Maintaining places of social inclusion : Ebola and the emergency department

We introduce the concept of places of social inclusion—institutions endowed by a society or a community with material resources, meaning, and values at geographic sites where citizens can access services for specific needs—as taken-for-granted, essential, and inherently precarious. Based on our study of an emergency department that was disrupted by the threat of the Ebola virus in 2014, we develop a process model to explain how a place of social inclusion can be maintained by custodians. We show how these custodians—in our fieldsite, doctors and nurses—experience and engage in institutional work to manage different levels of tension between the value of inclusion and the reality of finite resources, as well as tension between inclusion and the desire for safety. We also demonstrate how the interplay of custodians’ emotions is integral to maintaining the place of social inclusion. The primary contribution of our study is to shine light on places of social inclusion as important institutions in democratic society. We also reveal the theoretical and practical importance of places as institutions, deepen understanding of custodians and custodianship as a form of institutional work, and offer new insight into the dynamic processes that connect emotions and institutional work

Challenging the hidden curriculum : building a lived process for responsibility in responsible management education

This essay argues that conceptualisations of responsibility in the responsible management education literature are generally superficial or unstated. We propose that this leads to practical understandings of responsibility being drawn from the hidden curriculum of socialised learning in the background of formal educational contexts. To disrupt this and enable critical thought and action, we argue for the integration of three perspectives that can be combined in a dynamic, lived process. First, we suggest that evidence-based management challenges us to seek out evidence to inform responsible management practice in ways that are thoughtful, critical and reflexive. Second, we argue that an interpretive approach employing philosophical hermeneutics connects responsibility to situated judgement about how we should interpret evidence available to us in the context of lived human experience in dialogue with others. Third, deconstruction reveals (aspects of) the ways in which the hidden curriculum constructs responsibility in the context of responsible management education texts and talk – and helps us to remain open to other possibilities. We integrate these three perspectives to arrive at a definition of responsibility as a lived process with implications for students, educators and the institutions they inhabit

The role of space and place in organisational and institutional change : a systematic review of the literature

We present a systematic review of empirical articles investigating the role of place and space within the organisational and institutional change literature. In taking stock of the change literature, our aim is to better understand the nature and degree of scholarly engagement with concepts associated with place and space to inform a future research agenda. Our systematic review identified 290 empirical articles published between 1979 and 2020 that attended to organisational or institutional change and also engaged with space or place. Our analysis generated four archetypal perspectives that represent qualitatively different ways of viewing the role of place and space in how organisations and institutions change: functional perspective, situated perspective, experiential perspective, and mutually constituted perspective. We synthesise the four perspectives into a typology that reveals different levels of attention to change as process and to place and space as lived or physical phenomena, and cast light on different assumptions about the relationships between change and place or space that can guide future research

Theorizing as mode of engagement in and through extreme contexts research

We explore how management and organization scholars theorize when undertaking research on extreme contexts, which are organizational settings where potential adverse events arise from risks, emergencies and disruptions. We propose that different ‘modes of engagement’ arise as researchers connect different aspects of the self to the extreme context; namely, personal self, professional self, moral self and vulnerable self. Each self-context connection plays out in different modes of engagement in the conduct of empirical research and enables different theorizing practices. We present these self-context connections as four ideal-typical modes of engagement. Adventuresome inquiry connects a personal self to the extreme context and theorizes by phenomenon-driven problematization. Instrumental scholarship expresses a professional self in the extreme context and theorizes by theory elaboration. Ideological improvement galvanizes a moral self in the extreme context and theorizes by change-driven abstraction. Reflexive labor exposes a vulnerable self and theorizes by dialectical interrogation. Our comprehensive framework of theorizing as mode of engagement contributes to extreme context research by elucidating how theorizing in and through such contexts is accomplished by researchers with multiple selves and by offering some guidance on how the four modes can be used dynamically to ensure generative theorizing. We also contribute to the broader literature on theorizing in management and organization studies by highlighting the need to consider the interplay between the researcher and the academic contributions they produce and by proposing a reflexive and dynamic framework of theorizing as modes of engagement

Institutional logics, risk and extreme events : insights from and for management education

To shed light on the interrelationship between risk and logics, we explore how multiple institutional logics shape management educators’ experiences of risk in classroom teaching. Using a two-case re- search design, we analyse an empirical case study of management educators in a UK business school during the COVID-19 pandemic and a case study of emergency physicians during the Ebola epidemic. Comparing these two focal cases of different types of frontline professional work during global health crises, we develop a model of how perceptions of risks and their mitigation shape, and are shaped by, experiences of compatibility, contestation and rejection among multiple logics. Our study extends the literatures on institutional logics and risk by providing insight into the role of multiple logics in the social construction of risk. We also contribute to the management education literature by focusing attention on the risks of physical harm in classroom teaching and by theorizing when, how and why management educators apprehend these risks as ordinary or extraordinary to their normal profes- sional role. Finally, our study has practical implications for risk mitigation at individual and organi- zational levels and for creatively and safely adapting teaching and learning practices with students during extreme events

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans.

BACKGROUND: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19. METHODS: A global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian β-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations. RESULTS: The best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90·2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72·3 per cent. Globally, 81·7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37·7 per cent of cancer operations (2 324 070 of 6 162 311) and 25·4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45 weeks to clear the backlog of operations resulting from COVID-19 disruption. CONCLUSION: A very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe