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.

中文翻译：

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约束内的弹性：以事件为导向的危机应对方法

学者们已经开始解析个人、组织和社区如何互动，以建立共享的复原能力。然而，这项研究尚未考察制度环境如何影响当地对危机的反应。这是一个重要的遗漏，因为危机不会在真空中发生——行为者的决策在某种程度上限制或促进社区及其内部个人和组织的复原力反应。此外，关于复原力的研究通常假设危机具有相对静态的性质，而没有考虑到随着时间的推移修改应对措施的需要。我们使用一组关于美国 COVID-19 发病率的原始高频数据，调查了县级医疗保健决策机构与大流行发病率之间的关系（反映在各县的 COVID 病例数和死亡人数中）。我们的研究结果提供了强有力的证据，表明较高程度的决策自主权与较低的 COVID-19 病例和死亡率相关。也就是说，决策自主权和更高的复原能力之间存在正相关关系。我们进一步表明，这种关系得到加强，一个县内医疗机构的规模越大、越异质，考虑到危机性质的变化，修改应对措施的必要性就越高。我们的结果强调需要采用系统方法来研究复原力，并表明，通过根据当地需求和资源定制响应，决策自主权可以增强复原力的共享能力。