Global healthcare systems are facing growing rapid challenges, ranging from data breaches and workforce shortages to pandemics, severe overcrowding and technological disruptions (1–4). These pressures have revealed systemic vulnerabilities and emphasized the urgent need for more adaptive, responsive, and future-ready infrastructures (5, 6). In this context, digital resilience has gained growing attention as a pathway to sustainable healthcare transformation (7). Digital resilience refers to the ability to proactively respond to disruptions by leveraging digital tools, infrastructures, and collaborative networks to sustain and improve healthcare delivery (8, 9). While resilience more generally refers to the ability and capability to absorb and adapt to shocks (10), digital resilience focuses on how digital technologies can achieve these outcomes as well as the holistic process of developing more of such system-wide capacities.

Although healthcare systems have invested in digital technologies, the integration of these tools into clinical and organizational routines remains inconsistent. Persistent barriers such as professional silos, regulatory misalignment, and organizational inertia often hinder transformation (11–14). Moreover, much of the literature on digital resilience focuses on the adaptation of individuals or single organizations, rather than examining how resilience emerges at the system level through shared infrastructures and participatory governance.

This study addresses that gap by investigating how digital resilience is co-produced through the everyday practices of a national online community of healthcare professionals in Israel. We explore how a digitally mediated professional community supports digital resilience across three interrelated dimensions: the development of digital abilities (skills and practices), the emergence of system-wide capabilities (shared norms, coordination, and innovation mechanisms), and the expansion of overall capacity (the scalable potential to absorb shocks and reconfigure care delivery) (Table 1).

Our research question is: How does an online community contribute to the development of digital resilience in a national healthcare system? Drawing on longitudinal qualitative data collected between 2020 and 2024, including interviews, digital communications, and observations, we offer a conceptual model that shows how online, cross-sectoral collaboration can foster system-wide transformation. Our findings contribute to emerging literature on digital health by demonstrating how participatory, digitally enabled communities can build healthcare systems that are not only reactive but adaptive, innovative, and a process through which they become future-ready.

This qualitative study investigates how digital resilience is developed within a national online community of healthcare professionals, focusing on the dynamic interplay between professional, organizational, and system transformation. We adopt an interpretive research paradigm, viewing resilience not as a static trait but as a relational and evolving capacity enacted through interactions among individuals, technologies, and institutions (9, 18).

This study, designed to investigate the development of the Digital Health Community and its impact on the healthcare ecosystem, was conducted from November 2020 to August 2024, with full access to the community activities and documentation. Our data collection process involved detailed observations of numerous online community meetings, webinars, WhatsApp group communications, and social media engagements. We also conducted twenty five semi-structured interviews with community members and representatives from the MoH, of 30–60 min, which were transcribed and translated into English (Table 2). After completing the data collection, we employed a thematic qualitative data analysis methodology. This methodology identified emerging themes based on principles of naturalistic inquiry and a grounded approach to conceptual development.

The study explored how the community's digital interactions did not merely reflect resilience but actively produced it through new configurations of relationships, norms, and digital affordances. Using an analytic approach, grounded in an interpretive epistemology and informed by resilience theory and discourse (34, 35), we developed the analysis in three phases. We began with iterative close reading of the community documents, publications and announcements, interview and webinar transcripts, field notes, and digital artifacts such as discussion threads. In the second phase, we iteratively identified recurring themes linked to three resilience dimensions emerging from the literature: ability, capability, and capacity, and examined how these developed through professional, organizational, and system levels, as outlined in our conceptual framework (Figures 1, 2). In the last phase, we presented the analysis and conceptual framework to the MoH team to discuss the model and learn from their reflections and insights.

