'Protecting the NHS' - and its limits

ABSTRACTBackground: Health care organizations can be very complex, and are often the setting for crisis situations. In recent years, Canadian health care organizations have faced large-scale systemic medical errors, a nation-wide generic injectable drug shortage, iatrogenic infectious disease outbreaks, and myriad other crises. These situations often have an ethical component that ethics consultants may be able to address. Organizational leaders such as health care managers and governing boards have responsibilities to oversee and direct the response to crisis situations. This study investigates the nature and degree of involvement of Canadian ethics consultants in such situations. Methods: This qualitative study used semi-structured interviews with Canadian ethics consultants to investigate the nature of their interactions with upper-level managers and governing board members in health care organizations, particularly in times of organizational crisis. We used a purposive sampling technique to identify and recruit ethics consultants throughout Canada. Results: We found variability in the interactions between ethics consultants and upper-level managers and governing boards. Some ethics consultants we interviewed did not participate in managing organizational crisis situations. Most ethics consultants reported that they had assisted in the management of some crises and that their participation was usually initiated by managers. Some ethics consultants reported the ability to bring issues to the attention of upper-level managers and indirectly to their governing boards. The interactions between managers and ethics consultants were characterized by varying degrees of collegiality. Ethics consultants reported participating in or chairing working groups, participating in incident management teams, and developing decision-making frameworks. Conclusions: Canadian ethics consultants tend to believe that they have valuable skills to offer in the management of organizational crisis situations. Most of the ethics consultants we interviewed believed that they play an important role in this regard.

In the last decade, new policy initiatives emerged in Latin America as a response to the rise of a ‘creative turn’ in the global North. This article examines the impact of such turn on urban cultural policies for informal settlements in Rio de Janeiro, Brazil, focusing on the case of ‘Favela Criativa’ – a governmental programme to support young people’s cultural and creative work across favelas. The analysis reveals that the programme has effectively widened the visibility of favelas’ cultural and creative work, increased financial public support and developed practical strategies for working with informality. However, it also raises questions about the extent to which this innovative policy development actually challenges prevalent managerial views of creativity guided by a market logic. The article demonstrates that a focus on informality as groundwork for political resistance in the city can expand our understanding of the creative economy beyond precarization, self-exploitation and individualization.

The paper presents results of a research on the impact of the first wave of the COVID-19 pandemic on the life and work of cultural workers in South-Eastern Europe, which was carried out from May till July 2020. The paper shows how in that period in all of the researched countries (Bosnia and Herzegovina, Croatia, Northern Macedonia, Montenegro, Serbia and Slovenia) cultural workers noted a significant drop of income, expected decrease in total earnings and continued trend of the necessity of additional work and self-exploiting practices. In the researched countries, the measures for minimizing the negative impact of the pandemic on the cultural sector were mainly not adopted at the local level. If they were adopted on the national level, these predominantly included one-time assistance to artists and cultural workers, and selected indirect measures, where a difference between EU Member States and those outside of the EU exists. The data shows a limited influence of international foundations and networks on the sector, however, one can note an increase of initiatives and networks of solidarity of professional associations, NGOs and independent cultural workers. The research shows that for the cultural sector in South-Eastern Europe the first wave of the COVID-19 pandemic has brought about a number of negative consequences, while the early measures in most of the countries were of limited impact and scope. The positive effects are reflected in the strengthening of solidarity within the sector and greater networking among cultural workers, as well as in the strengthening of the view that a new, more sustainable approach to the cultural sector is needed, and which is not based on the market logic. © 2021 Institut za drustvena istraživanja u Zagrebu – Institute for Social Research in Zagreb Sva prava pridržana – All rights reserved.

Background The COVID-19-crisis has posed major challenges for organisations providing care in terms of fulfilling their contracts as well as maintaining their quality standards. This project aimed to analyse the implementation of gender and diversity sensitive crisis preparedness in health and social care organisations in Austria. The innovation of this project lies in the organisational crisis preparation including the interfaces of all organisations and actors involved in the care of a vulnerable person. Methods A comprehensive survey and analysis of existing structures and processes was carried out. A participatory approach was used to develop modular guidelines tailored to different crisis scenarios. This was followed by a detailed process analysis, integration of good practices and the creation of assessment tools for practical evaluation. Staff training and technology needs were identified, followed by an assessment of the applicability of the findings to other social sector organisations. Results This project created guidelines with modular structures that enable preparation for crises and their consequences. Thereby strategies for risk mitigation and good practice examples, e.g. from the COVID-19 pandemic, were developed. A self-assessment of the status of crisis preparation as well as the continuous monitoring with special consideration of the intersectional diversity of the target groups and their vulnerability was developed and made available on the web. Conclusions The project results in guidelines as well as a self-assessment and monitoring tool directly benefiting the participating organisations. Through its transferability to other organisations the project promotes overall crisis resilience and sustainably strengthens the care for vulnerable groups in times of crisis. In addition, solidarity-based help in crisis situations is promoted. The project promotes not only organisational, but also individual as well as macro-social and economic benefits. Key messages • The project developed guidelines for gender and diversity sensitive crisis preparedness for health and social care organisations, including risk mitigation strategies and self-assessment/monitoring. • Crisis preparation must be systematically implemented in health and social care organisations involved in care of vulnerable persons.

