assessing and measuring health system resilience in the context of shocks” at Fondation Brocher, Geneva, Switzerland organised by LSHTM and the Geneva Centre for Humanitarian Studies, 14th September 2022. Objectives for the workshop were: i) to bring together academic researchers and policymakers/practitioners working to strengthen health system resilience to shocks in low- and middle-income countries; ii) to build research and practice networks across high-, middle- and low-income settings to support future collaboration; and iii) to identify priority areas in the domains of resilience assessment/measurement to inform future applied work and research grant proposal development. The group had productive discussions and initiated the development of joint activities for the future including research, capacity building and knowledge exchange around health system resilience.

Photos of attendees at Fondation Brocher, Geneva

On September 22nd, Professor Steve Thomas and Dr Padraic Fleming were invited to present at the Department of Health Policy Seminar Series on “Implications for health system reform, workforce resilience and sustainability: Learning from the Great Recession and COVID-19”. The presentation introduced the RESTORE and Foundations research projects to almost 100 attendees, before outlining a recent paper that examined workforce trends in Ireland from 2008 to 2021 and how these trends align with current policy in the context of the 2008 financial crisis and more recently the COVID-19 pandemic. This paper was presented alongside highlights from a soon to be published realist review, providing recommendations to help the workforce deal with challenges presented during times of austerity. Finally, some reflections were offered in order to promote discussion with a panel of researchers from the Centre including Prof Thomas, Dr Fleming, Dr Sara Burke, Dr Sarah Barry, Ms Catherine O’Donoghue and Dr Arianna Almirall-Sanchez.

Graphic of presentation

Professor Steve Thomas gave his (Covid-19 delayed) Inaugural Lecture on 29th September 2022. Professor Thomas is the Edward Kennedy Chair of Health Policy and Management and the Director of Health Policy and Engagement for the School of Medicine. During his lecture, he reflected on his 27 years of international experience in health systems across four continents, as a global leader in research and policy around health system resilience and reform, alongside his experience of advising governments and international organisations. This event also provided Prof Thomas an opportunity to reflect on his personal journey, acknowledging the support and influence of his family, friends and colleagues. A recording of his Inaugural Lecture can be accessed here: 

Photo of Steve Thomas

Professor Steve Thomas was invited to speak at the 2nd plenary meeting of the PHSSR global partnership, led by LSE Health Policy, to update international partners on the progress to date with the Irish arm of the collaboration. Prof Thomas spoke about the metrics collected to date across the main health resilience and sustainability domains, highlighting lessons learned from the process for those in the earlier data collection phase. Of particular interest were reflections on the blue-sky discussion with an expert panel involving key national and international stakeholders, balancing feasibility of a relatively short-term project with the needs of longer-term strategic solutions. More information on the PHSSR collaboration can be found at Home > Partnership for Health System Sustainability and Resilience | World Economic Forum (

Slide from presentation showing bar graph of waiting lists

On June 7th, Prof Steve Thomas presented at a SYSTAC webinar: Health system resilience – framing, debates and latest evidence as we start to emerge from the COVID-19 pandemic. Prof Thomas reflected on the measurement of resilience and how the footprints left behind after health system shocks differ depending on the type of shock. Elements of resilience differ at different times and stages of the shock cycle, thinking about how best to deal with the legacies and avoiding the need or want to measure everything. Another nuanced view is about how resilience concepts, such as absorption, is translated within the context of different shocks – are we shock facing or system facing, perhaps leveraging the shock to capitalise political windows of opportunity. A full recording if the session with various international speakers is available from: SYSTAC European Hub News & Events - Geneva Centre of Humanitarian Studies

Image of presenters at SYSTAC webinar

On June 10th, Prof Thomas presented at the North American Observatory Lecture Series – Revitalising Health Care Reform through the pandemic: Further adventures of Sláintecare in Ireland. Prof Thomas explored how shocks to the health system can facilitate reform. He reviewed the different phases in Sláintecare implementation to date and what the factors were behind them. He evaluated the prospects for Sláintecare as it faces new post-pandemic challenges in the shape of looming austerity, low morale, regional reorganisation, and limited delivery on free care and waiting lists.

Slide for NAO lecture series

On June 15th, Dr Padraic Fleming presented at the European Health Management Association’s 27th Annual Conference. During the session titled: Management, operations and practice in the context of the COVID-19 pandemic, Dr Fleming presented recently published findings on Implications for health system reform, workforce recovery and rebuilding: Lessons from the Great Recession and COVID-19. The conference abstract can be seen in the book of abstracts (page 45), available here:

The full paper is available here:

Cover slide from EHMA 2022 presentation

New publication

Dr Padraic Fleming (RESTORE) led a recent collaboration between the RESTORE and Foundations’ teams in the Centre for Health Policy and Management, alongside partners in the Health Service Executive to produce a recently published paper: Implications for health system reform, workforce recovery and rebuilding in the context of the Great Recession and COVID-19: a case study of workforce trends in Ireland 2008–2021. Abstract and link to full article below.

Workforce is a fundamental health systems building block, with unprecedented measures taken to meet extra demand and facilitate surge capacity during the COVID-19 pandemic, following a prolonged period of austerity. This case study examines trends in Ireland’s publicly funded health service workforce, from the global financial crisis, through the Recovery period and into the COVID-19 pandemic, to understand resource allocation across community and acute settings. Specifically, this paper aims to uncover whether skill-mix and staff capacity are aligned with policy intent and the broader reform agenda to achieve universal access to integrated healthcare, in part, by shifting free care into primary and community settings.

Secondary analysis of anonymised aggregated national human resources data was conducted over a period of almost 14 years, from December 31st 2008 to August 31st 2021. Comparative analysis was conducted, by professional cadre, across three keys periods: ‘Recession period’ December 31st 2008–December 31st 2014; ‘Recovery period’ December 31st 2014–December 31st 2019; and the ‘COVID-19 period’ December 31st 2019–August 31st 2021.

During the Recession period there was an overall decrease of 8.1% (n = 9333) between December 31st 2008 and December 31st 2014, while the Recovery period saw the overall staff levels rebound and increase by 15.2% (n = 16,789) between December 31st 2014 and December 31st 2019. These figures continued to grow, at an accelerated rate during the most recent COVID-19 period, increasing by a further 8.9% (n = 10,716) in under 2 years. However, a notable shift occurred in 2013, when the number of staff in acute services surpassed those employed in community services (n = 50,038 and 49,857, respectively). This gap accelerated during the Recovery and COVID-19 phase. By August 2021, there were 13,645 more whole-time equivalents in acute settings compared to community, a complete reverse of the 2008 situation. This was consistent across all cadres. Workforce absence trends indicate short-term spikes resulting from shocks while COVID-19 redeployment disproportionately impacted negatively on primary care and community services.

This paper clearly demonstrates the prioritisation of staff recruitment within acute services—increasing needed capacity, without the same commitment to support government policy to shift care into primary and community settings. Concerted action including the permanent redistribution of personnel is required to ensure progressive and sustainable responses are learned from recent shocks.

Link to full article:



The RESTORE team issued a press release on Monday May 16th to launch a collaboration between RESTORE and the Partnership for Health System Sustainability and Resilience (PHSSR) project, which is global partnership between academic, non-governmental, life sciences, healthcare and business organisations, led by the London School of Economics, Department of Health Policy. Several tweets were posted throughout Monday 16th from the @TCDhpm Twitter account, to showcase early findings and quotes from experts feeding into the PHSSR project, highlighting the importance of the project for national and international initiatives.

Further details on the partnership can be found at the following press release:

Image of quote from Greg Dempsey

Dr Padraic Fleming presented findings from an ongoing realist literature review at the SPHeRE Network 8th Annual Conference: Wicked Policy Problems - Pulling Back the Curtain titled: The legacy of health system responses to the 2008 financial crisis and how this impacted health system resilience – A realist review. The presentation outlined a range of Context-Mechanism-Outcome configurations emerging from the realist analysis of 204 studies, which can be leveraged by policy -makers and health service management to develop strategies that protect and promote health system resilience. This was an online event and a recording of the ‘Health Systems’ session can be viewed online.

Image of slide from Padraic Fleming's SPHeRE presentation

Professor Steve Thomas was invited to give a guest lecture on health system resilience seminar series at the Canadian Centre for Health Economics, on February 18th 2022. The lecture titled ‘The Economics of Health System Shocks and Resilience’ examined evolving thinking and evidence around health system resilience and shocks and the economic ideas implicit in how to best navigate shocks to the health system.

Earlier in the month, Professor Thomas presented at the inaugural event of SYSTAC - Systems Thinking Accelerator, a community-of-practice for applied systems thinking on February 10th 2022. The webinar: ‘Systems approaches to strengthening health system resilience: Key concepts and lessons from COVID-19’ was organised by Geneva Centre of Humanitarian Studies and reached a global audience via the online forum. A recording of the webinar along with presentation slides can be viewed at the following link: SYSTAC webinar: Systems approaches to strengthening health system resilience: Key concepts and lessons from COVID-19. - Geneva Centre of Humanitarian Studies

Image of slide on Building Legacy

Professor Steve Thomas and Dr Pádraic Fleming presented early findings from the RESTORE project at the December 2021 Health Services Research webinar organised by Tampere University Sustainable Welfare Systems, Finnish Institute for Health and Welfare & Finnish Association for Social Medicine. This online presentation titled: Understanding Health System Resilience: Learning from Shocks and Building Legacy outlined findings from 1) an upcoming systematic review examining how health system resilience has been measured across different shocks over the past 20 years, 2) a realist review examining Context, Mechanism, Outcome Configurations (CMOCs) in relation to the 2008 financial crisis and the legacies for the COVID-19 response, 3) early indicators of resilience metrics within the Irish context and finally 4) highlights from the recent policy analysis of how Sláintecare has been impacted by the response to COVID-19.

Image of tweet from Liina-KaisaTynkkynen

This presentation was based on outputs from the 1st Annual workshop of the RESTORE project which took place in November 2021. A summary of the event, along with videos and presentations from the webinar can be found here Other Research Outputs - School of Medicine - Trinity College Dublin (


Full Programme for the upcoming RESTORE Annual Workshop - Measuring and building heath system resilience - November 16th, 9.30am to 1pm

Image of Restore workshop 2021 programme

1st Annual Workshop of the RESTORE project - 16 November 2021

Full Programme available for the upcoming RESTORE Annual Workshop - Measuring and building heath system resilience - November 16th, 9.30 to 1pm. 

Registration is now open for the 1st annual workshop of the RESTORE project (a HRB Research Leader Award) on the morning of 16th November 2021. The workshop, titled: “Measuring and building heath system resilience”, will feature speakers from the European Observatory of Health Systems and Policies and the University of Tampere, Finland alongside Prof Steve Thomas and colleagues from the Centre for Health Policy and Management, TCD.

Image of Restore workshop 2021 flyer

Image of slide - Irish troubled history with VHI

On June 16th the Swedish National Board of Health and Welfare and the European Observatory held a policy dialogue entitled: “Managing a growing VHI market in Sweden: lessons from other countries”. The purpose of this policy dialogue was to understand the experiences of countries that have faced similar challenges related to VHI (Voluntary Health Insurance) and dual practice, and to consider possible options for addressing unintended consequences of VHI growth in Sweden. Prof. Steve Thomas was invited to provide an expert view on lessons learned from Ireland. Prof. Thomas outlined various policy options available to Sweden based on Ireland’s troubled history with VHI.

Image of slide - What is Health System Resilience

On May 19th Prof. Steve Thomas provided a keynote presentation for the 4th workshop of The Nordic network for Health Policy, Health Management, and Health Services Research. The aim of the conference was to provide a forum for researchers within the Nordic arena to share ideas, broaden knowledge, collaborate, and network. Prof. Thomas was invited to offer an international perspective on how health system resilience can be assessed and strengthened.

