Quality Management in Health Care

Abstract A diverse group of governments have accepted “Major Non-NATO Ally” (MNNA) status since the designation's establishment in the late 1980s. This United States (U.S.) designation signals friendship and facilitates cooperation, but it provides no formal security commitments. Why and when have U.S. partners accepted MNNA status? I argue that designees will accept the status when they are ready to acknowledge America's appreciation—a perceptual and relational concept that conveys gratitude absent guarantees. For some designees, untimely embrace of U.S. appreciation could negatively impact their relations with their societies and/or third-party states. For others, accepting appreciation would preclude forming a formal alliance with the U.S. I analyze published sources and incorporate interviews to compare Qatar, which accepted MNNA status in 2022, and the United Arab Emirates, which has not accepted the status as of late 2024. This article contributes to the literature on asymmetric security alignments by centering the Gulf governments and it provides a timely evaluation of an underexplored aspect of global alliance politics.

Abstract Does the military strength of rebel movements affect conflict-related sexual violence by pro-government militias (PGMs)? Existing studies on PGMs show the significant role that PGMs can have in shaping conflict dynamics and outcomes. What remains understudied is how the variation in power capabilities between conflict actors and the sources of support for PGMs influences civilian victimization by militia groups. We argue that strong rebels tip the balance of power against the state, making the state more susceptible to authorizing or allowing sexual violence by PGMs. In addition, the level of autonomy of PGMs from the government is likely to influence their sexual violence, conditional on rebel strength. When rebels are militarily strong, states are likely to order or tolerate sexual violence by PGMs that they train and/or provide resources to, thereby resulting in sexual violence by state-dependent PGMs. Examining all civil conflicts from 1989 to 2009 and using newly collected data on state-dependence of PGMs, our empirical findings provide evidence that PGMs are associated with higher levels of conflict-related sexual violence when the government faces strong rebels. Results also show that the likelihood of sexual violence by state-dependent PGMs increases when rebels exhibit strong military capabilities.

Abstract How, why, and when nuclear deterrence works remains a puzzle. This article argues that a new theory, nuclear heuristics theory, explains the evidence better than existing explanations. An application of poliheuristic decision theory, nuclear heuristics theory posits that the main factor explaining the success of nuclear deterrence is the mutually assured destruction (MAD) heuristic, a decision-making shortcut that assumes that any nuclear war means MAD, even when capabilities fall short of the assured destruction level. Implications of the theory include the expectation that decision-makers never seriously consider nuclear preemption in a crisis, that the conventional military balance is important in determining the outcome of nuclear crises, and that the nuclear balance is not. This theory is tested against two existing theories, nuclear revolution theory and nuclear superiority theory. Evidence comes from a survey of the existing literature and a process-tracing analysis of US decision-making during the Cuban Missile Crisis based on transcripts of tape-recorded deliberations of President Kennedy's advisory executive committee. The evidence strongly supports nuclear heuristics theory: Leaders do speak and act in accordance with the MAD heuristic. Nuclear superiority theory is badly undermined.

Abstract This paper explores under what context the transnational ethnic kinship ties between the overseas Chinese in Southeast Asia and China have not led to their securitization and in what context they have. As the rising great power with exponential economic growth for the past few decades, China has transformed itself from a dirt-poor backwater state to the second largest economy in the world and is also seemingly on the way to reclaim the historical dominant status in East and Southeast Asia. During this process, overseas Chinese in various home states in Southeast Asia have not experienced a uniform securitization of their kinship ties. This paper investigates some of the dynamic patterns about overseas Chinese in Southeast Asia’s relationship between the changing kin state and their home states in the recent past. Focusing on how states in Southeast Asia maintain different types of relations with China in the context of the latter’s rising, this paper contends that the ways in which overseas Chinese communities in the region manage their political space and negotiate their belonging are a function of a combination of international structural changes and domestic political factors. Empirically, this paper compares three states of Southeast Asia—Thailand, Myanmar, and Indonesia—in the different ways of their treatment of the ethnic Chinese, as well as the responding strategies utilized by the ethnic Chinese in navigating their political space and belonging.

Abstract This article examines the relationship between national identity and foreign policy in the context of kin-state engagement in Europe. While the engagement of many European states with their ethnic kin abroad has been long defended as a form of minority protection in so far as it protects and promotes their particular identity and culture, de facto considerations of state security that define its scope have received little attention in the international relations (IR) scholarship. I show here that already in 2012 the dispute between Romania and Serbia over the identity and accommodation of the Vlach minority in Serbia is a conspicuous case in which considerations of (kin-)state security rather than minority protection have overtly justified the engagement of the kin-state. In fact, I argue that this case study calls attention to the multiplying significance of national identity for a kin-state: as a source of obligations, as well as one of (kin-)state ontological security. Yet, in this article, the contextual exploration highlights a tension between the two that originates in a lack of congruity between kin-state identity politics and home-state multiculturalism. While it appears to be unappeasable, in agreement with some constructivist IR scholarship, I contend that it could be reconciled. To this end, this article examines the scope of kin-state engagement at the intersection between justice and security and endorses the necessity to reconceptualize a state’s ontological security as a capability to adapt to a changing normative environment in Europe.