In response to the outbreak of the COVID pandemic in 2020, the Digital Health Division of the Ministry of Health (MoH) launched a digitally mediated “community of practice” designed to promote cross-organizational learning, telemedicine adoption, and health service innovation across the public healthcare system. Although framed as participatory and bottom-up, the initiative was significantly shaped by institutional interests and state reform goals, particularly those emphasizing efficiency, digital fluency, and shifting more care into the community and home using new digital technologies. The MoH, responsible for policy making and regulation of all healthcare organizations through mechanisms of supervision and financing, created and managed the online community of healthcare professionals, with over 1,200 members, including primarily doctors, therapists, nurses, and administrators, with an objective to connect to the “field” and promote bottom-up leadership across the healthcare system. The community, originally focused on remote care expanded its scope to cover broader aspects of digital transformation, resulting in a name change from the “Israel Telemedicine Community,” to the “Digital Health Community” in the post pandemic period. The community provided a platform for interdisciplinary working groups, knowledge-sharing webinars, and an innovation accelerator designed to support the development and scaling of new digital health solutions.

Engagement in the Digital Health Community has evolved significantly over time. During the pandemic's acute phase (2020–2022), participation was intensive and oriented toward urgent problem-solving, with frequent Zoom meetings and continuous WhatsApp exchanges and accelerator projects aimed at rapid deployment of telemedicine and remote care solutions. In the post-pandemic period (2023–2024), activity shifted toward more structured, less frequent interactions focused on broader digital health initiatives for long-term digital transformation, scaling successful pilots, and aligning innovations with national strategies. The community has continued to evolve in response to new crises and the AI revolution.

This section presents the key mechanisms through which the Israel Digital Health Community contributed to the development of digital resilience on multiple levels: professional level, organizational level, and system level. Figure 1 illustrates how the activities of the online community, incorporating emerging technologies, enhanced digital resilience by transforming practices across the three levels. The online working groups encouraged multidisciplinary collaboration at the professional level. The community webinars promoted cross-organization partnerships at the organizational level, and the accelerator for digital health promoted the scaling of new models of care at the system level. Drawing from interviews, observations, and analysis of online communication, we highlight the interrelated dynamics behind the changes on the three levels, leading to digital resilience through multidisciplinary collaboration, cross-organizational partnerships, and scaling new models of care.

The Digital Health Community has built digital resilience in the health system, enabling transformation of healthcare services. As summarized in Figure 2, transformation is enabled by learning to integrate digital technologies at multiple levels—with clinicians developing skills in their professional practice, organizational divides becoming minimized through ongoing knowledge sharing and integration across levels between users at the practice level and policy makers at the system level. Enabling digital resilience through improved digital abilities of the workforce, heightened digital capabilities across health services, and increased digital capacity for system-level resilience was foundational for transformation of the healthcare system. The transformation further supported and fueled the augmented digital resilience, which in a virtuous circle also enabled future-proofing the healthcare system to withstand future shocks and challenges. As such, our findings suggest that developing digital resilience at multiple levels helps healthcare entities not only to bounce back in response to crises and shocks, but rather to bounce “forward” for healthcare transformation (37).

Figure 2 illustrates how the online community, integrating emerging technologies for digital health, enabled digital resilience by changing practices on multiple levels (professional, organizational, and system levels). Building digital resilience of abilities, capabilities, and capacity supports redesigning healthcare services to lead healthcare transformation. The figure presents a few examples of healthcare transformation in developing integrated patient-centered care, managing workforce shortages and burnout, and more.

The online community more specifically provided mechanisms to span multiple levels of engagement: from individual role changes and multidisciplinary coordination to organizational alliances and national-level innovation scaling strategies. By starting with multidisciplinary collaboration, the community facilitates knowledge integration across traditional medical silos (36, 38) hereby improving adaptability to new ways of working. Over time, the online community fostered the creation of integrated care models that address complex patient needs by combining clinical, technical, and managerial expertise in new ways. Thus, while change at the level of professional practice is often stymied through resistance (39–41), the online community enabled conversations and learning between clinicians in an unthreatening manner so clinicians could learn new perspectives on technologies used in practice from each other. In the long run, these capacity building measures help to manage workforce shortages and prevent burnout, which are major global challenges (20, 42, 43).