Image of slide on Health Systems Resilience

Prof Steve Thomas joined, as guest speaker on health systems resilience, a seminar series at the School of Cities, University of Toronto, which seeks to develop a multi-disciplinary understanding of resilient supply chains by examining two which are of critical importance to everyday life: food and health supply chains. The talks in this series look at these supply chains, both independently and together, through the inclusion of diverse speakers representing at least the following perspectives:

  • Supply Chain Optimization
  • Northern and Remote Food and Health Security
  • Urban Food Systems
  • Systems of Food Production
  • Healthcare Systems

Prof Thomas covered the key findings from the WHO Policy Brief, including defining resilience and its distinct stages and outlining the shock strategies that countries and health systems around the world should consider.

Overview and recording of talk can available here.

Image of slide - future proofing our health system

At the 17th National Health Summit Steve Prof Thomas suggested that we may have to get used to shocks to our health system. Future pandemics, increasingly severe climate events and economic shocks like Brexit will test the resilience of our healthcare system. What can we learn from international experience of building health system resilience, what strategies can we use and where do we go from here in Ireland?

Image of slide - Using crisis to boost Sláintecare reform

Prof Thomas presented at The European Observatory on Health Systems and Policies COVID-19 HSRM webinar series, which draw on the lessons from country experiences, analysing how health systems can respond to the pandemic and what makes them more resilient to external shocks and crises. More information about the seminar series available here: WHO/Europe | Events - Observatory webinar series on the COVID-19 response

Recording of full webinar available here

Image of slide - strengthening health systems resilience

The RESTORE team kicked off 2021 to a good start, publishing a ‘Think Piece’ on the role of migrants and migration policies in strengthening health system resilience in the Migration Policy Hub. This followed a presentation by Professor Steve Thomas at an online conference on November 9th 2020 that launched the “Migrants and Systemic Resilience Hub” (MigResHub), a joint initiative of the Migration Policy Centre (MPC) at the European University Institute (EUI) in Florence and Migration Mobilities Bristol at the University of Bristol.

View the online conference session on Migrants and systemic resilience in health services here.

Paper abstract

The resilience of health systems has never been so important with the increasing frequency of extreme climate events, mass migration, economic crises and pandemics. This paper examines what strategies can build resilience; the central role of workforce in resilience before, during and after shocks; and whether migrant labour makes health systems more resilient or more vulnerable. The importance of sufficiency, flexibility and motivation / engagement, in relation to resilience building, are discussed within the context of a global shortage of health care workers and a profound demand and supply imbalance between high and low-middle income countries. The question of whether health system resilience can be bolstered by migration is nuanced. Governments who rely on health worker migration need to set robust policies, manage migration in a constructive way and adopt formal agreements for which they are accountable.

Full article available here.


Image of policy brief cover - Strengthening health systems resilience

Prof Steve Thomas and colleagues published (on 18 June 2020) a policy brief for the WHO European Observatory on Health Systems and Policies exploring health systems resilience during shocks like COVID-19 and economic downturns. It is important reading for anyone interested in how health systems can prepare for, recover from and learn from crises.

Key findings include the following strategies for enhancing health system resilience:

  • Governance: effective and participatory leadership with strong vision and communication; coordination of activities across government and key stakeholders; an organizational learning culture that is responsive to crises; effective information systems and flows; and surveillance enabling timely detection of shocks and their impact.
  • Financing: ensuring sufficient monetary resources in the system and flexibility to reallocate and inject extra funds; ensuring stability of health system funding through countercyclical health financing mechanisms and reserves; purchasing flexibility and reallocation of funding to meet changing needs; and comprehensive health coverage.
  • Resources: appropriate level and distribution of human and physical resources; ability to increase capacity to cope with a sudden surge in demand; and motivated and well-supported workforce.
  • Service delivery: alternative and flexible approaches to deliver care.

Full Policy brief available here.