Metaphors of Health System Resilience as Tools for Preparedness Imagination.

Abstract

This article explores how metaphor-based frameworks can enrich understanding of health system resilience and stimulate preparedness imagination, a reflexive practice aimed at generating innovative approaches for facing unknown threats. Observing that uncertainty is narrowly defined in resilience discussions, this study uses an abductive research approach to navigate surprises and creatively adapt knowledge. We propose four metaphors-sailing turbulent seas, zen-like fencing, evolving species, and jazz orchestras-as lenses to view resilience, each bringing unique insights into managing unforeseen crises. In a two-stage process, we began with associative writing, drawing on diverse experiences to question how resilience might manifest in contexts outside healthcare. This was followed by theoretical interpretations, inspired by Dewey's pragmatist learning theory, complexity thinking, and resilience literature. To conclude, we argue that metaphors challenge conventional thinking, detaching from established concepts and definitions to reveal fresh perspectives. The article offers theoretical and practical suggestions for advancing health system resilience, with relevance for training professionals in crisis preparedness and leadership. By treating metaphor development as a form of abductive theorizing, the study positions creative reframing not as an artistic supplement but as a systematic mode of conceptual inquiry essential for advancing resilience scholarship. This conceptual contribution expands the theoretical foundations on which future empirical research, operational models, and preparedness assessments can be built, thereby strengthening the scientific understanding of how health systems can navigate profound uncertainty.