Who can ‘Test. Test. Test.’? Boundary work around the scaling up of diagnostic testing in spain and the uk during the covid-19 pandemic

At the start of the Covid-19 pandemic, countries were encouraged by the World Health Organization to “Test. Test. Test.” This paper compares how healthcare systems in Spain and the UK, simultaneously facing a crisis of similar magnitude, developed diagnostic testing systems that greatly differed in their organizational boundaries. The paper shows how boundary work in each country, influenced by pre-existing institutional logics and established power structures, defined who could provide diagnostic testing during the crisis response - and very importantly - who was excluded. Results show that the greater influence of professional boundary work in Spain and efficiency boundary work in the UK resulted in testing systems that took divergent forms. The findings contribute to understanding of the durability of institutional logics during crisis situations as well as the importance of formal authority in boundary work. In the UK, the high centralization of authority over testing allowed policy makers to implement a radically novel organizational solution to scale up testing, while devolved authority favoured local clinical professionals in their attempts to retain control of testing in Spain. These findings highlight the importance of accounting for power in explaining the influence of institutional logics on the shaping of socio-technical systems. Finally, the legacy of the pandemic response already appears to be very different in these two countries. In Spain, the resources allocated to public hospital labs to expand their PCR capacity have extended and improved their diagnostic capabilities. In the UK, losses in testing capacity and expertise after the closure of most of the labs newly built during the pandemic suggests that the dominance of efficiency logic during the crisis may actually be inefficient, from the perspective of future pandemic preparedness, in the sense that the vast funds expended may have little tangible infrastructural legacy.

About David Barberá-Tomás

David Barberá es Profesor Titular en la Universidad Politécnica de Valencia. Con anterioridad a su carrera académica, ejerció de Director de Proyectos de I+D en una empresa de tecnologías médicas durante 7 años. En ese periodo dirigió numerosos proyectos de investigación y desarrollo de nuevos productos. Parte de los resultados de estos proyectos de investigación quedaron reflejados en dos patentes europeas en las que figura como inventor. La investigación académica del Dr. Barberá estudia diferentes ámbitos de la innovación, como la innovación en medicina, las políticas de innovación, la innovación en sectores creativos o la innovación y el emprendimiento social. Los resultados de su investigación han sido publicados en revistas de alto impacto en el ámbito de los Estudios de Innovación y el Management. Uno de sus trabajos en innovación en medicina fue seleccionado por Faculty Opinions, un servicio de selección y evaluación de investigación de alto impacto. Otra de sus investigaciones fue premiada con el "Best Entrepreneurship Paper Award" de la OMT Division en el congreso Academy of Management (Vancouver, 2015) y mencionado en medios internacionales. Ha trabajado en contratos y proyectos de investigación financiados por instituciones locales, nacionales e internacionales. Ha realizado estancias como investigador visitante en instituciones como UC Berkeley, Stanford University, Copenhaguen Business School, VU University Amsterdam, Aalto Business School (Helsinki) o la Universidad Carlos III de Madrid, donde ha presentado sus trabajos en diversos seminarios de investigación.