Governance & Strategy
Lecture 1: What is governance?
Targets:
- Students are able to describe contemporary challenges in healthcare governance.
- Students are able to explain how the (national) institutional context matters for goals and
challenges in healthcare governance and strategy.
Example Denmark: Healthcare of Denmark preparing for an increase in the elderly
population. Focus on:
- Efficiency
- Early detection
- Dementia
They use different types of technologies and innovations to both help the elderly and the
nurses involved.
Factors involved with organizational management → international treaties, technological
innovations, labor/ market, inequalities, economy and social norms.
Multi level approach:
Micro level→ in people’s daily practices
Meso level → within institutions
Macro level → in the broader context
There is a shift from government to governance. Empirical shift in society over the past
decades that changed how policy is made. Ideas about the government are based on
hierarchy. Governance is more focussed on the network of different stakeholders to
intervene in society and decision-making. For example:
- Supranational policy: TTIP, WHO, EU, UN
- The state
- Public and private providers
1
, Governance & Strategy
- Markets
- Communities
- Local authorities
Dual hospital governance → cooperation between top-down and bottom-up. Not
formalizing all the responsibilities. Gray area to try out some things.
Multi-problem households → complexity of organizations involved, which all might have
their own problems.
How to act with this complexity → strategy
- Strategy as design
- Strategy as practice
Research governing care during an emerging pandemic: ethnography. Challenges of
geography of NL. Framing the crisis:
- Scarcity of some goods at the beginning, for example with mouth masks.
- Summer 2020, focussing not only on covid anymore. Not just covid or non-covid.
Tried to coordinate patient flows in regions.
- Couldn’t function at the quality level as before. Modeling and forecasting of the virus
became important.
- Who can have a say in what to do?
Lessons for governing care: Resilient system is no quick fix but requires a long, layered
approach and system learning. Crisis changes over time, situation and actor, therefore it is
important to frame. Working on relations is important for trust and solidarity. Framing of
crises and differences in experience and knowledge is crucial. Make room for learning.
2
, Governance & Strategy
There are tensions between institutional logics (competition, cooporation and professional
self-regulation). A data-infrastructure requires (informal) work and politics. Representation of
the complete chain of care is crucial. The role of the frontline workers should be
acknowledged. Have clarity about the regions, what is a region? There is a decentralized
multicentered system at place, which makes coordination difficult.
3
, Governance & Strategy
Lecture 2: Decentralization of care
Targets:
- Students are able to explain the concepts of decentralization and neighborhood
gouvernance.
- Students are able to explain the connection between the decentralization of health policy
and the dynamics in the neighborhood.
- Students are able to explain the role of health inequality in the (local) design and provision
of care.
- Students are able to discuss the beliefs and disbeliefs/ side effects of informal care.
- Students can explain the forms of social capital that links up with, and constitutes the basis
of informal care as well as its conflict.
A network society is ‘a shift from government by a unitary state, to governance through and
by networks. (Rhodes, 2007)’
Characteristics:
- Including non-state actors
- Continuing interactions among network members
- Game-like interactions, developing trust
- Networks are self-organizing
Networks are political and power-sensitive.
Hybrid governance in Dutch healthcare: multiple, different
arrangements overlap and live parallel to each other.
Characteristics:
- Private delivery
- Professional autonomy
- Public means held by private organizations
- Government has responsibilities, but limited power.
There is inherent hybridity. There are a variety of
public-private partnerships and networks (national and
local).
Trends in governance:
Within the public domain (policy & politics): Within the civil society (community):
- More local government (decentralization) - Mobilization of networks
- More supervision and control - Informal care provision
- More international (EU) regulations - Fragmentation of organizations
- Trust on basis of regulation - Trust on basis of loyalty and involvement
Within the private domain (market): Within the medical domain (profession):
- Regulated competition - More focus on transparency
- Market-like management and instruments - Changing concepts of health and care
- Trust in negotiation mechanism - Competition and cooperation
- Trust on basis of knowledge and status
4
Lecture 1: What is governance?