Abstract The liberal vision of the early 1990s envisaged the eastward extension of the Western European security community formed during the Cold War, based on intergovernmental cooperation and integration around the shared norms embodied by the European Union (EU), Council of Europe, and Organisation for Security and Cooperation in Europe (OSCE). Yet, transborder ethnic ties have remained a security concern within the “New Europe.” As well as the external challenges posed by Russia’s aggression against Ukraine, growing transborder nationalism exhibited by Hungary and other states has also become a focus of tensions within the EU. These intra-EU concerns, I argue, should be understood primarily as an issue of ontological security and as part of a multilevel security dilemma implicating states, EU institutions, and national minorities as security-seeking non-state actors. The article focuses on the Federal Union of European Nationalities—a transnational umbrella NGO that in 2013–2021 led an unsuccessful European Citizens’ Initiative named “Minority SafePack” (MSPI) calling upon the European Commission to legislate on firmer guarantees of minority rights within EU member states. Applying the ontological security lens to the study of MSPI, I illustrate how it reflects specific claims voiced by transborder kin-minority activists consistently over the past century, before analyzing the counter-securitizing arguments deployed against it by states. Although MSPI was approved with a large majority within the European Parliament, the Commission ultimately rejected it. I consider why this was the case, as well as the implications of the rejection for the in varietate concordia concept that supposedly undergirds the European project.

Abstract This article extends the study of securitization of cross-border ethnicity beyond its conventional European focus, by analyzing ongoing security challenges surrounding ethnic Somalis in Ethiopia and their relationship to neighboring Somalia. In methodological terms, it looks beyond the irredentist prism through which this case is usually considered, applying newer conceptual and normative frameworks on cross-border ethnicity developed in a European context and assessing their applicability to Africa. Applying Brubaker's “triadic nexus' concept to the Ethiopian case, I discuss how the conclusion of the Ethiopia-Somalia war and Somalia's collapse as an external kin state did not end the securitization of cross-border Somali kinship, but merely repackaged it in new forms. In this regard, the article highlights a continued need to ensure the human security of Somalis in Ethiopia by recognizing and accommodating them as a cross-border ethnic group. From the standpoint of contemporary norms on the regulation of minority issues in interstate relations, the federalization model adopted by Ethiopia after 1991 seems to provide a promising foundation. Thus far, however, the hegemonic nature of the federal project has failed to grant Somalis an appropriate measure of internal self-determination.

Abstract This article analyzes processes of securitization in India’s former State of Jammu and Kashmir (SJK), a disputed borderland characterized by a three-dimensional conflict: the international conflict over Jammu and Kashmir, the inter-governmental conflict between the autonomous SJK and the Indian government, and the inter-communal conflict within the SJK. Applying the concept of securitization beyond its traditional Eurocentric perspective, we explore the securitization of transborder kinship in a case study outside the Global North. We examine the perceived threats vis-à-vis the SJK and the Kashmiri Muslim in light of ontological insecurities rooted in the main Indian national narratives and show how dysfunctional diversity governance in a complex geopolitical context intersects with processes of securitization, affecting inter-communal, inter-governmental, and inter-state relations. The article shows that ontological insecurities, combined with fear of separatism and short-sighted political strategies, led Indian political elites to erode the autonomy of the SJK, and undermine its democratic political processes. This, in turn, led to an increasing dissatisfaction among various communities and, in time, to civil unrest, strong religious polarization, communal and state violence, human rights abuses, insurgency, and the rise of separatist Islamic militant groups. This vicious circle turned New Delhi’s fears into a self-fulfilling prophecy. We highlight the continuum of securitization processes and argue that the former SJK could escape the vicious circle of securitization only through a combination of self-governance, good governance, and international governance.

Abstract When and where are kin-states more likely to engage in militarized territorial expansion against a kin-group's state of residence, i.e., irredentism, rather than merely employing irredentist rhetoric or engaging in non-irredentist kin-state politics that focus on nurturing cultural ties with co-ethnics abroad? For example, Why did Russia pursue an irredentist policy and annex Crimea but a non-irredentist one toward Narva? Why pursue the annexation of Crimea in 2014 but not in the 1990s or the early 2000s? Various valuable domestic explanations have been proposed, including diversionary war theory, shifts in regime type, and socioeconomic changes; but none has centered on balance of power considerations. I emphasize the role of two variables, whether the kin-group’s state of residence is within or outside the core alliance network of a particular pole and the polarity of the international system at any given point in time, operationalized through the number of poles in the system (one, two, or many). I contend that kin-states are unlikely to target any state of residence that is affiliated with the core alliance network of a pole. Furthermore, I argue that variations in polarity shape the nature and location of irredentism. In a bipolar system, irredentism is likely to take the form of proxy warfare outside each bloc. In a unipolar system, irredentism is more likely in areas where the hegemon exercises the least influence—such as areas linked to a former pole. Finally, in a multipolar system, irredentism is more likely to be pursued by rising powers against neighbors not affiliated with alliance networks of a pole in the international system. I evaluate my argument using an existing dataset of both actual and potential irredentist cases from 1946 to 2014, supplemented by illustrative case studies.

