Government decentralization and disaster impact, an exploratory study

The purpose of this study is to explore the link between decentralization and the impact of natural disasters through empirical analysis. It addresses the issue of the importance of the role of local government in disaster response through different means of decentralization. By studying data available for 50 countries, it allows to develop the knowledge on the role of national government in setting policy that allows flexibility and decision making at a local level and how this devolution of power influences the outcome of disasters. The study uses Aaron Schneider’s definition and rankings of decentralization, the EM-DAT database to identify the amount of people affected by disasters on average per year as well as World Bank Indicators and the Human Development Index (HDI) to model the role of local decentralization in mitigating disasters. With a multivariate regression it looks at the amount of affected people as explained by fiscal, administrative and political decentralization, government expenses, percentage of urbanization, total population, population density, the HDI and the overall Logistics Performance Indicator (LPI). The main results are that total population, the overall LPI and fiscal decentralization are all significant in relation to the amount of people affected by disasters for the countries and period studied. These findings have implication for government’s policies by indicating that fiscal decentralization by allowing local governments to control a bigger proportion of the countries revenues and expenditures plays a role in reducing the amount of affected people in disasters. This can be explained by the fact that local government understand their own needs better in both disaster prevention and response which helps in taking the proper decisions to mitigate the amount of people affected in a disaster. The reduction in the implication of national government might also play a role in reducing the time of reaction to face a disaster. The main conclusion of this study is that fiscal control by local governments can help reduce the amount of people affected by disasters.

Talking about quality: exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems

BACKGROUND: Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study. METHODS: This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics). RESULTS: The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided. CONCLUSION: The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts.