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Today the world is confronted with dual crises: creeping and acute threats unfolding at the same time—for example, the manifestation of extreme weather events such as drought and flooding and the creeping crisis of climate change. To cope with dual crises, this article develops a novel temporal perspective that offers policy actors a repertoire of interrelated strategies for enhancing the robustness of institutional efforts. The repertoire consists of five temporal strategies that policy actors can use to navigate the twin challenges of immediate and latent threats in conjunction: strategic coupling of short-term shocks and creeping crises, crafting time horizons, molding the pace of public problem-solving, mobilizing anticipatory capacity through futuring techniques, and adaptive iteration of policy decisions. We illustrate the practical application of these strategies in an exploratory case study of adaptive water management in the Netherlands. De wereld wordt geconfronteerd met duale crises: sluipende en acute dreigingen op hetzelfde moment, zoals extreme weersgebeurtenissen als droogte of watersnood tegelijkertijd met de sluipende crisis van klimaatverandering. Om te reageren op duale crises, ontwikkelt dit artikel een nieuw repertoire van vijf temporele strategieën voor beleidsmakers om de robuustheid van overheidssystemen te vergroten. Dit repertoire bestaat uit de volgende strategieën: strategische koppeling van onverwachte korte termijn schokken en sluipende crises, tijdshorizonnen creëren, het tempo aanpassen van implementatie, het mobiliseren van anticiperende capaciteit door middel van scenariotechnieken, en de adaptieve iteratie van beleidsbeslissingen. We illustreren de werking van deze vijf strategieën aan de hand van een uitgewerkt voorbeeld van adaptief watermanagement in Nederland: de invoering van het programma Ruimte voor de Rivier.

This reflective contribution tells the story of a veteran public sector crisis management (CM) researcher’s 35-year journey with educating students and CM practitioners, It offers preliminary insights about how the pandemic experience might – and should – induce a significant rethink of how educators conceptualize the nature of crises and the challenges governments and public agencies face in coping with them.

In Canada many public projects, programs, and services perform well, and many are very successful. However, these cases are consistently underexposed and commonly understudied in the public realm which, for various reasons, tends to focus on policy mistakes and learning from failures rather than successes. In fact, studies of public policy successes, as such, are rare not just in Canada, but the world over, although this has started to change. The aims of the book are to see, describe, acknowledge, and promote learning from past and present instances of highly effective and highly valued public policy-making. These aims are accomplished through detailed examination of selected case studies of policy success in different eras, governments, and policy domains in Canada.

This chapter reviews the volume’s 22 case studies of successful policies across Canada, which tracked policy histories and assessed policy outcomes over time. It seeks to generate broader lessons and themes for conceptualizing and explaining policy success. It begins by providing a summary of the success ratings arising from the case studies and considers the usefulness of the multidimensional PPPE (programmatic, process, political, endurance) framework for developing and analysing such case studies. Second, it draws on the cases to identify factors across policy domains—some common, some particular, some contingent—which contribute to the different dimensions of policy success. Third, we step back from the case studies to consider the complex influence of macro-institutions in Canada (e.g. federalism, executive-dominated parliamentary government, and the judiciary) in influencing policy success. Finally, based on lessons from the Canadian cases, future lines of research to strengthen our understanding of policy success are suggested.

Background Refugees in humanitarian settings commonly experience many health needs and barriers to access healthcare; health data from these settings are infrequently reported, preventing effective healthcare provision. This report describes health needs of refugees in Moria Camp on Lesvos, Greece—Europe’s largest refugee camp. Methods A set of routinely collected service data of 18 131 consultations of 11 938 patients, attending a primary care clinic in the camp over 6 months in 2019–20, was analysed retrospectively, focusing on chronic health conditions. Results The most frequent chronic conditions were musculoskeletal pain (25.1%), mental health (15.9%), cardiac (12.7%) and endocrine conditions (8.9%). In all, 70.4% of consultations were for acute health problems, with high rates of injuries and wounds (20.8%), respiratory infections (12.5%), gastroenteritis (10.7%) and skin problems (9.7%), particularly scabies. Conclusions The prevalence of acute and chronic health problems is high in this setting, with some likely attributable to the deplorable living conditions in the camp. Despite its magnitude, the interpretability of routine health data is limited. A research agenda is identified, and a framework for chronic disease management in refugee camps is proposed.

This introductory chapter sets out the objectives, approach and methodology of this volume. The main rationale for the volume is to identify, reconstruct and narrate instances of governments in Nordic countries ‘getting it right’, and to do so in a manner that is analytically robust yet presented in easy-to-read and helpful-to-teach case-study narratives. It presents the central analytical tool that all case studies use, the PPPE assessment framework, which calls on analysts to ascertain cases against programmatic, process, political and endurance criteria. And it situates the question of individual instances of policy successes in Nordic instances in the context of the broader narrative about a ‘Nordic’ approach to politics, governance and public policy, in particular but not limited to socio-economic policies and the ethos and architecture of welfare states in Northern Europe. It concludes by offering some emerging patterns of success-enabling factors across the cases and by formulating implications for future research.

The primary purpose of this study was to evaluate the clinical outcomes of patients who underwent reverse total shoulder arthroplasty performed for primary glenohumeral osteoarthritis (GHOA) with an intact rotator cuff compared with rotator cuff tear arthropathy (CTA).This was a retrospective review of prospectively collected data including consecutive patients who underwent primary reverse total shoulder arthroplasty for GHOA or CTA with a minimum of 2-year follow-up. Baseline patient demographics and clinical outcomes including active range of motion, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numerical Evaluation, and visual analog scale for pain were collected. Univariate and multivariate regression analyses were performed to evaluate the effect of preoperative diagnosis on clinical outcomes.Patients with a preoperative diagnosis of GHOA demonstrated significantly better postoperative active forward elevation (138.6° versus 127.3°; P0.01), external rotation (54.2° versus 43.8°; P0.01), and change in internal rotation (Δ 2.1 points versus Δ 1.2 points; P0.01). Patients with GHOA demonstrated significantly better postoperative ASES (86.8 versus 76.6; P0.01), Single Assessment Numerical Evaluation (89.7 versus 78.5; P0.01), and visual analog scale scores (0.63 versus 1.2; P0.01). Minimal clinically important difference for ASES score was achieved by 97.5% of patients with GHOA compared with 86.7% of patients with CTA (P0.01), whereas substantial clinical benefit was achieved by 90.4% of patients with GHOA and 71.7% of patients with CTA (P0.01). After a multivariate linear regression analysis, postoperative ASES scores were independently associated with previous ipsilateral shoulder surgery (P = 0.042), preoperative ASES score (P = 0.01), and primary diagnosis of GHOA (P0.01).RTSA performed in patients with GHOA and an intact rotator cuff is associated with improved functional and clinical outcomes compared with those patients treated for CTA.Level III Therapeutic Study.

This chapter reviews the main governance challenges policymakers faced during the COVID-19 crisis. It examines how governments mobilized institutional capacity to tackle these challenges. We focus on attempts to centralize crisis decision-making and discuss whether centralization contributed to government effectiveness and legitimacy.

Communication is pivotal when a society faces a sudden, disruptive and disturbing event. People want to know what is going on, why it is happening, what is done to safeguard them and what they can to protect themselves. During COVID-19, governments were the main sources of that information, at least initially. Governments tried to shape the attitudes, emotions and behaviours of citizens in accordance with their policies. Over time, alternative crisis narratives emerged and influenced citizen behaviour. This chapter examines crisis communication in the COVID-19 crisis: how did leaders try to ‘make making’ of this unprecedented threat? How did they deal with the alternative crisis frames that emerged over time?

The COVID-19 crisis has tested public institutions, crisis leadership and societal solidarity to the core. Fault lines have come to the fore; unsuspected strengths have been noted. But will this be enough to initiate the necessary steps to prepare our societies for the future crises that will come? In this chapter, we offer the building blocks for an action agenda. We identify various pathways to enhanced resilience.

COVID-19 brought the ‘unthinkable’ to our doorstep. The pandemic caused a series of global, and interconnected, health, economic, social, institutional and political crises that are unprecedented in living memory. Political leaders struggled to contain the virus and persuade anxious, weary citizens to behave this or that way in order to overcome a giant collective action problem. This chapter is a primer for the detailed examination of political and policy responses to this impossible challenge. It describes pivotal governance challenges and the constraints operating on the crisis response.

For a crisis to be effectively governed, it must first be noticed, interpreted, understood and assessed. This chapter explores how policymakers ‘made sense’ of the emerging COVID-19 pandemic. We focus on: (1) how policymakers around the world detected the developing threat as it emerged first in China and then in Italy; (2) the prominent involvement of scientific expertise in government sense-making processes (and in narratives about those processes). We discuss the complex dynamics between experts, decision-makers and publics that ensued.

