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Health systems are periodically confronted by crises – think of Severe Acute Respiratory Syndrome, H1N1, and Ebola – during which they are called upon to manage…
Health systems are periodically confronted by crises – think of Severe Acute Respiratory Syndrome, H1N1, and Ebola – during which they are called upon to manage exceptional situations without interrupting essential services to the population. The ability to accomplish this dual mandate is at the heart of resilience strategies, which in healthcare systems involve developing surge capacity to manage a sudden influx of patients. The paper aims to discuss these issues.
This paper relates insights from resilience research to the four “S” of surge capacity (staff, stuff, structures and systems) and proposes a framework based on complexity theory to better understand and assess resilience factors that enable the development of surge capacity in complex health systems.
Detailed and dynamic complexities manifest in different challenges during a crisis. Resilience factors are classified according to these types of complexity and along their temporal dimensions: proactive factors that improve preparedness to confront both usual and exceptional requirements, and passive factors that enable response to unexpected demands as they arise during a crisis. The framework is completed by further categorizing resilience factors according to their stabilizing or destabilizing impact, drawing on feedback processes described in complexity theory. Favorable order resilience factors create consistency and act as stabilizing forces in systems, while favorable disorder factors such as diversity and complementarity act as destabilizing forces.
The framework suggests a balanced and innovative process to integrate these factors in a pragmatic approach built around the fours “S” of surge capacity to increase health system resilience.
We argue that national security is a public good and its production can be analyzed in a strategic context. We first present the context of the border between Canada and…
We argue that national security is a public good and its production can be analyzed in a strategic context. We first present the context of the border between Canada and the United States. Next, we discuss the options of status quo and adoption of a common security perimeter relative to sovereignty and security. We show that efficient border policies could require cooperation among countries but motivating such collaboration may be difficult since joint border security policies may involve a prisoners’ dilemma problem. On the other hand, we show that the likelihood of joint increased security will be higher if there are country-specific benefits for a country improving security at its border. If this is the case, we demonstrate it is possible to reach optimal security using independent border policies.