ABSTRACT
Health services are inherently subject to several internal and external variabilities, both expected and unexpected, which demand slack resources (e.g., extra staff, materials, and money) to provide effective responses and preserve critical functionalities. Although slack resources are ubiquitous in health services (e.g., staff on standby in emergency departments; alternative drugs for the same disease), they often grow disorderly over time and are not deliberately designed into the system. Therefore, health services frequently do not have the right amount and type of slack resources at the right place and at the right time. Furthermore, the definition of what counts as slack and what counts as waste is both a political and a technical decision-making, which makes slack vulnerable to efficiency pressures. This essay discusses these and other facets of slack in health services, highlighting its key role for the delivery of safe and effective care while acknowledging its different manifestations and potential drawbacks. Several examples are presented to illustrate the importance and implications of slack in practice.