In this chapter, the editors make the case for positive policy evaluation. They survey classic and contemporary public policy and governance research and debates to demonstrate how they are slanted towards fault-finding, the language of disappointment, failure and crisis. They reflect on the contributions and the limitations of this state of the art and argue that it needs to be complemented by a more sustained and systematic conceptualization and empirical study of highly (and perhaps improbably) successful public policy endeavours. This chapter ends by outlining the analytical protocol used in this project, and debating the methodological strengths and limitations of the brand of positive policy evaluation applied in this volume.

Contrary to stereotype, democratic governments are not so bad at what they do. What can we learn about the craft and politics of policy design and policy implementation from instances of public policy success? Systematically distinguishing between program, process, political success as wel as endurance of success over time, this volume presents fifteen in-depth case studies of policy successes from around the world. Each case study contains a detailed narrative of the policy processes and assesses the extent to which the policies pursued can be regarded as successful. It offers a unique tool for researchers, teachers and students to apply theories of policy design, policymaking, and implementation to.

This concluding chapter reflects on how the LCI has performed and how it can be developed. Application of the LCI is analyzed across different leadership puzzles and contexts and for what this tells us about the authority of political leaders. Some interpretations of capital fluctuation across the chapters are presented. The LCI allows exploration of how skills, relations, and reputations create, build, or erode authority. Questions remain over the weighting of indicators, the balance between hard and soft measurements, and broader questions about how capital is acquired, preserved, and, in rare cases, regained. Leaders in weakly democratic systems may be less prone to “normal” patterns of capital fluctuation. Overall, the LCI does allow students of political leadership to think about the difference between political office-holding and exercising political leadership, and about why and when some leaders are able to make the political weather rather than being swept along by it.

When consular emergencies happen – in which a considerable number of nationals are affected by a disaster while abroad – it is not clear what affected citizens and their relatives can and cannot expect from their government. Meanwhile, governments have to contend with issues of distance and the inability to exercise their authority on-the-ground. In such complex, multi-actor and often multi-national settings, one cannot measure governmental emergency management by the same yardsticks used to assess domestic emergency management performance. This article develops an evaluation framework that is tailored to large-scale consular emergencies. We operationalise six key response functions into indicators, which provide a more nuanced perspective on governments’ performance in an emergency. The relevance of the framework is illustrated with reference to case study vignettes from British, Swedish and Australian responses to three major consular emergencies: the 2002 Bali bombings, 2004 Indian Ocean tsunami, and 2006 evacuations from war-stricken Lebanon.

The February 2009 bushfires have prompted a debate with regard to contemporary arrangements for dealing with large-scale disasters. In this article, we seek to contribute to that debate by culling lessons learned from the literature on crisis and disaster management. We discuss what constitutes an effective disaster response system, we identify some key barriers to the effective functioning of such a system, and offer some suggestions for improvement.

The article investigates an important recent dispute within systematic theology over the interpretation of Thomas Aquinas. John Milbank has defended the view that the doctrine of analogy in Aquinas is peculiarly implicated with his entire ontology, that it cannot be understood in merely semantic terms, and that it involves a less “agnostic” position on knowledge of God than is often assumed. The article critically engages this position in two ways. It offers an archaeology of the prior polemical context out of which the claim arose, for the meaning and purpose of Milbank's claim are illuminated once it is seen as the vigorous repudiation of a “grammatical” or “linguistic” interpretation of Thomas on analogy which had been proffered earlier by Nicholas Lash. It will also provide a close investigation of the citations and interpretations of Aquinas texts that Milbank uses to ground his position, in order to adjudicate the dispute with Lash. The result will be to call strongly into question the plausibility of Milbank's readings of Aquinas. The article also indicates at several points the way in which those readings are shaped by an overriding anti-Kantian thrust in Milbank's entire approach to the discussion. In conclusion, it adumbrates the larger and older question which subtends the entire dispute: to what degree is some kind of vision or intuitive grasp of being as such, or of God's being, granted human beings in this life?

In this article, we reconstruct and interpret the Adenauer–Erhard leadership rivalry in the CDU. This leadership struggle culminated in Erhard replacing Adenauer in 1963 and Adenauer's continued ‘guerrilla’ warfare against Erhard's leadership, which was one of the contributing factors to the brevity of Erhard's tenure. The case is of intrinsic historical interest but also provides a muster for recent and ongoing leadership succession predicaments in governing parties in Germany and elsewhere. The article presents a conceptual framework of party leadership succession, and zooms in on the (mis)match between the tactical choices made by the incumbent leader and key succession candidates as a key factor explaining the nature and impact of successions. The framework is then applied to the case, and the implications of the findings are placed in a broader comparative context.