Abstract Russia’s full-scale invasion of Ukraine in 2022, launched under the pretext of protecting the rights of Russian kin populations outside of Russia, had a massive impact on security concerns beyond Ukraine. An important consequence was the intensification of insecurities about the presence of large Russian-speaking minorities in Russia’s neighboring states. Scholars have long emphasized that kin-state involvement can lead to the securitization of minority issues, harming the willingness of governments to support collective claims by minorities associated with that kin-state. Yet there is scarce empirical knowledge about whether and under what conditions an assertive kin-state triggers securitization resulting in restrictive minority policy. We assessed this securitization-minority policy nexus comparatively, focusing on the impact of intensifying Hungarian and Russian kin-state activism on policies toward Hungarian and Russophone minorities in five states in Central and Eastern Europe. Our main finding is that intensified kin-state activism does not significantly disrupt previously established paths in minority policy-making, unless a kin-state turns to territorial revisionism. We also found that titular ontological insecurity (faced by actors belonging to a state’s dominant ethnic group) is a helpful heuristic for explaining instances when securitization results in policy restrictions, and we offer conceptual tools for analyzing the salience of both internal and external sources of titular insecurity. Ultimately, our findings highlight the necessity for scholars to distinguish between nonterritorial and territorial types of kin-state intervention in studies about the security dimension of kin-state involvement.

Abstract Modern-day insurgencies are adaptive, enduring, and increasingly intertwined with criminal elements, and therefore pose serious threats to regional and global security. In response, counterinsurgency strategies have become more diversified. One of the strategies that states can employ toward insurgencies is the use of domestic law enforcement, which includes operations by police and intelligence agencies. Given the predominant focus on military approaches, however, there is little empirical work that examines the use of domestic law enforcement in counterinsurgencies. To address this, we investigate the underlying reasons behind a government’s decision to deploy domestic law enforcement against insurgencies. We argue that specific attributes of insurgent groups significantly shape this decision. Using the BAADI2 dataset, our analysis shows that insurgent groups that participate in cooperative alliances and engage in criminal activities are most likely to motivate a state’s decision to deploy domestic law enforcement as a counterinsurgency strategy against them.

Abstract The field of security studies largely focuses its gaze on the security provider without consideration of how security practice is perceived as legitimate by those it is meant to protect. This article presents a framework for categorizing how security is understood based on two viewpoints: first, the core responsibility of the state for providing protection and, second, the universality of rights beyond one’s core identity group. These two angles shape a person’s worldview, which then informs how different forms of security practice are seen as legitimate by those who constitute the referent object of that practice. In this article, we offer security studies scholars and practitioners a sorting tool that categorizes these worldviews in four ways: statist, federalist, nativist, and cosmopolitan. We examine each of these four categories and discuss how each perspective shapes practice by so-called security providers and the legitimacy of that practice by referent populations. We introduce four illustrative examples that demonstrate how these perspectives operate in practice. Finally, we discuss the implications of varied security perspectives as they relate to the current global security architecture.

Abstract New military technologies in space and cyberspace have led to an interest in cross-domain deterrence, the threat of one type of attack to deter an attack of a different type. However, fundamental questions remain unanswered. Previous studies do not explain why threats often default to in-domain or “in-kind” retaliations or why cross-domain threats often lack credibility. In this article, I argue that “in-kind” retaliation is essentially a symbolic act. In its resemblance or relationship to the original attack, it communicates its purpose as a retaliation for that attack. I also argue that cross-domain threats can sometimes be imbued with the same symbolic meaning and be redefined as an “in-kind” response, and I explore mechanisms through which this can be done.

Abstract Sometimes physical security may come at the cost of ontological security for refugees. They may struggle to develop stable narratives of identity and fail to situate themselves within their new social environments. States often prioritize addressing refugees’ physical security needs to facilitate their integration, but largely overlook the importance of identity security. This study argues that ontological security is crucial to integration processes, and refugees reestablish it by engaging in various forms of identity backlash, lowering their interest in the politics of the host country, and heightening their desire to return home. In other words, identity backlash, political disinterest, and an intensified desire to return home function as ontological security-seeking mechanisms and anxiety responses. The study contributes to ontological security theory (OST) by introducing a novel and nuanced framework that defines a set of indicators for the emotional and narrative-oriented aspects of ontological security among refugees. It takes a micro-level approach examining ontological security at the individual level for Syrian refugees in Turkey and Germany. The specific findings of this study are threefold. First, I find a significantly lower level of narrative-oriented security among Syrian refugees in Turkey than in Germany. Second, the results indicate that narrative-oriented ontological security among Syrian refugees is strongly associated with identity backlash, low political interest, and a willingness to return to the home country. Third, the results show that physical security and ontological security are not always correlated. Overall, this study demonstrates how OST can provide insights into the complex interplay between perceptions of security, identity backlash, political integration, and willingness to return among refugee communities.