Samenvatting

Regionalization is foregrounded among policymakers as a solution to the complex problems elderly care is facing, such as a pertinent staff shortage, a greying population and a lack of suitable accommodation. In this article, following a decentered approach, we analyze how field parties like nursing homes and policymakers in interaction give shape to regional collaborations within a market-oriented institutional healthcare context. Our findings show the emerging frictions, due to layered institutional arrangements and the proliferation of policy initiatives and partnerships. We find different responses of institutional actors to these frictions; actors holding off closer regional cooperation, actors creating urgency and commitment to organize care regionally, creating interstices in rules and regulations and building regional networks and care infrastructures. We argue that a focus on the iterative processes through which actors on different layers of the healthcare system give shape to policies adds a valuable perspective to the study of policy changes. We conclude that ‘layered work’ – mobilizing and working with and between different organizational and policy layers simultaneously – is required to develop appropriate (layered) ways to deal with complex problems.