Who can "Test. Test. Test."? The interplay between boundary work and institutions in the organisation of diagnostic testing for COVID-19
Who can "Test. Test. Test."? The interplay between boundary work and institutions in the organisation of diagnostic testing for COVID-19
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DOI：
10.1080/14479338.2023.2254740
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发表时间：
2023-11-29
影响因子：
2.8
通讯作者：
Hopkins，Michael M.
中科院分区：
文献类型：
--
作者：
Barbera-Tomas，David;Bates，James;Hopkins，Michael M.
在COVID-19大流行开始时，世界卫生组织鼓励各国进行“测试。Test.测试。”本文比较了西班牙和英国如何面临类似规模的危机，建立了诊断测试系统，在他们的组织有很大的不同。我们展示了边界如何在每个国家发挥作用，受预先存在的制度条件的影响，定义了谁可以提供诊断检测，以及至关重要的是，谁被排除在外。结果表明，持久的制度条件允许临床实验室专家从事边界工作，这些专家可以接触到具有正式权威的决策者，由此产生的测试系统反映了他们的专业逻辑。如果不是这种情况，其他人的边界工作，基于效率的逻辑，是有影响力的组织测试。我们的研究结果有助于理解危机期间的制度条件之间的相互作用-特别是条件规范的正式权力的领土分配-和边界工作。在英国，医疗预算的高度集中化使得政策制定者能够实施一种新的组织解决方案，包括新建的高通量实验室。在西班牙，下放的权力有利于当地的临床实验室专家，他们试图保持对实验室检测的控制。最后，大流行病应对措施的遗产似乎大不相同。在西班牙，分配给公立医院实验室的资源提高了它们的诊断能力。在英国，新建成的实验室在大流行急性期后关闭，几乎没有留下基础设施遗产，并可能限制未来的大流行准备工作。
At the start of the COVID-19 pandemic, countries were encouraged by the World Health Organization to “Test. Test. Test.” This article compares how Spain and the UK, facing a crisis of similar magnitude, established diagnostic testing systems that greatly differed in their organisation. We show how boundary work in each country, influenced by pre-existing institutional conditions, defined who could provide diagnostic testing and, crucially, who was excluded. Results show that enduring institutional conditions allowed clinical laboratory specialists to engage in boundary work, where these specialists had access to decision makers with formal authority, with the resulting testing system reflecting their professional logic. Where this was not the case, boundary work by others, based on the logic of efficiency, was influential in the organisation of testing. Our findings contribute to the understanding of the interplay between institutional conditions during a crisis - especially conditions regulating the territorial distribution of formal authority - and boundary work. In the UK, the high centralisation of authority over healthcare budgets allowed policy makers to implement a novel organisational solution involving newly built high-throughput labs. In Spain, devolved authority favoured local clinical laboratory specialists in their attempts to retain control of testing in their labs. Finally, the legacy of the pandemic response appears to be very different. In Spain, resources allocated to public hospital labs have improved their diagnostic capabilities. In the UK, the closure of newly built labs after the acute phase of the pandemic has left little infrastructural legacy and may have limited future pandemic preparedness.