Purpose – The purpose of the paper is to discuss and illustrate how contemporary market discourses rearticulate socio-political relationships and identities, including the rights, duties, and opportunities of individuals and categories of individuals as citizens. More specifically, the purpose is to analyze how “economic citizenship” is articulated and negotiated in the intersection of (Nordic) welfare state ideals and shareholder-oriented market discourses. The paper further elaborates on how different identity markers, especially gender and class, intersect in these articulations and contribute to exclusionary practices. Design/methodology/approach – The paper approaches the articulation of economic citizenship through an empirical study that focusses on business media representations and online discussions of a major factory shutdown in Finland. Drawing from discourse theory and the notions of representational intersectionality and translocational positionality, the paper analyzes how gender and class intersect in the construction of economic citizenship in the business media. Findings – The study illustrates how financialist market discourses render citizenship intelligible in exceedingly economic terms, overriding social and political dimensions of citizenship. The business media construct hierarchies of economic citizens where two categories of actors claim full economic citizenship: the transnational corporation and the transnational investor. Within these categories, particular systems of privilege intersect in similar ways, rendering them masculine and upper middleclass. Whether interpreted as hegemonic or counter-hegemonic, the financialist discourses rearticulate the social hierarchies and moral landscape in Finnish society. Originality/value – The paper contributes to critical/feminist management studies by elaborating on the role of the business media as an important site of political identity work, positioning, and moral regulation, where neoliberal ideas, based upon and reproducing masculine and elitist systems of privilege, appear as normalized and self-evidently valued.

The structure and organization of health care is a salient political issue across nations and welfare states. It is important not only from an economic perspective, but also from a social and political perspective regarding the possibility of maintaininga proper qualitative level of health care as well as a system that is broadly accessible to the citizenry. Equal access to health care and social care is thus a key factor when the general quality of public life is discussed, not only in Denmark but also in many other welfare states. A common prerequisite for the existence of such a system is a strong general norm of reciprocity in social and political contexts. The norm states that everybody should contribute to our common welfare by working, paying taxes and participating in political institutions and in return be treated as equal members (citizens) of the state. However, not all citizens are capable of working, and far from everybody has equal access to health care and social care. In theory everybody should enjoy the same rights and access to common services, but in reality the boundary between being considered entitled to and deserving of public assistance and being perceived as responsible for one’s condition is more a political than an objective measure (Stone, 1984: 26; Møller, 2009b: 235). In practice, the principle of equal access is interpreted and implemented by doctors who treat patients, health care professionals promoting health strategies, caseworkers who manage clients and schoolteachers teaching children and at the end of the day it is professionals like them who decide who is given access to services, transactions, preventive interventions and treatments.In health care the diagnostic system works as a platform for deciding who should treat which citizens with what, but in social care such a system is more invisible. Instead the main criterion for access to services and transactions is a systemdesigned to detect and measure the workability of every assistance-seeking citizen. The method of evaluating assistance-seeking citizens’ workability seeks to differentiate between needs and claims because an absolute main reason why citizens cannot maintain a job and need to apply for public support is health problems such as chronic pain, for which they seek medical, psychological or therapeutic help. On an economic level this demand of public support is often seen as creating incentives to exploit the social sector to reduce labor costs; on a practical level it constitutes a difficult and paradoxical interplay between the role of the doctor, the social worker and the idea of the independent citizen, in theory, the equal member of the state. This volume focuses explicitly on the case of chronic pain in such different social and political contexts.

PurposeFacility management (FM) in healthcare is an organisational function that provides non-medical activities, ensuring operational functionality of critical health infrastructure. FM leaders are under pressure to implement the digital transformation, confronted with a highly complex and challenging operational environment. However, the current scope and understanding of the digital transformation in FM is rather limited, with a strong focus on technology. This perspective is inadequate to realise a digital transformation in healthcare organisations and requires a new framework. To ensure the practical applicability, a clearer depiction on how FM practitioners in the field, currently understand the digital transformation, is necessary.Design/methodology/approachA sequential exploratory mixed-methods design was chosen with a qualitative data collection and quantitative data analysis phase. A total of 23 semi-structured research interviews with professionals from FM in healthcare in Switzerland were carried out. Topic modeling was used to analyse, identify and cluster topics.FindingsIn total, nine distinct digital transformation topics were generated: ‘addressing future organisational and people needs’, ‘end-user-oriented processes’, ‘digitalisation management vs. digital tools’, ‘major organisational change’, ‘information exchange and work culture’, ‘digital systems’, ‘pressure’, ‘company-wide strategy’ and ‘management support and communication involving non-medical support services’. The findings indicate that FM practitioners perceive the digital transformation beyond the purely technological viewpoint, although they lack the know-how and instruments necessary to implement the digital transformation.Originality/valueThis study employs an innovative research design, resulting in foundational insights on how FM in healthcare perceives the digital transformation. As such, the study expands the notion on what the digital transformation means for the FM field.

Oregon’s drastic budget cuts and the national nursing shortage pose severe barriers for consumers and providers of human services and health care in rural areas. Because of the unique culture, demographics and a deficit of human service and health care providers, metropolitan based decision and policy making aimed at improving human service and health care delivery, may actually cause harm in rural areas. This time of crisis must be viewed as a transformational opportunity for nurses. Creative alternatives must be explored to decrease the higher rates of human service and health-related disparities for individuals, families, and communities in rural areas compared to those in metropolitan areas. In addition, nurses must invest in furthering the development of the field of nursing to reverse the nursing shortage and prevent shortages in the future. This paper will explore the effect of Oregon’s economic crisis and the national nursing shortage on human service and healthcare delivery and economic development in rural areas. In addition, the effects of the unique culture of rural areas and metropolitan-based decision and policy making on recruitment and retention of nurses in rural areas will be explored. Finally, solutions will be explored to reverse the nursing shortage, prevent future nursing shortages and further the field of nursing.

This chapter discusses how research on welfare state crisis has evolved, influenced by empirical developments as well as theoretical innovations. The chapter identifies four research themes: new social risks, populism and welfare chauvinism, austerity, and social investment. The first three of these four themes deal with dimensions of welfare state crisis: A crisis of benefit adequacy (new social risks), a crisis of political legitimacy of the welfare state (populism and chauvinism), and a crisis of financing (austerity). The last theme, social investment, contrasts with the three sections on welfare state crises. It emerged as a proposal for a policy approach intended to overcome crisis, and thus offered an ideational tool that appears suitable to overcome the legitimacy crisis of the welfare state as well as economic crisis. Future research should focus on how and to which degree a reorientation of social policy towards social investments will take place.

Social security and macro-economics: social security, macro-economics and the European Union, A.B. Atkinson. Part 1 Pensions and retirement: the role of social insurance, private pensions and earnings in explaining the vulnerability of widowed women in the United States, Karen C. Holden and Cathleen D. Zick old age provisions for women - Bismarck or Beveridge?, Christopher Prinz employment and retirement - conflicting aims within the welfare society, Marin Rein and Narry L. Friedman cross-national patterns of labour force withdrawal, Timothy M. Smeeding and Joseph Quinn. Part 2 Employment and social security: the welfare state and full employment, Robert H. Haveman government mandates, health insurance, and the deterioration of the low-wage labour market - are they connected?, Barbara L. Wolfe, Amy Wolaver and Timothy McBride. Part 3 Family policy and economic wellbeing: policy response to household vulnerability - the Norwegian case in an international context, Einar Overbye the state-parent-child relationship after family break-ups - child maintenance in Norway and Great Britain, Anne Skevik changes in economic well-being and income distribution in the 1980s - different measures, different outcomes, Amy D. Crews and Richard V. Burkhauser. Part 4 Privatization of social insurance: dimensions of privatization, Tor E. Eriksen and Lars Soderstrom privatization of retirement income, John A. Turner and David Rajnes private provision of disability insurance - how does the Dutch policy of privatizing disability insurance compare with US experience in workers compensation, Leo J.M. Aarts and Philip R. de Jong. Part 5 Health care: cautionary lessons from the West - what (not) to learn from other countries experiences in the financing and delivery of health care, Theodore R. Marmor and Kieke G.H. Okma intergenerational equity - the concept of e fiar innings, Alan Williams.

The actions needed to mitigate the spread of the coronavirus 2019 (COVID-19) have forged rapid paradigm shifts across healthcare delivery. In a time of crisis, continued access to and delivery of medication for opioid use disorder (M-OUD) is essential to save lives. However, prior to COVID-19, large variability in M-OUD adoption existed across the Veteran Health Administration (VHA) and it is unknown whether the COVID-19 pandemic exacerbated this divide. For the past two years, our team worked with eight VHA facilities to enhance adoption of M-OUD through a multi-component implementation intervention. This commentary explores these providers’ responses to COVID-19 and the subsequent impact on their progress toward increasing adoption of M-OUD. Briefly, the loosening of regulatory restrictions fostered accelerated adoption of M-OUD, rapid support for telehealth offered a mechanism to increase M-OUD access, and reevaluation of current practices surrounding M-OUD strengthened adoption. Overall, during the COVID-19 crisis, facilities and providers responded positively to the call for increased access to M-OUD and appropriate care of patients with OUD. The VHA providers’ responses and continued progress in enhancing M-OUD amidst a crisis may, in part, be attributable to their participation in an implementation effort prior to COVID-19 that established resources, expert support, and a community of practice. We anticipate the themes presented are generalizable to other healthcare systems grappling to deliver care to patients with OUD during a crisis. We propose areas of future research and quality improvement to continue to provide access and high quality, life-saving care to patients with OUD.

1Physician, Peachtree Orthopaedic Clinic, Atlanta, GA, USA X. A. Duralde, Peachtree Orthopaedic Clinic, 2045 Peachtree Drive, Suite 700, Atlanta, GA 30309 USA, Email: [email protected] This CORR Insights® is a commentary on the article "What was the Prevalence of COVID-19 in Asymptomatic Patients Undergoing Orthopaedic Surgery in One Large United States City Mid-pandemic?" by Gutman and colleagues available at: DOI: 10.1097/CORR.0000000000001697. The author certifies that neither he, nor any members of his immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

Disaster preparedness in the healthcare setting traditionally focuses on accepting the capacity surge and influx of patients in time of crisis. The concept of a hospital evacuation is given little thought, and minimal time is spent practicing even though healthcare organizations have identified a hazard vulnerability that may require a full-scale evacuation. One healthcare organization recently pushed its staff to stretch its idea of disaster preparedness when it evacuated a community hospital and skilled nursing facility to ensure the safety of its patients and staff. The success of the evacuation was attributed to communication, preplanning, and leadership within the organization.

Today's healthcare organizations are facing significant demands with respect to managing population health, demonstrating value, and accepting risk for clinical outcomes across the continuum of care. The patient's environment outside the walls of the hospital and physician's office-and outside the electronic health record (EHR)-has a substantial impact on clinical care outcomes. The use of big data is key to understanding factors that affect the patient's health status and enhancing clinicians' ability to anticipate how the patient will respond to various therapies. Big data is essential to delivering sustainable, highquality, value-based healthcare, as well as to the success of new models of care such as clinically integrated networks (CINs) and accountable care organizations.Sentara Healthcare, based in Norfolk, Virginia, has been an early adopter of the technologies that have readied us for our big data journey: EHRs, telehealth-supported electronic intensive care units, and telehealth primary care support through MDLIVE. Although we would not say Sentara is at the cutting edge of the big data trend, it certainly is among the fast followers. Use of big data in healthcare is still at an early stage compared with other industries. Tools for data analytics are maturing, but traditional challenges such as heightened data security and limited human resources remain the primary focus for regional health systems to improve care and reduce costs. Sentara primarily makes actionable use of big data in our CIN, Sentara Quality Care Network, and at our health plan, Optima Health. Big data projects can be expensive, and justifying the expense organizationally has often been easier in times of crisis. We have developed an analytics strategic plan separate from but aligned with corporate system goals to ensure optimal investment and management of this essential asset.

The use of CRM-based curriculum has been implemented in the field of health education and training, and evidence shows that there are changes in behavior and improvements in teamwork performance; however, it is necessary to continue researching their impact on the organization and patient safety (Levine et al (eds), The comprehensive textbook of healthcare simulation. Springer, New York, 2013; Salas et al, J Hum Factors Ergonom Soc 48(2): 392–412, 2006). The Covid-19 crisis has affected patient safety that of clinical teams, and healthcare organizations, leading to reflections on outstanding challenges in the use of simulation as a standard in healthcare training that should lead to a safety culture (Park et al, Manifesto for healthcare simulation practice. BMJ Simulation and Technology Enhanced Learning. Published Online First: 04 September 2020, 2020; Hardeep Singh et al, BMJ Qual Safety 30: 141–145, 2020). Simulation modalities provide answers to many different objectives, and professionals must get trained to make the best use of this powerful education tool through different modalities that make it possible to harness its strengths (Levine et al (eds), The comprehensive textbook of healthcare simulation. Springer, New York, 2013; Posner et al, Adv Simul 2: 1–5, 2017). SBE and training-based simulation will solve many existing problems in the healthcare field that were mentioned since Kohn’s publication more than 20 years ago (Kohn et al., (eds), To err is human: building safer healthcare system. National Academy Press, Washington, DC, 2000).KeywordsSimulationTrainingHealthcareCrisisPatient safety