Crisis management (prevention, preparedness, response, and reconstruction) is a tough task for political and bureaucratic leaders. This article documents the persistent tensions between the expectations and realities of crisis leadership. It explores the popular notion that crises provide key opportunities for reform. The very occurrence of a crisis is then thought to expose the status quo as problematic, making it easier to gain momentum for alternative policies and institutions. We argue that the opportunities for reform in the wake of crisis are smaller than often thought. The prime reason is that the requisites of crisis leadership are at odds with the requirements of effective reform.

This paper describes, analyzes and compares two cases of major policy and institutional reform in economic policy: Australia's 1983 decision to float its currency and Sweden's 1990 decision to align itself economically and politically by applying for EU membership. Both involved the overturning of long-standing policy commitments and deeply held beliefs on the part of the social-democratic governments that took these steps. We argue that notwithstanding the major institutional differences between the two countries, both changes are explained by the exercise of change-oriented leadership along the lines set out in five propositions that have been derived from the literatures on policy change and comparative government.

Bureaucratic politics—for example, the “political” interaction between individuals and organizations in the executive branch of government—is a potentially significant force affecting the course and outcomes of governmental policymaking processes. In this article, an empirical and normative model and operationalization of bureaucratic politics is developed, treating it as a variable rather than as an immutable (and by definition problematic) property of policy decision-making. A conceptual model, linking the nature and intensity of bureaucratic politics in advisory systems to the characteristics of the political leaders served by them, is also developed. On the basis of earlier studies of presidential leadership (e.g., Preston, 1996), the leader's need for power, cognitive complexity, and prior policy experience/expertise are hypothesized to affect the organization and operation of the advisory system in terms of bureaucratic politics. Using Hermann's (1983) Personality Assessment-at-a-Distance (PAD) coding technique, theoretical assertions are illustrated in a detailed case study of two critical episodes in U.S. decision-making in the conduct of the Vietnam war in 1965 and 1968.

This chapter characterizes the role of prime ministers as public leaders: of the government, their parties, and the nation. It reviews the current state of knowledge about prime ministers, signals its limitations and sets out the research agenda of the study. It argues that understanding and evaluating how prime ministers perform their leadership function requires delving into the interplay between personal, institutional and contextual factors. It maps out the design of the collaborative and comparative research project the remainder of the book reports on.

The dynamics of intractability, frame multiplicity and intense controversy not only characterize policy formation struggles, as described by Schon and Rein, but also affect the evaluation of policies and government action. Policy analysts play an important part in the politics of policy evaluation. This article demonstrates that they tend to produce very different explanations for controversial, failing policies. Such differing explanations imply different causal attributions, different allocations of blame, and different lessons for future policy-making. Such differences are not random occurrences; they are embedded in the analytical frames that evaluators use to reconstruct policy processes and to explain their outcomes. It is shown that at least three deep-rooted frames can be reconstructed: fiascoes as failures of public problem solving, fiascoes as institutional imbalances, and fiascoes as system artefacts. One of the great epistemological challenges is how to deal with multiple analytical frames. The final part of the article discusses various strategies.

In this article Schon and Rein’s views about policy controversies and their resolution are introduced and critically examined. The broader context of their argument can be found in the emergence of the “negotiatory state,” where public policy is made in coproduction between interdependent actors in shared-power settings. Policy controversies, conceived of as conflicts rooted in clashes between the action frames that actors employ when they define problems and propose solutions to public issues, constitute a challenge to this institutional logic of policy-making. Schon and Rein’s book is largely devoted to identifying ways to resolve them. This article revisits their conceptualization of controversies, reassesses their implications for the integrity of the policy-making process, and places their proposed philosophy of “design rationality” in a broader repertoire of ways to cope with frame multiplicity and frame conflict in public policy-making.

