Putting adaptive capacity into the context of people’s lives: a case study of two flood-prone communities in Puerto Rico

2009 ◽  
Vol 52 (2) ◽  
pp. 277-297 ◽  
Author(s):  
Tania López-Marrero ◽  
Brent Yarnal
BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042847 ◽  
Author(s):  
Sina Furnes Øyri ◽  
Geir Sverre Braut ◽  
Carl Macrae ◽  
Siri Wiig

A new regulatory framework to support local quality and safety efforts in hospitals was introduced to the Norwegian healthcare system in 2017. This study aimed to investigate hospital managers’ perspectives on implementation efforts and the resulting work practices, to understand if, and how, the new Quality Improvement Regulation influenced quality and safety improvement activities.DesignThis article reports one study level (the perspectives of hospital managers), as part of a multilevel case study. Data were collected by interviews and analysed according to qualitative content analysis.SettingThree hospitals retrieved from two regional health trusts in Norway.Participants20 hospital managers or quality advisers selected from different levels of hospital organisations.ResultsFour themes were identified in response to the study aim: (1) adaptive capacity in hospital management and practice, (2) implementation efforts and challenges with quality improvement, (3) systemic changes and (4) the potential to learn. Recent structural and cultural changes to, and development of, quality improvement systems in hospitals were discovered (3). Participants however, revealed no change in their practice solely due to the new Quality Improvement Regulation (2). Findings indicated that hospital managers are legally responsible for quality improvement implementation and participants described several benefits with the new Quality Improvement Regulation (2). This related to adaptation and flexibility to local context, and clinical autonomy as an inevitable element in hospital practice (1). Trust and a safe work environment were described as key factors to achieve adverse event reporting and support learning processes (4).ConclusionsThis study suggests that a lack of time, competence and/or motivation, impacted hospitals’ implementation of quality improvement efforts. Hospital managers’ autonomy and adaptive capacity to tailor quality improvement efforts were key for the new Quality Improvement Regulation to have any relevant impact on hospital practice and for it to influence quality and safety improvement activities.


2021 ◽  
Vol 5 ◽  
Author(s):  
Luis Alexis Rodríguez-Cruz ◽  
Maya Moore ◽  
Meredith T. Niles

Farmers across the globe are experiencing compounding shocks that make evident the need to better understand potential drivers and barriers to strengthen adaptive capacity. This is especially true in the context of a disaster, where a disruption in the natural and built environment hinders livelihood strategies and exposes the underlying dynamics that perpetuate vulnerability to natural hazards. As such, the interconnections of structural and individual attributes must be considered when evaluating adaptive capacity. This paper uses a convergent mixed-methods approach to assess Puerto Rican farmers' actual and intended adoption of adaptation practices, in light of the obstacles they faced toward recovery after 2017's category four Hurricane Maria, to contribute to better understanding adaptive capacity. This study uses data from 405 farmers across Puerto Rico (87% response rate), surveyed 8 months after Maria by agricultural agents of the Extension Service of the University of Puerto Rico at Mayagüez. Quantitative data was assessed through negative binomial regressions (actual adoption) and generalized linear models (intended adoption), while qualitative data (reported obstacles) were analyzed through thematic analysis. This study found that almost half of farmers adopted an adaptation practice after Maria, and that in many cases, broader structures, such as systems of governance, farmers' social networks, and infrastructure, affect adaptive capacity more than individual perceptions of capacity. Future adaptation strategies and interventions, especially in the context of disaster, should consider the extent to which structural factors hinder individuals' ability to prepare for, respond, and recover from the impacts of these shocks. Our results show that there might be opportunity to enact new systems in light of catastrophic events, but this does not solely depend on individual actions. The mixed-methods approach used can inform future studies in better assessing adaptive capacity from a standpoint that incorporates individual and structural components.


2015 ◽  
Vol 60 (1) ◽  
pp. 265-271
Author(s):  
Vo Hong Tu ◽  
Mitsuyasu Yabe ◽  
Nguyen Thuy Trang ◽  
Huynh Viet Khai

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