Resilience Within Constraints: An Event Oriented Approach to Crisis Response
研究美国县级医疗决策自主权与新冠疫情病例和死亡率的关系，发现自主权越高，疫情控制越好，且这种效应在医疗机构多样性和危机动态变化时更强。
Scholars have started unpacking how individuals, organizations, and communities interact to build a shared capacity for resilience. This research, however, has not yet examined how the institutional environment influences local responses to crises. This is an important omission since crises do not occur in a vacuum—decisions of actors, at one level, constrain or catalyze the resilience responses of communities and the individuals and organizations within them. Furthermore, research on resilience often assumes a relatively static nature of crises, without accounting for the need to revise responses over time. Using an original set of high frequency data on COVID-19 rates in the United States, we investigate the relationship between healthcare decision agency at the county level and the incidence of the pandemic as reflected in the number of COVID cases and death by county. Our results provide robust evidence that higher degrees of decision-making autonomy are associated with lower rates of COVID-19 cases and deaths. That is, a positive relationship exists between decision-making autonomy and higher capacities for resilience. We further show that this relationship is strengthened, the larger and more heterogeneous is the mix of healthcare organizations in a county, and the higher is the need for revising responses given the changing nature of the crisis. Our results emphasize the need for a system approach to the study of resilience, and suggest that, by enabling the customization of responses to local needs and resources, decision-making autonomy enhances the shared capacities for resilience.