Concerning digital abilities and capabilities, the discussions and implementations of new digital technology in care processes developed clinicians' abilities to work with technology and enabled improved digital resilience. Experience in using digital tools brings confidence and helps reinforce safety by improving care quality, streamlining workflows, and reducing errors through enhanced information access and decision support (44). At the service delivery level, cross-organizational partnerships, involving new ways of working across boundaries to deliver care pathways in more cooperative ways, such as psychiatrists joining family doctors to support rapid access to mental health services at a distance, were enabled by technologies which spanned coordination between previously siloed institutions. As services develop new capabilities using technologies, old patient pathways can be questioned, rearranged and ultimately improved to cope with an evolving crisis. While the development and integration of new services is often a slow process (41, 45) fraught with inertia (39, 46), new digital capabilities can aggregate resources into innovative configurations (3, 38, 44, 47–50).

Cross-organization partnerships also improve care continuity for patients between healthcare providers and institutions and enhance the overall efficiency of the healthcare system. The ability to scale new models of care through the community infrastructure, supporting the rapid expansion of innovative services, is evidence of digital resilience at the system level, with capacity and readiness for future disruptions. By enabling digital capacity of the system, the online community served as an impetus for redesigning healthcare services, as emerging technologies were adopted and adapted to enhance the flexibility of operations on a national scale in response to the crisis. In many national contexts, policy makers are removed from the realities of emerging grassroots clinical concerns (51) or working to a different timeline of priorities (52). The disconnect hampers a timely response to crisis and system shocks, with important stakeholders left unaligned. In our study, we found that the MoH direct involvement in seeding and supporting innovative technology development at the system level within the incubator context allowed them to scale emerging new practices into national guidelines or specific resource allocation.

The mechanism for community transformation at multiple levels was enabled through the use of remote communication and social media technology. WhatsApp, Zoom, and LinkedIn, provided an inexpensive neutral space for connection and collaboration among community members from competing organizations, including the ministry's regulatory officials. This was especially relevant during the challenging era surrounding the rapid establishment of the community amid the COVID-19 pandemic. Additionally, technology allowed for the convenience of meeting from diverse locations, which is important to support time efficiency, given the busy schedules of all stakeholders involved. Therefore, technology has been an essential factor in the ensuing transformations within the community, adapting to and navigating during and after the pandemic crisis. These digital technologies worked well with the online community as a digital space for redesigning healthcare services, where members collectively imagined, discussed, and shaped future scenarios on issues relevant to the community. Through storytelling, debate, brainstorming, and co-writing, participants critically assess current realities and creatively construct alternative futures they agree on for future development.

Although the mechanisms of the community are social at their core, our findings demonstrate that the digital affordances of the online community shaped its operation and impact. Digital tools such as Zoom enabled synchronous engagement among geographically dispersed actors without the logistics and costs of travel. WhatsApp allowed for persistent, asynchronous exchanges that preserved the continuity of dialogue, captured decision trails, and enabled rapid peer support outside scheduled meetings. LinkedIn extended the reach of the community's outputs, providing public recognition that reinforced professional legitimacy and encouraged cross-sector uptake. These affordances did not simply replicate existing face-to-face dynamics online; they reconfigured them, accelerating feedback loops, flattening hierarchies by obscuring visible status markers, and allowing parallel work streams to progress in multiple spaces simultaneously. In this way, the “digital” in digital resilience refers not only to the integration of emerging technologies for digital health but to the community digital platforms that expanded the speed and scale of resilience-building processes.

The involvement of the MoH in engaging with and supporting ideas from community members and groups was significant for the national adoption of projects and guidelines, thereby extending the reach beyond local efforts on a larger scale. It also provided community members with a sense of legitimacy, as they would have an actual influence on the practical arrangement of healthcare services. While bottom-up grassroots involvement of community members in working groups was fundamental for immediate impact and served as a cornerstone for more extensive, systemic change, the study highlighted the parallel need for a top-down strategy that is essential for scaling and achieving a broader impact, while mitigating tensions between governance and leadership.