Background Preliminary studies suggest that desflurane and isoflurane potentiate the action of muscle relaxants equally. However, variability between subjects may confound these comparisons. A crossover study was performed in volunteers on the ability of desflurane and isoflurane to potentiate the neuromuscular effect of vecuronium, to influence its duration of action, and on the magnitude and time course of reversal of potentiation when anesthesia was withdrawn. Methods Adductor pollicis twitch tension was monitored in 16 volunteers given 1.25 MAC desflurane on one occasion, and 1.25 MAC isoflurane on another. In eight subjects, vecuronium bolus dose potency was determined using a two-dose dose-response technique; the vecuronium infusion dose requirement to achieve 85% twitch depression also was determined. Also in these subjects, the magnitude and time course of spontaneous neuromuscular recovery were determined when the anesthetic was withdrawn while maintaining a constant vecuronium infusion. In the other eight subjects, the time course of action of 100 micrograms/kg vecuronium was determined. Results Vecuronium's ED50 and infusion requirement to maintain 85% twitch depression were 20% less during desflurane, compared to isoflurane, anesthesia; vecuronium plasma clearance was similar during the two anesthetics. After 100 micrograms/kg vecuronium, onset was faster and recovery was longer during desflurane anesthesia. When the end-tidal anesthetic concentration was abruptly reduced from 1.25 to 0.75 MAC, twitch tension increased similarly (approximately 15% of control), and time for the twitch tension to reach 90% of the final change was similar (approximately 30 min) with both anesthetics. Decreasing anesthetic concentration from 0.75 to 0.25 MAC increased twitch tension by 46 +/- 10% and 25 +/- 7% of control (mean +/- SD, P < 0.001) with desflurane and isoflurane, respectively; 90% response times for these changes were 31 +/- 10 min and 18 +/- 7 min (P < 0.05), respectively. Conclusions Desflurane potentiates the effect of vecuronium approximately 20% more than does an equipotent dose of isoflurane.

This essay reconsiders the well-known thesis that, under conditions of crisis, administrative decision making becomes centralized. It discusses the theoretical and administrative underpinnings of this thesis and focuses on the role of small groups in crisis decision making, central government intervention in crisis situations, and crisis government doctrines. Using findings from recent comparative case research in crisis management, alternative patterns of governmental response to crises are outlined. These include formal and informal decentralization, non-decision making, and paralysis. This article concludes with a set of hypotheses that outline the conditions for the emergence of alternative structural patterns in coping with crises and a call for more contingent and reflective thinking about crisis management issues.

1. Crises as political battlegrounds Dramatic episodes in the life of a polity such as financial crises and major recessions can cast long shadows on the polities in which they occur (Birkland 1997, 2006; Baumgartner and Jones 1993, 2002; Lomborg 2004; Posner 2004).1 The sense of threat and uncertainty they induce can profoundly impact people’s understanding of the world around them. The occurrence of a large-scale emergency or the widespread use of the emotive labels such as ‘crisis’, ‘scandal’ or ‘fiasco’ to denote a particular state of affairs or trend in the public domain implies a ‘dislocation’ of hitherto dominant social, political or administrative discourses (Wagner-Pacifici 1986, 1994; Howarth et al. 2000). When a crisis de-legitimises the power and authority relationships that these discourses underpin, structural change is desired and expected by many (’t Hart 1993).

The global economic downturn that followed the collapse of major US financial institutions is no doubt the most significant crisis of our times. Its effects on corporate and governmental balance sheets have been devastating, as have been its impacts on the employment and well being of tens of millions of citizens. It continues to pose major challenges to national policymakers and institutions around the world. Managing public uncertainty and anxiety is vital in coping with financial crises. This requires not just prompt action but, most of all, persuasive communication by government leaders. At the same time, the very occurrence of such crises raises acute questions about the effectiveness and robustness of current government policies and institutions. With the stakes being so high, defining and interpreting what is going on, how and why it happened, and what ought to be done now become key questions in the political and policy struggles that crises invariably unleash. In this volume, we study how heads of government, finance ministers and national bank governors in eight countries as well as the EU engage in such 'framing contests', and how their attempts to interpret the cascading events of the economic downturn were publicly received. Using systematic content analysis of speeches and media coverage, this volume offers a unique comparative assessment of public leadership in times of crisis.

Political decision-making is not only the sole responsibility of constituted government but it is the concern of various individuals and organizations involved in its interests and influence. This chapter emphasizes these interests and influence when taking into account the ability of liberal democracies to foster political pluralism, as freedom of speech and association and the legitimacy of democratic dissent make such pluralism inevitable. An ancient and non-democratic form of leadership is curiously preserved by constitutional monarchies and although this is assumed to be harmlessly ceremonial the chapter asks if this is more significant than the role of the monarch. A variety of contemporary leadership avenues in liberal democracies have resulted in the creation of a complex and opaque political system. An inquiry is made in this chapter on the necessity of a dispersed leadership as it has become inevitable in a democracy.