Organizational Resilience in Primary Care: Puerto Rico

RAND's August 17, 2026 report found that Puerto Rico primary care clinics sustain operations under chronic financial, workforce, infrastructure, and disaster stress by layering absorptive, adaptive, and transformative strategies (RAND).

• RAND conducted 25 semi-structured interviews between May and October 2025, covering physicians and clinic leaders across all major health regions in Puerto Rico.
• RAND reports that interviews were conducted in Spanish and analyzed using an AI-assisted coding platform (Muse) with inter-rater reliability κ = 0.85.
• RAND identified five themes organized across three resilience levels (absorptive, adaptive, transformative) in its August 17, 2026 publication.
• RAND observed that Federally Qualified Health Centers concentrated transformative resilience by institutionalizing telemedicine, multidisciplinary teams, and formal community partnerships.

RAND conducted a cross-sectional qualitative study of primary care clinics in Puerto Rico, using purposive sampling and 25 virtual semi-structured interviews between May and October 2025.

RAND reports that interview participants included physicians and executive or medical directors from Federally Qualified Health Centers and non-FQHC practices across all major health regions.

RAND analyzed transcripts in Spanish using an AI-assisted qualitative coding platform (Muse) and a matrix framework thematic analysis, with reported inter-rater reliability κ = 0.85.

RAND summarizes findings as five themes across three resilience levels: at the absorptive level clinicians expanded roles and personal accessibility; at the adaptive level clinics diversified communication and service delivery; at the transformative level FQHCs institutionalized telemedicine and multidisciplinary care.

RAND wrote, "a layered suite of resilience strategies forged under chronic systemic stress, " and RAND also noted that "individual clinician burden [served] as the primary buffer against system failure."

Researchers should treat the three resilience levels (absorptive, adaptive, transformative) as distinct analytic frames when studying clinic responses, because RAND organized findings into these levels in its August 17, 2026 report.

Policymakers and health leaders should prioritize payment parity and workforce retention, because RAND concluded that federal reimbursement inequities and migration constrain all resilience levels and limit organizational transformation.

Clinic leaders should document informal practices such as home visits and multi-modal records as part of preparedness planning, because RAND found these adaptive practices maintained care continuity during infrastructure disruptions.

Researchers using bilingual data should plan for validated Spanish transcription and AI-assisted coding, because RAND conducted interviews in Spanish and reported AI-assisted coding with κ = 0.85 in May–October 2025.

RAND's August 17, 2026 report documents how Puerto Rico primary care clinics used absorptive, adaptive, and transformative strategies to sustain services under chronic stress and recurrent disasters.

Researchers and health leaders can replicate RAND's mixed human-AI workflow (25 interviews, validated Spanish transcription, AI-assisted coding with inter-rater checks) to produce policy-facing evidence.

To test these methods on your data and accelerate synthesis from transcripts to recommendations, Try Evidano for free.