While the community achieved many notable successes, it also operated within a set of inherent tensions, including professional controversy and competition between healthcare organizations. One of the most significant tensions was the complicated dynamic created by the MoH dual role as both convener for innovation and health system regulator. As the primary initiator and formal leader of the community, the MoH brought legitimacy, resources, and the ability to connect grassroots initiatives with national decision-making channels. However, its leadership also meant that the community was not entirely self-directed. The MoH held an explicit agenda to steer digital transformation in line with its broader policy objectives, which could influence which projects were prioritized, how resources were allocated, and the speed at which ideas were scaled or not. This dynamic sometimes created unease among participants, particularly when bottom-up innovation proposals did not align with the MoH's strategic direction, and in some cases led to declining engagement and inactive groups.

Further, our study revealed the importance of developing digital resilience in understanding technology use in the present and future. Our findings emphasis the need to go beyond the use of technologies within specific service or clinical contexts, to building a collective form of resilience. This multi-faceted community-level resilience emphasizes the collaborative dynamics necessary for enhancing the healthcare system's capacity to withstand and adapt to disruptions. It extends beyond a solely individual-focused view of digital resilience, suggesting that the healthcare system's resilience depends not only on individual adaptability but also on the strength and flexibility of its professional networks.

The study demonstrates that digital resilience is not a static attribute, but an emergent capability shaped through social learning, collaborative governance, and digital affordances within an online environment. These processes enabled the community to function as a strategic platform for experimentation, shared problem-solving, and policy engagement, thereby strengthening the healthcare system's ability to respond flexibly to future disruptions.

This study explored how a digitally mediated professional community functioned as a platform for developing system-wide digital resilience. By examining the online community's position in reshaping professional roles, enhancing cross-organizational collaboration, and fostering a culture of innovation, we demonstrate that digital resilience is not a static trait but an emergent, co-constructed capability that spans individuals, institutions, and digital infrastructures.

Our findings highlight three interrelated mechanisms through which the online community supported systemic transformation: (1) enabling professionals to operate beyond traditional disciplinary boundaries, facilitating digitally integrated care and workforce agility; (2) creating neutral, virtual spaces for cross-organizational collaboration, even among competitors and regulators; and (3) enhancing an innovation culture, through system level incubators which allowed healthcare actors to co-design new care models leveraging digital tools.

This study also emphasizes the critical interplay between social and digital infrastructures in cultivating long-term system resilience. While much attention in digital health has been directed toward tools and platforms, our findings demonstrate that social factors, such as relationships, trust, norms, and collaborative practices sustained through the online community, is also vital for digital resilience. Importantly, this type of digitally enabled collaboration does not rely solely on formal mandates or predefined hierarchies but thrives through voluntary participation, shared values, and mutual accountability. As such, the study underscores the need to conceptualize resilience not only as a technological capacity but as a deeply sociotechnical achievement.

For policymakers and health system leaders, this study offers a model for nurturing digital resilience through investment in participatory structures that blend digital platforms with collaborative practices. Such infrastructures can ensure that healthcare systems remain adaptive, inclusive, and future-ready amidst growing uncertainty and complexity. However, it is important to note that the Israeli healthcare context, characterized by four dominant HMOs operating under a universal national insurance law and a central Ministry of Health with regulatory and financing authority, which provides a relatively coordinated environment for national-level initiatives, is a specific and unique case. In more fragmented, privatized, or decentralized healthcare systems, establishing similar cross-organizational communities may require different governance structures, incentive mechanisms, or technological infrastructures. Nonetheless, we believe that the mechanisms identified in the study, including multidisciplinary collaboration, cross-organization partnerships, and innovation scaling, are likely transferable to other contexts, though their implementation would need to be adapted to take account of specific local structural and policy environments.

Future research could extend this work by examining how similar communities function in different national and industry contexts or how digital resilience unfolds over longer time horizons, facing multiple crises. Nonetheless, this study provides a foundational understanding of how online professional communities can act as strategic assets for digital resilience and health transformation at scale.