In this course we have emphasized a social science perspective to highlight the inherent complexities of managing healthcare organizations as ‘social arenas’. The concepts discussed during the course touch upon the social, cultural and ethical dimensions of organizing healthcare and the constant dilemmas and challenges that healthcare organizations are faced with.

These concepts criss-cross, and are inherently inseparable, with one of the most defining phenomena of our time –the COVID-19 pandemic –and its relation to healthcare organization sand processes of organizing. The influence and effects of the pandemic on the organization of care have been, and still are, to say the least –dynamic. Over the last year, the inherent social complexities of organizing these processes have been widely debated and centre-staged the public debate throughout the course of the pandemic. To name just a few such challenges and dilemmas: whether or not to make the use of face masks mandatory? What todo if the ICU reaches full capacity? Who will we vaccinate first (or whether to vaccinate at all for some)? What has been the role of primary care in response to the pandemic? How do we coordinate care between hospitals, primary care, public health and local authorities in light of the challenges placed by the pandemic? And the list goes on…

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To finalize this course you are required to individually write a paper of 2000 words on a well-defined topic of your choice relating to the course content and literature. The paper can deal with one of the topics of the course and in addition address one of the challenges or dilemmas concerning the response of health care organizations to the COVID-19 pandemic. The paper should demonstrate the ability to identify and delineate a theme, elaborate on the dimensions pertaining to the theme in a critical manner, demonstrate the ability to apply the theme to current debates and produce a substantial piece of relevant scholarship.

Your paper should be an individually written essay. An essay-style paper needs to introduce a specific challenge or issue, is argumentative and reflective in nature, and tries to convince the reader of the position taken by the author. Your paper needs to include an introduction and background section(s) in which the challenge, or issue of concern is outlined and placed in context; there should be clear explanation of the importance of the chosen topic and its relevance to societal partners, also presenting multiple perspectives. Relevant evidence and factual information are expected to be cited. You are expected to use health care management theory and concepts taught in the course to analyze your topic in more depth and move beyond simple description. Your paper needs to also include a concluding section, where you synthesize new learning; either describe a clear action plan stemming from your analysis, or reflect on a new realization of the situation and how existing assumptions are being challenged from your reflections on the topic.

The guidelines for paper writing are as follows:
The paper should be 2000 words (+/-10%). This is excluding the bibliography.
Use 1,5 line spacing, Times New Roman 11pt., include in-text referencing and bibliography according to APA (see APA style guide on Canvas).
On the first page, mention your full name, student number and word count. Include a title for your paper.
You may but not need to use sub-headings for different sections of the paper.
You must use at least 15 academic sources (articles or book chapters), and you may also cite additional non-academic sources (media, government sources, reports etc.)

This is the article I based my topic choice on:

Modification of admission or non-admission strategies (triage):

The massive influx of patients raised questions on the eventual modification of our admission criteria to the detriment of the most vulnerable populations.

The decision to refuse admission of a severely ill patient to an ICU is a regular part of the intensivist’s work. Guidelines have been drawn up to guarantee fairness, avoid unreasonable obstinacy and ensure respect for the patient’s wishes and transparency with families [6]. Theoretically, even during an epidemic ICU patient admission decision-making should be identical to that of a routinely applied decision-making method. However, the number of requests for admission made at a time of extreme scarcity of ICU beds dramatically increased.

It has been shown that in case of shortage of ICU beds, the criteria for patient selection are modified, patients being more frequently considered as necessitating mainly palliative comfort care [7, 8]. It is also necessary to underline the increased risk of mortality for patients who cannot be admitted to ICU due to lack of beds, whatever the secondary course adopted: delayed admission, transfer to another distant unit or admission to a less specialized unit [9].

Faced with a massive influx of patients and extreme scarcity of ICU beds, the theoretical risk of “sacrificing the most vulnerable patients” shakes our ethical convictions. Herein, a triage plan with ethical justifications (Table 1) has been proposed to maximize benefit for the greatest number of people [3, 4, 10, 11]. Were the plan to be applied, utilitarian ethics would take precedence over individual ethics and employ the means least restrictive to individual liberty in view of accomplishing the public health goal. In other words, an unprecedentedly dramatic experience has taken place in which, due to compressed temporality, exacerbated emotional factors and massive influx of patients, a choice in the sorting cursor is made to the detriment of a reasoned strategy. Such a situation is likely to contradict our caregiving-based ethical values [12]. Indeed, in addition to the elements linked to the lack of available beds, several factors in the decision-making process were sources of concern: reduction of the minimum time necessary to make such occasionally “life-or-death” decisions, decrease due to containment measures in the essential time to be spent with relatives and pressure from the continuous flow of arriving ICU patients.


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