Targets:
- Students are able to describe contemporary challenges in healthcare governance.
- Students are able to explain how the (national) institutional context matters for goals and
challenges in healthcare governance and strategy.
Example Denmark: Healthcare of Denmark preparing for an increase in the elderly
population. Focus on:
- Efficiency
- Early detection
- Dementia
They use different types of technologies and innovations to both help the elderly and the
nurses involved.
Factors involved with organizational management → international treaties, technological
innovations, labor/ market, inequalities, economy and social norms.
Multi level approach:
Micro level→ in people’s daily practices
Meso level → within institutions
Macro level → in the broader context
There is a shift from government to governance. Empirical shift in society over the past
decades that changed how policy is made. Ideas about the government are based on
hierarchy. Governance is more focussed on the network of different stakeholders to
intervene in society and decision-making. For example:
- Supranational policy: TTIP, WHO, EU, UN
- The state
- Public and private providers
1
, Governance & Strategy
- Markets
- Communities
- Local authorities
Dual hospital governance → cooperation between top-down and bottom-up. Not
formalizing all the responsibilities. Gray area to try out some things.
Multi-problem households → complexity of organizations involved, which all might have
their own problems.
How to act with this complexity → strategy
- Strategy as design
- Strategy as practice
Research governing care during an emerging pandemic: ethnography. Challenges of
geography of NL. Framing the crisis:
- Scarcity of some goods at the beginning, for example with mouth masks.
- Summer 2020, focussing not only on covid anymore. Not just covid or non-covid.
Tried to coordinate patient flows in regions.
- Couldn’t function at the quality level as before. Modeling and forecasting of the virus
became important.
- Who can have a say in what to do?
Lessons for governing care: Resilient system is no quick fix but requires a long, layered
approach and system learning. Crisis changes over time, situation and actor, therefore it is
important to frame. Working on relations is important for trust and solidarity. Framing of
crises and differences in experience and knowledge is crucial. Make room for learning.
2
, Governance & Strategy
There are tensions between institutional logics (competition, cooporation and professional
self-regulation). A data-infrastructure requires (informal) work and politics. Representation of
the complete chain of care is crucial. The role of the frontline workers should be
acknowledged. Have clarity about the regions, what is a region? There is a decentralized
multicentered system at place, which makes coordination difficult.
3
, Governance & Strategy
Lecture 2: Decentralization of care
Targets:
- Students are able to explain the concepts of decentralization and neighborhood
gouvernance.
- Students are able to explain the connection between the decentralization of health policy
and the dynamics in the neighborhood.
- Students are able to explain the role of health inequality in the (local) design and provision
of care.
- Students are able to discuss the beliefs and disbeliefs/ side effects of informal care.
- Students can explain the forms of social capital that links up with, and constitutes the basis
of informal care as well as its conflict.
A network society is ‘a shift from government by a unitary state, to governance through and
by networks. (Rhodes, 2007)’
Characteristics:
- Including non-state actors
- Continuing interactions among network members
- Game-like interactions, developing trust
- Networks are self-organizing
Networks are political and power-sensitive.
Hybrid governance in Dutch healthcare: multiple, different
arrangements overlap and live parallel to each other.
Characteristics:
- Private delivery
- Professional autonomy
- Public means held by private organizations
- Government has responsibilities, but limited power.
There is inherent hybridity. There are a variety of
public-private partnerships and networks (national and
local).
Trends in governance:
Within the public domain (policy & politics): Within the civil society (community):
- More local government (decentralization) - Mobilization of networks
- More supervision and control - Informal care provision
- More international (EU) regulations - Fragmentation of organizations
- Trust on basis of regulation - Trust on basis of loyalty and involvement
Within the private domain (market): Within the medical domain (profession):
- Regulated competition - More focus on transparency
- Market-like management and instruments - Changing concepts of health and care
- Trust in negotiation mechanism - Competition and cooperation
- Trust on basis of knowledge and status
4
