Flexible working in the UK: interrogating policy through a gendered Bacchi lens

This article focuses on organisations’ flexible working policies and the UK’s Right to Request Flexible Working legislation first introduced in 2002 and progressively extended in 2009 and 2014. It critically explores the existing literature around flexible working to examine the UK’s policy approach through a gendered lens and by adopting Bacchi’s framework «What’s the problem represented to be». Three themes from the literature are identified and explored to problematise the deep-seated assumptions and silences underpinning policy: namely, the dominance of the business case rationale; the gendered substructure of organisations; and the disjuncture between policy «on paper» and policy «in practice». Through the lens of Bacchi, the article highlights that the «problems» underpinning the UK’s Right to Request legislation and organisation’s flexible working policies are neither fixed nor static, discursively shifting across «time», and that flexible working policies must be analytically situated within their social and economic contexts.Este artículo se centra en las políticas de trabajo flexible de las organizaciones y en la legislación del Reino Unido sobre el derecho a solicitar trabajo flexible, introducida en 2002 y ampliada progresivamente en 2009 y 2014. Explora críticamente la literatura existente sobre el trabajo flexible para examinar el enfoque de políticas del Reino Unido a través de una lente de género y adoptando el marco de Bacchi «¿Cómo se representa el problema?». A partir del marco teórico, se identifican y exploran tres temas para problematizar los supuestos y silencios que están profundamente arraigados y sostienen la política: a saber, el predominio de la lógica de los negocios; la subestructura de género de las organizaciones; y la brecha entre la política «en papel» y la política «en la práctica». A través de la lente de Bacchi, el artículo destaca que los «problemas» que yacen debajo de la legislación sobre el derecho a solicitar trabajo flexible del Reino Unido y las políticas de trabajo flexible de las organizaciones no son fijos ni estáticos, cambian discursivamente a través del «tiempo», y que las políticas de trabajo flexibles deben estar situadas analíticamente dentro de sus contextos sociales y económicos

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised