The Reality Dysfunction: 1 (The Night's Dawn trilogy, 1)

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The watchword now is resilience, and it is at the heart of preparations that the opposition Labour Party, which has a consistently large lead in opinion polls, is making for government after a general election that is most likely to take place between May and October in 2024. The task is considerable. Politics based in precedence and making it up as you go along may have worked in the past (although as ever in Britain, the country’s performance is seen through rose-tinted spectacles), but there’s little reason to think they will be adequate to present and future transnational crises—from climate to migration to natural resources to another pandemic. Both are unconventional personalities, and their aversion to the tribalism that’s rampant in Washington is perhaps even more pronounced now that their careers in elected office are likely done. (Brown served a total of 16 years as California governor; Schwarzenegger, 76, served seven years and batted down any suggestion he might run for the U.S. Senate on Friday at a luncheon event in the state capital. “I’m totally ruling it out; it’s not even in there,” he said.)

New Public Management: Measures to contract out clinical and non-clinical services to both public and private providers, combined with public-private-partnerships to build new facilities, will generate better performance [ 14]. Patient choice of public or private providers, with money following patients, will reinforce pressure for higher quality outcomes [ 36, 37]. Buchan J. Health sector reform and human resources: Lessons from the United Kingdom. Health Policy Plan. 2000;15(3):319–25.The third area of organizational dysfunction that public hospitals suffer from reflects the explicit political character of policy and management decision-making in these institutions. There is no shortage of literature that describes the non-linear, non-optimizing, and sometimes seemingly non-rational elements that compose typical politically structured decision-making in all sectors of public policy (see for example [ 67, 68]). To suggest that public sector decision-making is broadly dysfunctional when viewed from the perspective of health provider and/or service organizations as well as of the staff working in those institutions is not novel.

Sutherland K, Leatherman S. Regulation and quality improvement: a review of the literature. London: The Health Foundation; 2006.The second argument examines the core structural problems that public hospitals present. The paper contends that there are three separate structural characteristics which, together, inhibit effective problem description and policy design for public hospitals. These three structural constraints are i) the dysfunctional characteristics found in most organizations, ii) the particular dysfunctions of professional health sector organizations, and iii) the additional dysfunctional dimensions of politically managed organizations.

Riska E. The professional status of physicians in the Nordic countries. Milbank Q. 1988;66 Suppl 2:133–47. An area of policy decision-making that never goes away is the question of the public/private mix in service provision. While a number of European countries now view this issue as a pragmatic one tied to care standards and performance [ 74], it is still a live political issue [ 75, 76].Beyond these structural problems inherent in legislation and administration, there are a number of specifically health sector dilemmas that require difficult policy decisions which are never permanently resolved. The superiority of decentralized as against centralized and/or re-centralized models of decision-making is continually debated, with different variants of Rondinelli’s four forms of decentralization (d

Critical minerals such as lithium, cobalt, and graphite are essential for the manufacturing of batteries for electric vehicles, and the Chinese government currently controls more than 90% of the world’s supply. Rouse WB. Health Care as a Complex Adaptive System: Implications for Design and Management. Bridge-Washington-National Academy of Engineering. 2009. p. 1–9. Saltman RB. National planning for locally controlled health systems: the Finnish experience. J Health Polit Policy Law. 1988;13:27–51. The extraordinary capacity of contemporary medicine to intervene and/or restore human functioning requires high levels of technically sophisticated and financial costly capital equipment, carefully configured physical space, and high levels of coordination and cooperation among different categories of medical and non-medical staff both within and beyond hospitals walls. These institutional requirements to deliver good medical care take great organizational focus and managerial skill to achieve and sustain. The continued expansion of diagnostics and treatments, and the associated safety hazards, has added a further dimension to hospital complexity.Saltman RB, Bankauskaite V, Vrangbaek K, editors. Decentralization in Health Care: Strategies and Outcomes. European Observatory on Health Systems and Policies Series. Berkshire: Open University Press/McGraw-Hill Education; 2007.