This editorial offers an introduction to the current issue.

Bureaucracy and ‘red tape’ are seen as a main annoyance in healthcare practice. ‘Rules’ like guidelines and performance indicators would withdraw professionals from their real work, that is, helping patients. However, rules may also improve quality of care if they foster high quality practices. In this research, we explore how healthcare rebels deal with rules in their everyday work: how rebels ignore, engender and bend rules to build new environments for doing good care. Drawing on ethnographic research in three hospitals in the Netherlands (2017-2018), we reveal how rebels build and care for clinical microsystems containing their own clinical unit and related contexts (e.g. pharmaceutical suppliers, ICT companies, primary care) to evoke alternative and situated practices of good care delivery – i.e. focusing on quality of life and person-centred care. Rebels enact mechanisms of decoupling and recoupling to disconnect rules that embark on good care in specific patient situations, and build new routines that foster good care. However, such caring practices are hard to generalize as they often occur ‘under the radar’ and hence remain hardly noticed to the outside world. We argue that through revising accounting processes, and paying more attention to narratives of good care, more convenient quality systems could be found.

The recent decentralization of many healthcare and welfare responsibilities from the national to the municipal level in the Netherlands was aimed at reducing unnecessary bureaucracy and giving discretion to the professional. However, this is not (yet) fully achieved. Therefore, calls have been made for more purpose-driven organizations. Pro-social rule breaking, which refers to acts of rule breaking motivated by the benefits that this creates for citizens, might be a way to make organizations more focused on their organizational purpose. Since little is known about the antecedents of pro-social rule breaking, this article looks at the possible effects of red tape and supportive leadership on pro-social rule breaking behavior of professionals. Based on a quantitative large-n study of professionals in the social domain, the results show that red tape significantly affects pro-social rule breaking. Stimulating leadership does not affect pro-social rule breaking behavior, which may be caused by the fact that intended leader support is not be perceived that way by the professional. The article concludes with a discussion on the desirability of rule breaking in a public sector context, followed by practical implications and further avenues for researchers.

Both education and housing are highly regulated sectors in the Netherlands. According to various stakeholders, regulations and formal and informal rules hinder the development of new initiatives aimed at providing attention to personal needs and wishes of children (in education) and older people (in housing). This article focuses on founders of initiatives in both sectors that, despite institutional obstacles, dare to do things differently. We adopt a rebellion perspective, which focuses on how individual and collective actors aim to create favorable circumstances for providing better services, even if this means they have to disrupt existing institutions. In-depth interviews were conducted with 22 founders of rebellious initiatives in education and housing for older people. According to the founders, what makes them different from others is having a dream, learning by doing, and critically assessing rules and regulations. Founders in both sectors not only interpret rules differently, but also try to change them. In order to do so, they need supportive internal and external contexts, which they create through personal contacts and social media. Although rebellion in both sectors has many similarities, sector-specific institutional settings and past events do shape its appearance.

Healthcare is often dominated by the curative domain. Yet, for a new way of improving of and accounting for quality of care, we have to shift our focus to the care for people with disabilities. Since long, quality of care is translated into performance indicators and standards. This reductive way of measuring quality was pursued for the entire healthcare sector. Where this might fit in with hospital care, it was experienced as constraining in care for the disabled. In this sector it was seen as a poor representation of the plurality of healthcare provision. A number of ‘quality rebels’ aimed to create a more suitable and rich Quality Framework for the sector, with attention for objective, subjective and intersubjective dimensions of care. In this article, we analyze the way in which the sector has realized this aim, and we show how this rebellious sector succeeded in transforming the idea of accountability for quality of care, by emphasizing on the reflection and learning processes that take place at all levels of the sector, and beyond. A new approach which requires a continuous cycle of disrupting, creating, and maintaining institutionalized patterns of thinking and doing. It requires ‘rebel learning’.

In this feature authors discuss recent research findings that are of interest to readers of Beleid en Maatschappij.

In this feature authors discuss recent research findings that are of interest to readers of Beleid en Maatschappij.

In this feature authors discuss recent research findings that are of interest to readers of Beleid en Maatschappij.

In this feature authors discuss recent research findings that are of interest to readers of Beleid en Maatschappij.

In this feature authors review recently published books on subjects of interest to readers of Beleid en Maatschappij.